Klecha Artur, Bryniarski Leszek, Dragan Jacek, Królikowski Tadeusz, Jankowski Piotr, Rajzer Marek, Zabojszcz Michał, Styczkiewicz Marek, Kawecka-Jaszcz Kalina
I Klinika Kardiologii, Collegium Medicum Uniwersytetu Jagiellońskiego, Kraków.
Przegl Lek. 2002;59(9):687-90.
In patients following a myocardial infarction, heart rate variability is an important prognostic factor. Decreased heart rate variability is associated with a higher mortality rate. This study evaluated the influence of recanalisation by percutaneous coronary intervention (PCI) in totally occluded coronary arteries on the heart rate variability in patients with myocardial akinesis in the recanalised artery area. The study group included 22 men (average age 52.8 +/- 7.7) after successful PCI recanalization of the totally occluded artery. All patients had akinesis in the recanalised artery area. All patients underwent 24-hour continuous electrocardiographic Holter monitoring with HRV analysis and echocardiographic dobutamine tests both before the PCI and 6 months afterwards. The population was divided into two groups: group A (10 patients) had contractility adjustments in echocardiographic tests that were performed 6 months after the PCI. Group B (12 patients) did not have contractility adjustments. Before the PCI, there were no differences in the wall motion score index (WMI) or the time-domain HRV parameters between the two groups. After 6 months, there was a significant increase in the WMI value in group A, whereas this index remained unchanged in group B. In group A the time-domain HRV parameters had improved 6 months after the PCI, whereas they remained unchanged in group B. Successful percutaneous revascularization of the totally occluded coronary artery in patients with myocardial akinesis in the occluded artery area leads to an increase in HRV parameters. This improvement occurred only in patients that had a contractility adjustment after the PCI in previous akinetic segments of myocardium.
在心肌梗死后的患者中，心率变异性是一个重要的预后因素。心率变异性降低与较高的死亡率相关。本研究评估了经皮冠状动脉介入治疗（PCI）对完全闭塞冠状动脉再通后，梗死相关动脉区域心肌运动减弱患者心率变异性的影响。研究组包括22名男性（平均年龄52.8±7.7岁），他们的完全闭塞动脉成功进行了PCI再通。所有患者梗死相关动脉区域均存在心肌运动减弱。所有患者在PCI术前及术后6个月均接受了24小时连续心电图动态监测及心率变异性分析，以及超声心动图多巴酚丁胺试验。将研究对象分为两组：A组（10例患者）在PCI术后6个月进行的超声心动图检查中有收缩力调整；B组（12例患者）没有收缩力调整。PCI术前，两组间的室壁运动评分指数（WMI）或时域心率变异性参数无差异。6个月后，A组的WMI值显著增加，而B组该指数保持不变。A组在PCI术后6个月时域心率变异性参数有所改善，而B组则保持不变。梗死相关动脉区域心肌运动减弱的患者，完全闭塞冠状动脉成功进行经皮血管重建后，心率变异性参数增加。这种改善仅发生在PCI术后梗死前运动减弱心肌节段有收缩力调整的患者中。
