Turner A W, Malik M
Department of Cardiological Sciences, St. George's Hospital Medical School, London, England.
Herz. 1995 Jun;20(3):200-12.
Accurate and reliable identification of those survivors of acute myocardial infarction who are at high risk of sudden death remain an important and challenging problem. This review summarises the current state-of-the-art of the risk stratification techniques and lists achievements in this field. The review comments in detail on individual factors used in risk stratification. Residual ischemia may be considered as one of the main triggering factors of post-infarction arrhythmia. Depressed left ventricular ejection fraction indicates deterioration of ventricular function. Electrical instability of the myocardium reflects the potential substrate of arrhythmia. Frequent ventricular ectopic activity provides triggers of ventricular tachycardia and/or fibrillation when acting on a suitable substrate. Impaired autonomic status of the heart may lead to the loss of vagal antiarrhythmic protection. Further, the tests used for risk stratification are discussed. Ventriculography provides estimates of left ventricular ejection fraction. Holter monitoring is used for the assessment of ventricular ectopic activity and heart rate variability. Exercise testing is used to address residual ischemia. Programmed ventricular stimulation and the analysis of signal averaged electrocardiograms estimate electrical instability of the myocardium. Baroreflex sensitivity is a measure of cardiac parasympathetic reflexes. The design and results of different experimental and clinical studies which utilised these tests are also discussed.
准确可靠地识别急性心肌梗死猝死高危幸存者仍然是一个重要且具有挑战性的问题。本综述总结了当前风险分层技术的最新进展，并列出了该领域的成就。该综述详细评论了风险分层中使用的个体因素。残余缺血可能被视为梗死后心律失常的主要触发因素之一。左心室射血分数降低表明心室功能恶化。心肌电不稳定反映了心律失常的潜在基质。频发室性异位活动在作用于合适的基质时会引发室性心动过速和/或颤动。心脏自主神经状态受损可能导致迷走神经抗心律失常保护作用丧失。此外，还讨论了用于风险分层的检测方法。心室造影可提供左心室射血分数的估计值。动态心电图监测用于评估室性异位活动和心率变异性。运动试验用于评估残余缺血。程序心室刺激和信号平均心电图分析可估计心肌电不稳定。压力反射敏感性是心脏副交感神经反射的一种测量方法。还讨论了利用这些检测方法的不同实验和临床研究的设计及结果。
