Curione M, Lucia P, Proietti E, Cedrone L, Bernardini F, Trappolini M, Di Giovine M, Puletti M, Cugini P
Istituto di Clinica Medica II, Università degli Studi La Sapienza, Roma.
Cardiologia. 1996 Dec;41(12):1175-82.
The aim of this study was to investigate the circadian variability of heart rate in acute myocardial infarction (AMI) in identifying patients at high risk for malignant ventricular arrhythmias (MVA) and sudden death within 1 year of the acute event. The investigation was carried out in 43 patients, who underwent 24-hour Holter monitoring within 3 months of AMI. Besides the time domain indexes of heart rate variability (SDNN, SDNN index, pNN50, rMSSD), the circadian rhythm of hourly total beats (HTB) and hourly qualified beats (HQB) has been analyzed by the Cosinor method. The AMI patients with MVA and those with MVA who died within 1 year the acute event showed SDNN, SDNN index and pNN50 values lower than subjects without MVA and survived patients with MVA, respectively; the individuals with AMI at high risk for MVA and for sudden death had an SDNN value < 105 ms and 50 ms, respectively. The circadian rhythm of HTB and HQB was statistically validated only in the group without MVA; patients without the circadian rhythm of HTB and HQB showed a higher mortality rate within 1 year of AMI, and the majority was in the group with MVA. The contemporary evidence of an SDNN value < 105 ms and the lack of HTB and HQB circadian rhythm increased sensitivity for identifying patients with MVA to 75%. On the other hand, the contemporary evidence of an SDNN value < 50 ms and the lack of HTB and HQB circadian rhythm increased sensitivity for identifying patients who died within 1 year of AMI to 100%. In conclusion, the assayed methods seem to be both useful and complementary in identifying patients at high risk for MVA and sudden death within 1 year of AMI.
本研究旨在探讨急性心肌梗死（AMI）患者心率的昼夜变异性，以识别急性事件发生后1年内发生恶性室性心律失常（MVA）和猝死的高危患者。该研究对43例患者进行，这些患者在AMI后3个月内接受了24小时动态心电图监测。除了心率变异性的时域指标（SDNN、SDNN指数、pNN50、rMSSD）外，还采用余弦分析法分析了每小时总心搏数（HTB）和每小时有效心搏数（HQB）的昼夜节律。发生MVA的AMI患者以及急性事件后1年内死于MVA的患者，其SDNN、SDNN指数和pNN50值分别低于未发生MVA的患者和存活的MVA患者；MVA和猝死高危的AMI患者，其SDNN值分别<105 ms和50 ms。仅在未发生MVA的组中，HTB和HQB的昼夜节律得到统计学验证；HTB和HQB无昼夜节律的患者在AMI后1年内死亡率较高，且大多数在发生MVA的组中。SDNN值<105 ms以及缺乏HTB和HQB昼夜节律这两个因素同时存在，可将识别MVA患者的敏感性提高到75%。另一方面，SDNN值<50 ms以及缺乏HTB和HQB昼夜节律这两个因素同时存在，可将识别AMI后1年内死亡患者的敏感性提高到100%。总之，所检测的方法在识别AMI后1年内发生MVA和猝死的高危患者方面似乎既有用又具有互补性。
