急性心肌梗死患者直接冠状动脉成形术后QT间期及QT间期变异性的病程及预后意义

Course and prognostic implications of QT interval and QT interval variability after primary coronary angioplasty in acute myocardial infarction.

作者信息

Bonnemeier H, Hartmann F, Wiegand U K, Bode F, Katus H A, Richardt G

机构信息

Medizinische Klinik II, Medizinische Universität zu Lübeck, Germany.

出版信息

J Am Coll Cardiol. 2001 Jan;37(1):44-50. doi: 10.1016/s0735-1097(00)01061-5.

DOI:10.1016/s0735-1097(00)01061-5

PMID:11153771

Abstract

OBJECTIVES

The aim of this study was to determine the influence of early reperfusion on the course of QT interval and QT interval variability in patients undergoing primary percutaneous transluminal coronary angioplasty (PTCA) in acute myocardial infarction (AMI) and its prognostic implications on major arrhythmic events during one-year follow-up.

BACKGROUND

Although early coronary artery recanalization by primary angioplasty is an established therapy in AMI, a substantial number of patients is still threatened by malignant arrhythmias even after early successful reperfusion, which may be caused by an inhomogeneity of ventricular repolarization despite reperfusion.

METHOD

Temporal fluctuations of ventricular repolarization were studied prospectively in 97 consecutive patients with a first AMI by measurements of QT interval and QT interval variability during and after successful PTCA (Thrombolysis in Myocardial Infarction flow grades 2 and 3). Continuous beat-to-beat QT interval measurement was performed from 24-h Holter monitoring, which was initiated at admission before PTCA.

RESULTS

Reperfusion caused a significant continuous increase of mean RR interval (738 +/- 98 to 808.5 +/- 121 ms; p < 0.001) and a significant decrease of parameters of QT interval (QTc: 440 +/- 32 to 416.5 +/- 37ms; p < 0.001) and QT interval variability (QTcSD: 27.5 +/- 3 to 24.9 +/- 6 ms; p < 0.001) in the majority of patients. However, in patients with major arrhythmic events at the one-year follow-up (sudden cardiac death, ventricular fibrillation or sustained ventricular tachycardia, n = 15), parameters of QT interval remained unaltered after successful reperfusion (QTc: 447.3 +/- 41 to 432.9 +/- 45 ms, p = NS; QTcSD: 35.1 +/- 13.4 to 29.0 +/- 9.1 ms, p = NS).

CONCLUSIONS

Reduction of QT interval and QT interval variability after timely reperfusion of the infarct-related artery may be a previously unreported beneficial mechanism of primary PTCA in AMI, indicating successful reperfusion.

摘要

目的

本研究旨在确定早期再灌注对急性心肌梗死（AMI）患者接受直接经皮腔内冠状动脉成形术（PTCA）时QT间期进程及QT间期变异性的影响，及其对一年随访期间主要心律失常事件的预后意义。

背景

尽管通过直接血管成形术进行早期冠状动脉再通是AMI的既定治疗方法，但即使早期成功再灌注后，仍有相当数量的患者受到恶性心律失常的威胁，这可能是由于再灌注后心室复极的不均匀性所致。

方法

对97例首次发生AMI的连续患者进行前瞻性研究，通过在成功PTCA期间及之后（心肌梗死溶栓血流分级为2级和3级）测量QT间期和QT间期变异性，研究心室复极的时间波动。从入院时PTCA前开始的24小时动态心电图监测中进行连续逐搏QT间期测量。

结果

再灌注导致大多数患者的平均RR间期显著持续增加（从738±98毫秒增至808.5±121毫秒；p<0.001），QT间期参数（校正QT间期：从440±32毫秒降至416.5±37毫秒；p<0.001）和QT间期变异性（校正QT间期标准差：从27.5±3毫秒降至24.9±6毫秒；p<0.001）显著降低。然而，在一年随访期间发生主要心律失常事件的患者（心脏性猝死、心室颤动或持续性室性心动过速，n = 15）中，成功再灌注后QT间期参数保持不变（校正QT间期：从447.3±41毫秒降至432.9±45毫秒，p = 无显著性差异；校正QT间期标准差：从35.1±13.4毫秒降至29.0±9.1毫秒，p = 无显著性差异）。