Department of Medicine, Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
Cleveland Clinic Foundation, Cleveland, Ohio, USA.
Ann Noninvasive Electrocardiol. 2023 Jan;28(1):e13035. doi: 10.1111/anec.13035.
BACKGROUND: Sudden cardiac death (SCD) risk is elevated following acute myocardial infarction (MI). The time course of SCD susceptibility post-MI requires further investigation. METHODS: In this observational cohort study, we employed state-of-the-art noninvasive ECG techniques to track the daily time course of cardiac electrical instability and autonomic function following ST-segment elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI). Preventice BodyGuardian MINI-EL Holters continuously recorded ECGs for 7 days at hospital discharge and at 40 days for STEMI (N = 5) or at 90 days for NSTEMI patients (N = 5). Cardiac electrical instability was assessed by T-wave alternans (TWA) and T-wave heterogeneity (TWH); autonomic tone was determined by rMSSD-heart rate variability (HRV). RESULTS: TWA was severely elevated (≥60 μV) in STEMI patients (80 ± 10.3 μV) at discharge and throughout the first recording period but declined by 50% to 40 ± 2.3 μV (p = .03) by Day 40 and remained in the normal range (<47 μV). TWH, a related phenomenon analyzed from 12-lead ECGs, was reduced by 63% in the five STEMI patients from discharge to normal (<80 μV) at follow-up (105 ± 27.3 to 39 ± 3.3 μV, p < .04) but increased by 65% in a STEMI case (89 to 147 μV), who received a wearable defibrillator vest and later implantable cardioverter defibrillator. In NSTEMI patients, TWA was borderline abnormal (47 ± 3.3 μV) at discharge and declined by 19% to normal (38 ± 1.2 μV) by Day 90 (p = .05). An overall reciprocal increase in rMSSD-HRV suggested recovery of vagal tone. CONCLUSIONS: This study provides proof-of-principle for tracking post-MI SCD risk in individual patients with implications for personalized therapy.
背景：急性心肌梗死（MI）后，心源性猝死（SCD）风险增加。MI 后 SCD 易感性的时间过程需要进一步研究。
方法：在这项观察性队列研究中，我们采用最先进的非侵入性心电图技术，跟踪 ST 段抬高型心肌梗死（STEMI）和非 ST 段抬高型心肌梗死（NSTEMI）后心脏电不稳定性和自主功能的日常时间过程。预防性 BodyGuardian MINI-EL 动态心电图仪在出院时和 STEMI 患者的 40 天（N=5）或 NSTEMI 患者的 90 天（N=5）时连续记录 7 天的心电图。通过 T 波交替（TWA）和 T 波异质性（TWH）评估心脏电不稳定性；通过 rMSSD-心率变异性（HRV）确定自主神经张力。
结果：STEMI 患者在出院时（80±10.3μV）和整个第一个记录期内 TWA 严重升高（≥60μV），但在第 40 天下降了 50%至 40±2.3μV（p=0.03），并保持在正常范围内（<47μV）。TWH 是从 12 导联心电图分析得出的一种相关现象，在 5 名 STEMI 患者中，从出院到随访时（105±27.3 至 39±3.3μV，p<0.04），TWH 降低了 63%，而在一名接受可穿戴除颤背心且后来植入心脏除颤器的 STEMI 患者中，TWH 增加了 65%（89 至 147μV）。在 NSTEMI 患者中，TWA 在出院时处于临界异常（47±3.3μV），并在第 90 天下降了 19%至正常（38±1.2μV）（p=0.05）。rMSSD-HRV 的整体反向增加表明迷走神经张力恢复。
结论：本研究为个体化治疗提供了 MI 后 SCD 风险个体患者的初步证据。
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