Puljević D
Klinika za bolesti srca i krvnih zila, Klinicki bolnicki centar Rebro, Zagreb.
Lijec Vjesn. 1999 Jun;121(6):188-93.
Malignant arrhythmia and sudden death are one of the greatest challenges in cardiology. In prevention, it is important to correctly select patients under risk. Simple and non-invasive methods, by which we could make selection for invasive testing in wider population, need to get importance. The methods in risk stratification can be divided into classical and those recently accepted. Classical methods, which are mostly indirect methods, are echocardiography, exercise stress testing, Holter-ECG, coronary arteriography and electrophysiological testing. Predictive accuracy of classical methods is not satisfactory. This is the reason why new direct methods are developing. According to preliminary results they have better predictive accuracy. Accepted methods are analysis of late potentials and autonomic imbalance estimation, while in T wave alternans and QT interval dispersion some technical problems need to be resolved before routine application. Considering that these methods show various elements of arrhythmogenesis, the best predictive accuracy should be achieved by combination of all methods. But, before definite recommendation, this needs to be demonstrated in large prospective studies.
恶性心律失常和猝死是心脏病学面临的最大挑战之一。在预防方面，正确选择高危患者至关重要。我们需要重视那些能够在更广泛人群中进行侵入性检查筛选的简单、非侵入性方法。风险分层方法可分为经典方法和最近被认可的方法。经典方法大多为间接方法，包括超声心动图、运动负荷试验、动态心电图、冠状动脉造影和电生理检查。经典方法的预测准确性并不令人满意。这就是新的直接方法不断发展的原因。根据初步结果，它们具有更好的预测准确性。已被认可的方法有晚电位分析和自主神经失衡评估，而在T波电交替和QT间期离散度方面，在常规应用之前还需要解决一些技术问题。鉴于这些方法显示了心律失常发生的各种因素，所有方法联合应用应能达到最佳预测准确性。但是，在给出明确推荐之前，这需要在大型前瞻性研究中得到证实。
