心肌梗死后室壁瘤患者的静息心率与主要不良心脑血管事件相关:基于227例回顾性队列研究  

Resting heart rate correlates with major adverse cardiovascular and cerebrovascular events in patients with post-myocardial infarction ventricular aneurysms:a retrospective cohort study

作　　者：卢丽萍 钟嘉鑫 吴锡林 陈琴[1,2,3] 林慧中 陈良龙[1,2,3] 罗育坤 LU Liping;ZHONG Jiaxin;WU Xilin;CHEN Qin;LIN Huizhong;CHEN Lianglong;LUO Yukun(Department of Cardiology,Fujian Medical University Union Hospital,Fuzhou 350001,China;Fujian Heart Medical Center,Fuzhou 350001,China;Fujian Institute of Coronary Artery Disease,Fuzhou 350001,China;Department of Neurology,Fujian Medical University Union Hospital,Fuzhou 350001,China)

机构地区：[1]福建医科大学附属协和医院心内科,福建福州350001 [2]福建省心血管病医学中心,福建福州350001 [3]福建省冠心病研究所,福建福州350001 [4]福建医科大学附属协和医院神经内科,福建福州350001

出　　处：《南方医科大学学报》2023年第3期400-404,共5页Journal of Southern Medical University

基　　金：国家自然科学基金(81770362);福建省科技创新联合基金(2020Y9098)。

摘　　要：目的分析静息心率(RHR)高低与心肌梗死后室壁瘤患者不良预后的关系。方法回顾性收集2017~2019年入住我院的心梗后室壁瘤患者资料,最终共227例纳入研究,随访24月,随访期间任何主要不良心脑血管事件(MACCEs)的发生都是终点事件。根据基线RHR测量值高低分为RHR<10%、10%~90%和>90%三组,使用Cox比例风险模型、限制性立方样条(RCS)模型来研究RHR对MACCEs的影响,结果以风险比(HR)的95%置信区间(CI)表示。结果在24月的随访中,90例(39.6%)患者发生MACCEs。RCS曲线显示RHR与MACCEs发生之间存在非线性“U”型相关性。与RHR在10%~90%组的个体相比,RHR>90%组的MACCEs风险增加了3.01倍(HR=4.01,95%CI:2.07-7.76,P<0.001)。患者在RHR<10%组,10%~90%组和91%~100%组的MACCEs发生率分别为39.1%、36.6%、66.7%(P=0.027),其中,室性心动过速/心室颤动(VT/VF)的发生率分别为17.4%、2.7%、4.8%(P=0.005),心衰再入院的发生率为8.7%、26.8%、42.9%(P=0.036)。结论持续监测和管理心率范围可为心梗后室壁瘤患者的预后提供指导。Objective To analyze the association of resting heart rate(RHR)with the prognosis of patients with post-infarction ventricular aneurysms.Methods We retrospectively analyzed the clinical data of 227 patients with post-infarction ventricular aneurysms admitted to our hospital during 2017-2019.The endpoint event was the occurrence of any major adverse cardiovascular and cerebrovascular events(MACCEs)during the follow-up for 24 months.According to RHR measurements,the patients were divided into 3 groups with baseline RHR<10%,10%-90%,and>90%.The Cox proportional risk model and restricted cubic spline(RCS)model were used to analyze the effect of RHR on MACCEs.Results During the 24-month followup,90 patients(39.6%)experienced MACCEs.The fully adjusted RCS curves showed a nonlinear"U"shaped correlation between RHR and the occurrence of MACCEs.In the fully adjusted model,the risk of MACCEs increased by 3.01-fold(Hazard ratio[HR]=4.01,95%CI:2.07-7.76,P<0.001)in patients with RHR>90%,as compared with patients with RHR of 10%-90%.In patients with RHR in 1-9th percentile,10th-90th percentile and 91st-100th percentile,the incidences of MACCEs were 39.1%,36.6%and 66.7%(P=0.027),the incidences of ventricular tachycardia/ventricular fibrillation(VT/VF)were 17.4%,2.7%and 4.8%(P=0.005),and the incidences of readmission for heart failure were 8.7%,26.8%and 42.9%(P=0.036),respectively.Conclusion Continuous monitoring and management of heart rate range may provide guidance for prognosis prediction in patients with post-infarction ventricular aneurysms.

关 键 词：心肌梗死后室壁瘤 静息心率 主要不良心脑血管事件 

分 类 号：R542.22[医药卫生—心血管疾病]