利用心血管系统0.1赫兹节律同步化评估急性心肌梗死后患者5年心血管事件风险
Evaluation of 5-year risk of cardiovascular events in patients after acute myocardial infarction using synchronization of 0.1-Hz rhythms in cardiovascular system.
作者信息
Kiselev Anton R, Gridnev Vladimir I, Prokhorov Mikhail D, Karavaev Anatoly S, Posnenkova Olga M, Ponomarenko Vladimir I, Bezruchko Boris P, Shvartz Vladimir A
机构信息
Center of New Cardiological Informational Technologies, Saratov Research Institute of Cardiology, Saratov, Russia.
出版信息
Ann Noninvasive Electrocardiol. 2012 Jul;17(3):204-13. doi: 10.1111/j.1542-474X.2012.00514.x.
BACKGROUND
Synchronization between 0.1-Hz rhythms in cardiovascular system is deteriorated at acute myocardial infarction (AMI) leading to a disruption of natural functional couplings within the system of autonomic regulation.
OBJECTIVE
This study evaluates the prognostic value of autonomic regulation indices for the 5-year risk of fatal and nonfatal cardiovascular events in patients after AMI.
METHODS AND RESULTS
We studied 125 patients (53 [42%] female) after AMI aged between 30 and 83 years. The period of observation was 5 years with checkpoints at the first week after AMI and after each year after AMI. We compared the prognostic value of established clinical characteristics and degree S of synchronization between 0.1-Hz rhythms in heart rate and microcirculation for evaluation of the 5-year risk of mortality and recurrent myocardial infarction (MI) in patients after AMI. Acute heart failure Killip 2-4 at AMI and S < 20% at the first week after AMI were identified as the most important factors for evaluation of the risk of 5-year mortality in patients after AMI (χ(2) = 14.2, P = 0.003). Sensitivity and specificity of low S (<20%) at the first week after AMI were 76% and 43%, respectively. For evaluation of the 5-year risk of recurrent MI index S had no advantage over established clinical characteristics.
CONCLUSION
The value of S below 20% in patients with AMI is a sensitive marker of high risk of mortality during the subsequent five years. It is characterized by better prognostic value than most of established clinical characteristics.
背景
急性心肌梗死（AMI）时心血管系统中0.1赫兹节律之间的同步性恶化，导致自主调节系统内自然功能耦合的破坏。
目的
本研究评估自主调节指标对AMI后患者5年致命和非致命心血管事件风险的预后价值。
方法与结果
我们研究了125例年龄在30至83岁之间的AMI后患者（53例[42%]为女性）。观察期为5年，在AMI后第一周及AMI后每年设置检查点。我们比较了既定临床特征以及心率与微循环中0.1赫兹节律之间的同步程度S对评估AMI后患者5年死亡和复发性心肌梗死（MI）风险的预后价值。AMI时急性心力衰竭Killip 2 - 4级以及AMI后第一周S < 20%被确定为评估AMI后患者5年死亡风险的最重要因素（χ(2)=14.2，P = 0.003）。AMI后第一周低S（<20%）的敏感性和特异性分别为76%和43%。对于评估5年复发性MI风险，指标S相比既定临床特征并无优势。
结论
AMI患者中S低于20%是随后五年高死亡风险的敏感标志物。其预后价值优于大多数既定临床特征。
Zotero 插件