心率减速力对急性心肌梗死后猝死风险的预测价值  

The predictive value of deceleration capacity of heart rate for sudden cardiac death after acute myocardial infarction

作　　者：李杨[1] 秦勤[1] 寇璐[1] 陈刚[1] 路雅茹[1] 

机构地区：[1]天津市胸科医院心内科,300222

出　　处：《天津医药》2015年第3期288-291,共4页Tianjin Medical Journal

基　　金：天津市科技支撑计划项目(10ZCKFSF00800)

摘　　要：目的：探讨急性ST段抬高型心肌梗死后早期无创性指标心率减速力（DC）对急性心肌梗死患者发生心脏性猝死（SCD）的预测价值。方法以417例急性ST段抬高型心肌梗死患者为研究对象，入院后行24 h动态心电图检查，计算DC值，临床随访观察12个月，记录发生的SCD事件（SCD组），并与未发生SCD者（存活组）比较各观测指标。结果在心肌梗死后12个月内，20例（4.8%）患者发生SCD。与存活组患者相比，SCD组患者的左室射血分数（LVEF）和DC值明显降低[0.393±0.065 vs 0.528±0.042，（2.85±1.66）ms vs（5.49±1.71）ms，均P＜0.05]。多因素Cox回归分析显示，LVEF＜0.35[RR（95%CI）：2.167（1.384～4.661），P=0.013]和DC＜4.5 ms[RR（95%CI）：3.706（2.709～5.374），P=0.020]为发生SCD的危险因素。LVEF和DC降低预测SCD发生的敏感度分别为52.1%和76.4%，特异度分别为84.5%和86.1%。结论急性心肌梗死后DC值的降低能预测远期SCD的发生。Objective To investigate the predictive value of the non-invasive indicator deceleration capacity of heart rate （DC） in the sudden cardiac death （SCD） after acute myocardial infarction. Methods A total of 417 myocardial infarc-tion patients with ST-segment elevation in sinus rhythm were enrolled in this study. DC was assessed from data of 24-hour ECG Holter. Regular follow-ups were carried out within 12 months. The SCD events were recorded and compared with pa-tients without SCD. Results During 12 months of follow-up, 20 patients were died due to SCD （4.8%）. Compared with sur-vival group, patients showed significantly lower left ventricular ejection fraction （LVEF, 0.393 ± 0.065 vs 0.528 ± 0.042, P〈0.05） and DC [（2.85±1.66） ms vs （5.49±1.71） ms,P〈0.05]in SCD group. Multivariate Cox proportional hazard regression analysis showed that lower LVEF（〈0.35）[RR： 2.167（1.384-4.661）, P=0.013]and DC （DC〈4.5 ms）[RR： 3.706（2.709-5.374）,P=0.020]were risk factors for the occurrence of SCD. The prediction sensitivity by the decreased LVEF and DC was 52.1%and 76.4%respectively, and the specificity was 84.5%and 86.1%respectively. Conclusion The decreased value of DC after acute myocardial infarction can predict the SCD events.

关 键 词：心肌梗死 猝死 心脏 左室射血分数 心率减速力 

分 类 号：R541.1[医药卫生—心血管疾病]