Bošković Aneta, Belada Nataša, Knežević Božidarka
Vojnosanit Pregl. 2014 Oct;71(10):925-30.
BACKGROUND/AIM: Depressed heart rate variability (HRV) indicating autonomic disequilibrium and propensity to ventricular ectopy can be useful for risk stratification in patients following acute myocardial infarction (AIM). The aim of the study was to assess heart rate variability as a predictor of all-cause mortality in post-infarction patients.
We analyzed the 24-hour electrocardiographic (ECG) recordings of 100 patients (80 males) during hospitalization for
The mean age of patients was 56.99 + 11.03 years. Time domain heart rate variability analysis was obtained from 8 to 13 days after index infarction by mean of a 24-hour ECG recording, and the calculated parameters were: standard deviation of all normal to normal RR intervals (SDNN), RRmax-RRmin (difference between the longest RR interval and the shortest RR interval), mean RR interval. We also analyzed ventricular premature complexes from the ECG data. The patients underwent clinical evaluation, laboratory tests and echocardiography.
Within a one-year follow-up period 11 patients experienced death, 10 of them because of cardiac reason and one because of stroke. There were significantly lower values of SDNN (60.55 ± 12.84 ms vs 98.38 ± 28.21 ms), RRmax-RRmin (454.36 ± 111.00 ms vs 600.99 ± 168.72 ms) and mean RR interval (695.82 ± 65.87 ms vs 840.07 ± 93.97 ms) in deceased patients than in the survivors, respectively (p < 0.01). The deceased patients were of higher mean age, with lower left ventricular ejection fraction (0.46 ± 0.05 vs 0.56 ± 0.06 in survivors), and more frequent clinical signs of heart failure and ventricular ectopic activity (> 10VPCs/h; p < 0.01). Multivariate Cox analysis showed that SDNN was a significant, independent predictor of all-cause mortality in post-infarction patients. The other independent predictors were clinical signs of heart failure--Killip class II and III and ventricular ectopic activity.
Depressed HRV is an independent predictor of mortality in post-infarction patients and may provide useful additional prognostic information in non-invasive risk stratification of these patients.
背景/目的：心率变异性（HRV）降低表明自主神经失衡和室性早搏倾向，这对于急性心肌梗死（AMI）后患者的风险分层可能有用。本研究的目的是评估心率变异性作为梗死患者全因死亡率的预测指标。
我们分析了100例患者（80例男性）住院期间的24小时心电图（ECG）记录。
患者的平均年龄为56.99±11.03岁。通过24小时心电图记录在梗死指数后的8至13天进行时域心率变异性分析，计算的参数有：所有正常RR间期的标准差（SDNN）、RRmax - RRmin（最长RR间期与最短RR间期之差）、平均RR间期。我们还从心电图数据中分析室性早搏。患者接受了临床评估、实验室检查和超声心动图检查。
在一年的随访期内，11例患者死亡，其中10例死于心脏原因，1例死于中风。死亡患者的SDNN值（60.55±12.84毫秒对98.38±28.21毫秒）、RRmax - RRmin（454.36±111.00毫秒对600.99±168.72毫秒）和平均RR间期（695.82±65.87毫秒对840.07±93.97毫秒）分别显著低于存活患者（p<0.01）。死亡患者的平均年龄较高，左心室射血分数较低（存活者为0.56±0.06，死亡者为0.46±0.05），心力衰竭和室性异位活动的临床体征更频繁（>10次室性早搏/小时；p<0.01）。多变量Cox分析表明，SDNN是梗死患者全因死亡率的显著独立预测指标。其他独立预测指标是心力衰竭的临床体征——Killip分级II级和III级以及室性异位活动。
HRV降低是梗死患者死亡率的独立预测指标，可能为这些患者的非侵入性风险分层提供有用的额外预后信息。
