摘要
目的评价窦性心律震荡（HRT）和微伏级T波电交替（mTWA）对心肌梗死（简称心梗）后患者猝死的预测价值。方法入选心梗后患者212例，根据24h动态心电图记录，计算HRT的两个参数震荡初始（TO）和震荡斜率（TS），同时检测mTWA；随访2年，主要终点为心源性猝死（SCD），次要终点为全因死亡率，心血管疾病相关死亡，比较死亡组与存活组，死亡各亚组（SCD组及非SCD组）之间HRT及mTWA。结果①死亡组中慢性肾病、心功能Ⅳ及胺碘酮使用率增多；SCD亚组左室射血分数（LVEF）下降更明显。②死亡组mTWA及HRT2明显升高。其中SCD亚组mTWAmax和HRT2异常较非SCD组明显升高。③LVEF、HRT、mTWA（06：00AM）为最有意义的独立致死因子；LVEF、HRT、mTWA（100次／分）和室性早搏数量为SCD的危险因素。④异常TO／TS联合mTWA（100次／分）大于58．5mcV则显著增加全因死亡率ERR，32．5（95％CI4．2～188．5），P〈0．001]及SCD风险ERR，60．5（95％CI6．2～508．5），P〈0.001]。结论当患者HRT和mTWA异常时总死亡率及SCD风险明显增加。
Objective To evaluate the predictive value of heart rate turbulence （HRT） and microvolt T-wave alternans （mTWA） for sudden cardiac death （SCD） in patients after myocardial infarction （MI）. Methods We studied 212 patients with MI in the previous 60 days before inclusion. HRT and mTWA were evaluated using 24 h ambulatory electrocardiogram monitoring. The primary endpoint was SCD, and the secondary endpoint was all-cause mortality and non-sudden death from cardiovascular causes. Result ① Patients of non-survivors had more chronic kidney diseases, NYHA IV, amiodarone usage; LVEF was the lowest in SCD. ②Non-survivors had significantly higher mTWA values,absolute HRT compared with survivors. In patients with SCD,mTWA, and HRT2 significantly higher than in patients with non-sudden death. All parameters were significantly worse in non-survivors than in survivors. ③We found that LVEF, HRT, mTWA（06 ： 00AM）were the most significant independent mortality risk factors. The most significant risk factors for SCD were LVEF, HRT, mTWA（100bpm）, the number of premature ventricular beats . ④We found that the combination of abnormal HRT2 with mTWA（100bpm）〉58.5 mcV significantly increased overall mortality risk [RR, 32.5 （95 % CI 4.2-188.5）, P〈0. 001-1 and SCD risk [RR,60. 5 （95 %CI 6.2-508.5）, P〈0. 001]. Conclusion The overall mortality and SCD will be increased in patients with abnormal HRT and mTWA.
出处
《中国心脏起搏与心电生理杂志》
2016年第4期354-358,共5页
Chinese Journal of Cardiac Pacing and Electrophysiology
关键词
心血管病学
T波电交替
窦性心律震荡
心肌梗死
猝死
Cardiology
T-wave alternans
Heart rate turbulence
Myocardial infarction
Sudden cardiac death
