Bilchick Kenneth C, Fetics Barry, Djoukeng Ronnie, Fisher Susan Gross, Fletcher Ross D, Singh Steven N, Nevo Erez, Berger Ronald D
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Am J Cardiol. 2002 Jul 1;90(1):24-8. doi: 10.1016/s0002-9149(02)02380-9.
Although the value of heart rate variability (HRV) for risk stratification after acute myocardial infarction has been demonstrated, the value of low HRV as a predictor of sudden cardiac death in patients with ischemic cardiomyopathy has not been shown convincingly to date. We retrospectively analyzed electrocardiographic data from 179 patients in the Veterans Affairs' Survival Trial of Antiarrhythmic Therapy in Congestive Heart Failure to determine if HRV (expressed as the SD of the normal-to-normal RR intervals [SDNN]) would be useful as a predictor of overall mortality and sudden death. Because our goal was to identify high-risk patients, we compared patients in the lowest quartile of HRV with the remaining patients. Among the 127 patients meeting inclusion criteria, SDNN <65.3 ms (the lowest quartile) was the sole independent factor predictive of survival in a multivariate model (p = 0.0001). A Cox proportional-hazards model revealed that each increase of 10 ms in SDNN conferred a 20% decrease in risk of mortality (p = 0.0001). Furthermore, patients with SDNN <65.3 ms had a significantly increased risk of sudden death (p = 0.016). Thus, HRV was the sole independent predictor of overall mortality and was significantly associated with sudden death in this population.
尽管心率变异性（HRV）对急性心肌梗死后风险分层的价值已得到证实，但迄今为止，低HRV作为缺血性心肌病患者心源性猝死预测指标的价值尚未得到令人信服的证实。我们回顾性分析了退伍军人事务部充血性心力衰竭抗心律失常治疗生存试验中179例患者的心电图数据，以确定HRV（以正常RR间期标准差[SDNN]表示）是否可作为总体死亡率和猝死的预测指标。由于我们的目标是识别高危患者，我们将HRV最低四分位数的患者与其余患者进行了比较。在127例符合纳入标准的患者中，SDNN<65.3毫秒（最低四分位数）是多变量模型中预测生存的唯一独立因素（p = 0.0001）。Cox比例风险模型显示，SDNN每增加10毫秒，死亡风险降低20%（p = 0.0001）。此外，SDNN<65.3毫秒的患者猝死风险显著增加（p = 0.016）。因此，HRV是总体死亡率的唯一独立预测指标，并且在该人群中与猝死显著相关。
