Copie X, Hnatkova K, Staunton A, Fei L, Camm A J, Malik M
Department of Cardiological Sciences, St. George's Hospital Medical School, London, England, United Kingdom.
J Am Coll Cardiol. 1996 Feb;27(2):270-6. doi: 10.1016/0735-1097(95)00454-8.
The aim of this study was to compare the predictive value of mean RR interval assessed from predischarge Holter recordings with that of heart rate variability and left ventricular ejection fraction for risk stratification after myocardial infarction.
Heart rate variability is a powerful tool for risk stratification after myocardial infarction. Although heart rate variability is related to heart rate, little is known of the prognostic value of 24-h mean heart rate.
A total of 579 patients surviving the acute phase of myocardial infarction were followed up for at least 2 years. Predischarge heart rate variability, 24-h mean RR interval and left ventricular ejection fraction were analyzed.
During the first 2 years of follow-up, there were 54 deaths, 42 of which were cardiac (26 sudden). Shorter mean RR interval was a better predictor of all-cause mortality as well as cardiac and sudden death than depressed left ventricular ejection fraction. Depressed heart rate variability predicted the risk of death better than mean RR interval for sensitivities < 40%. For sensitivities > or = 40%, mean RR interval was as powerful as heart rate variability. All three variables performed equally well in predicting nonsudden cardiac death. For cardiac death prediction, a left ventricular ejection fraction < 35% had a 40% sensitivity, 78% specificity and 14% positive predictive accuracy; a mean RR interval < 700 ms had a 45% sensitivity, 85% specificity and 20% positive predictive accuracy; and a heart rate variability < 17 U had a 40% sensitivity, 86% specificity and 20% positive predictive accuracy.
Predischarge 24-h mean heart rate is a strong predictor of mortality after myocardial infarction that can compete with left ventricular ejection fraction and heart rate variability.
本研究旨在比较出院前动态心电图记录评估的平均RR间期与心率变异性及左心室射血分数对心肌梗死后危险分层的预测价值。
心率变异性是心肌梗死后危险分层的有力工具。尽管心率变异性与心率有关，但关于24小时平均心率的预后价值知之甚少。
共对579例心肌梗死急性期存活患者进行了至少2年的随访。分析出院前的心率变异性、24小时平均RR间期和左心室射血分数。
在随访的前2年中，有54例死亡，其中42例为心脏性死亡（26例为猝死）。较短的平均RR间期比左心室射血分数降低更能预测全因死亡率以及心脏性死亡和猝死。对于敏感性<40%的情况，心率变异性降低比平均RR间期更能预测死亡风险。对于敏感性≥40%的情况，平均RR间期与心率变异性的预测能力相当。这三个变量在预测非心性猝死方面表现相当。对于心脏性死亡预测，左心室射血分数<35%时，敏感性为40%，特异性为78%，阳性预测准确率为14%；平均RR间期<700毫秒时，敏感性为45%，特异性为85%，阳性预测准确率为20%；心率变异性<17 U时，敏感性为40%，特异性为86%，阳性预测准确率为20%。
出院前24小时平均心率是心肌梗死后死亡率的有力预测指标，可与左心室射血分数和心率变异性相媲美。
