电机械活动时间比值对院内心脏不良事件的预测意义  

The value of activation time ratio in predicting the major adverse events in hospitalized patients

作　　者：张静[1] 刘文娴[1] Zhang Jing Liu Wenxian(Department of Cardiology Coronary Care Unite, Capital Medical University Affiliated Beijing Anzhen Hospital, Beijing 100029, China)

机构地区：[1]首都医科大学附属北京安贞医院心内科重症监护室,北京100029

出　　处：《中华急诊医学杂志》2017年第11期1313-1318,共6页Chinese Journal of Emergency Medicine

摘　　要：目的分析心脏电机械活动时间比值（adjusted electro—mechanical activation time，EMAT％）对心脏病患者发生住院期间心脏不良事件的预测意义。方法连续收集由2016年1月1日至2016年8月1日因心脏疾病入北京安贞医院心内科住院治疗患者453例，入组标准：年龄〉18周岁，临床资料完整。排除标准：瓣膜病或先天性心脏病等结构性心脏病；妊娠期或围产期患者；恶性肿瘤未治愈患者。入院24h内使用无创心电心音仪连续3次记录校正心脏电-机械活动时间比值，同时记录B型钠尿肽、左室射血分数和肌钙蛋白I等指标，并记录患者是否发生院内心脏不良事件（包括：急性左心衰发作、心源性休克、院内心肌梗死、心源性死亡、室性心动过速／室颤、心脏骤停），按是否发生心脏不良事件分为两组，心脏不良事件组和未发生组。采用多因素Logistic回归分析发生不良事件的独立危险因素，使用受试者工作曲线（ROC）计算EMAT％对发生不良事件的预测意义。结果EMAT％升高与BNP〉200pg／mL同为院内心脏不良事件的独立危险因素（EMAT％OR=1．444，95％C／：1．201～1．736，P〈0．05）。受试者工作曲线计算EMAT％对不良事件的预测作用曲线下面积（AUC）为0．887，95％CI：0．812～0．962，P〈0．05，约登指数为0．653，EMAT％〉11．5％对终点事件预测灵敏度为0．840，特异度为0．813。结论EMAT％升高是心血管疾病患者发生院内不良事件的独立危险因素，可用来甄别心脏重症患者。Objective To evaluate the value of adjusted electro-mechanical activation time ratio （EMAT%） in predicting the major adverse events occurred in hospitalized patients with cardiovascular diseases. Methods A cohort of 453 patients aged 〉 18 years with cardiovascular diseases were consecutively enrolled from January 1st 2016 to August 1st 2016. The data of EMAT% were documented three times in the first 24 hours after admission, and at the same time, B type natriuretic peptide, left ventricle ejection fraction and troponin I were recorded. The exclusion criteria were valvular heart diseases, congenital heart diseases, the pregnant and perinatal women, and the patients with untreated cancer. The major adverse events were defined to be cardiogenic death, onset of acute heart failure, cardiogenic shock, myocardial infarction, ventricular tachycardia/fibrillation, and heart arrest. There were 25 patients suffering from major adverse events and 428 patients without any form of adverse events. Multivariate logistic regression analysis was used to determine the association between adjusted electro-mechanical activation time ratio （EMAT%） and major adverse events. The predictive value was established by receiver operating characteristic curve. Results From this trial, elevated EMAT% was proved to be the independent risk factor （EMAT% OR = 1. 444, 95% CI： 1. 201 - 1. 736, P 〈 0. 05 ） for the occurrence of major adverse events in patients with cardiovascular diseases admitted in hospital, and BNP 〉 200 pg/mL was independent risk factor too. The area under the curve of EMAT% was 0. 887 （95% CI：0. 812 - 0. 962, P 〈 0.05 ）, Youden index 0. 653, the sensibility of predicting the end point of major adverse events was 0. 840 when the optimal cutoff point was set at EMAT% 〉 11.5% and the specificity was 0. 813. Conclusion The elevated EMAT% is found to be the independent risk factor for predicting the onset of major adverse events in patients with cardiovascular diseases admitted in hospital, and it can

关 键 词：电-机械活动时间比值 心脏不良事件 心电心音技术 心血管疾病 急性心力衰竭 

分 类 号：R541[医药卫生—心血管疾病]