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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[RR,32.5(95%CI 4.2~188.5),P<0.001]及SCD风险[RR,60.5(95%CI 6.2~508.5),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 sinus rhythm shock (HRT) and micro-volt T wave alternation (mTWA) for sudden death in patients with myocardial infarction (MI). Methods Two hundred and thirteen patients with myocardial infarction were enrolled in this study. According to 24h Holter recording, two parameters of HRT, oscillatory onset (TO) and concussion slope (TS), were calculated and mTWA was measured simultaneously. The follow-up was 2 years and the primary endpoint was sudden cardiac death ), The secondary end point was all-cause mortality, death associated with cardiovascular disease, HRT and mTWA between death and survival groups, death subgroups (SCD group and non-SCD group). Results The incidence of chronic kidney disease, cardiac function IV and amiodarone increased in 1 death group. The decline of left ventricular ejection fraction (LVEF) in SCD subgroup was more obvious. 2 death group mTWA and HRT2 significantly increased. The abnormalities of mTWAmax and HRT2 in SCD subgroup were significantly higher than those in non-SCD subgroup. 3LVEF, HRT and mTWA (06:00 AM) were the most significant independent lethal factors. The number of LVEF, HRT, mTWA (100 beats / min) and premature ventricular contractions were the risk factors for SCD. 4 abnormalities TO / TS combined with mTWA greater than 58.5 mcV significantly increased all-cause mortality [RR, 32.5 (95% CI 4.2-188.5, P <0.001] and SCD risk [RR, 60.5 CI 6.2 ~ 508.5), P <0.001]. Conclusions The overall mortality and the risk of SCD were significantly increased when HRT and mTWA were abnormal.