摘要
目的研究震荡斜率起始时间(TT)新指标在急性心肌梗死(AMI)患者中的变化及HRT各指标与传统高危预测指标的相关性。方法选择AMI后3-4周的患者97例以及年龄、性别相匹配健康体检者65例分别作为AMI组和对照组。入选者经24h动态心电图及超声心动图检查获取HRT的三个参数:震荡斜率起始时间(TT)、震荡初始(TO)、震荡斜率(TS)和心率变异性时域指标(SDNN)、平均心率及左室射血分数(LVEF)。其中AMI组按Killip心功能分级分为合并心衰组与未合并心衰组,按发生持续性室速、室颤分为恶性室性心律失常组与非恶性室性心律失常组,比较AMI组与对照组及AMI各亚组之间HRT等指标的差异,及其与传统预测指标的相关性。结果AMI组TT、TO高于对照组,TS低于对照组(P<0.05);心衰组TS低于非心衰组(P<0.05),恶性室性心律失常组TT高于非恶性室性心律失常组(P=0.001),TS低于非恶性室性心律失常组(P<0.05);AMI组各指标相关性分析结果显示,年龄与TO正相关,与TS负相关,平均心率与TS负相关(P<0.05);HRT各指标中TO与TS负相关(P=0.002);TT与各指标及HRT与SDNN、LVEF等指标均无显著相关性(P>0.05)。结论AMI组HRT明显减弱,心衰组和恶性室性心律失常组减弱更甚,尤以TT和TS变化显著;TT新指标在测量时不受年龄、平均心率等因素影响,提示与TO、TS相比,TT可提供更客观预测价值;HRT可作为独立于SDNN及LVEF的又一项新的高效预测指标。
Objective To investigate the change of turbulence timing（TT）and its correlation with traditional prognostic indices of HRT in patients with acute myocardial infarction （AMI）. Methods Ninety-seven patients with AMI for 3 - 4 weeks（AMI group） and 65 healthy controls（control group） were chosen. Heart rate turbulence including TT, turbulence onset （TO） and turbulence slope （TS） , heart rate variability （HRV）, mean heart rate and left ventricular ejection fraction （LVEF） were determined by 24 h ambulatory electrocardiograph （Hoher） and ultrasonic cardiogram （UCG）. Patients with AMI were divided into two subgroups ac- cording to Killip classification and the complication of ventricular arrhythmia, respectively. The value of above indices were compared between AMI group and control group, and between subgroups of AMI. The correlation of HRT with traditional prognostic indexes was analyzed. Results The levels of TT and TO in the patients with AMI were significantly higher than those of the controls, and TS were lower than those of the controls （ P 〈 0.05）. Patients in Killip class Ⅱ - Ⅳ had significantly lower TS than those in class Ⅰ （P〈 0.05）, and patients with malignant ventricular arrhythmia had higher TT （P = 0. 001 ） and lower TS （P 〈 0.05） than those without malignant ventricular arrhythmia. Both TO and ＂IS were significantly correlated with age. ＂IS was negatively correlat- ed with mean heart rate（P 〈 0.05）, and TO was negatively correlated with ＂IS （P = 0. 002）. But TO, TS and TT were not corrected with SDNN and LVEF, and TT was not corrected with all the other risk predictors（P 〉0.05）. Conclusion The results indicate that TT may be a more objective index for predicting myocardial infarction than TO and TS. HRT could serve as a new and strong predictor for high-risk patients independent on SDNN and LVEF.
出处
《山西医科大学学报》
CAS
2008年第1期41-45,共5页
Journal of Shanxi Medical University
基金
山西省卫生厅科技攻关计划基金资助项目(200504)
关键词
心肌梗死
心率震荡
震荡斜率起始时间
myocardial infarction
heart rate turbulence
turbulence timing
