[心电图频谱湍流分析在预测心肌梗死后心律失常风险中的作用]

[Role of spectral turbulence analysis of ECG in predicting risk of arrhythmia after myocardial infarction].

作者信息

Vado A, Bruna C, Rossetti G, Isoardi D, Cherasco E, Borello W, Uslenghi E

机构信息

Divisione di Cardiologia, Azienda Ospedaliera S. Croce, Cuneo.

出版信息

G Ital Cardiol. 1997 Jul;27(7):674-81.

PMID:9303857

Abstract

BACKGROUND

Spectral turbulence analysis (STA) of the signal-averaged electrocardiogram (SAECG) is a recently described frequency-domain analysis evaluating the changes in the wave front velocity in the QRS complex as a whole. In this study we prospectively assessed the role of STA in predicting arrhythmic events [(EA): ventricular tachycardia, ventricular fibrillation and sudden death] relative to ejection fraction (EF), complex ventricular arrhythmias (CVA) on Holter monitoring and site of myocardial infarction (MI) in 266 patients (pts) (209 M; 57 F; mean age 62.3 +/- 10.3)-14 with bundle branch block-surviving an acute MI.

METHODS

SAECG was recorded in all pts 13 +/- 3 days after MI. STA was performed by using a PC software implementing the algorithm proposed by Kelen. The conventional parameters of STA (inter-slice correlation mean, inter-slice correlation SD, low-slice correlation ratio and spectral entropy) were calculated separately for each orthogonal lead (X, Y and Z) and their average (X + Y + Z). Ejection fraction was assessed in 241 pts and Holter recordings were analyzed in 195 pts 13 +/- 4 and 13 +/- 5 days after MI, respectively.

RESULTS

During a mean follow-up of 13 +/- 10 months, there were 20 (7.5%) AE: 9 pts had sustained ventricular tachycardia, two had cardiac arrest due to ventricular fibrillation and 9 died suddenly. In 41% of pts STA was abnormal. STA sensitivity was 65%, specificity 61%, positive predictive value 12%, negative predictive value 96%, relative risk (RR) 2.67 (95% confidence bounds = 1.1-6.48; p = 0.023). Sensitivity, specificity, positive predictive value and RR for EF and CVA were 65, 78, 21%, 6.5 and 64, 66, 10%, 3.4, respectively. Abnormal STA was present in 46% of pts with anterior MI and in 42% of pts with inferior MI (ns). Sensitivity, specificity and RR were 88, 58% and 7.95 (p = 0.015) for anterior MI and 50, 59% and 1.41 (p = ns) for inferior MI.

CONCLUSION

The value of STA of the SAECG is poor when performed two weeks after MI. STA theoretical advantages over time-domain analysis of the SAECG were not verified in our study.

摘要

背景

信号平均心电图（SAECG）的频谱湍流分析（STA）是一种最近描述的频域分析方法，用于评估整个QRS波群中波前速度的变化。在本研究中，我们前瞻性地评估了STA在预测心律失常事件（EA：室性心动过速、心室颤动和猝死）方面相对于射血分数（EF）、动态心电图监测中的复杂性室性心律失常（CVA）以及266例患者（pts）（209例男性；57例女性；平均年龄62.3±10.3岁）中心肌梗死（MI）部位的作用，其中14例有束支传导阻滞的患者急性心肌梗死后存活。

方法

所有患者在心肌梗死后13±3天记录SAECG。使用实现Kelen提出算法的计算机软件进行STA。分别为每个正交导联（X、Y和Z）及其平均值（X+Y+Z）计算STA的常规参数（层间相关均值、层间相关标准差、低层相关比率和频谱熵）。分别在241例患者中评估射血分数，并在心肌梗死后13±4天和13±5天对195例患者的动态心电图记录进行分析。

结果

在平均13±10个月的随访期间，有20例（7.5%）发生心律失常事件：9例患者发生持续性室性心动过速，2例因心室颤动发生心脏骤停，9例猝死。41%的患者STA异常。STA的敏感性为65%，特异性为61%，阳性预测值为12%，阴性预测值为96%，相对危险度（RR）为2.67（95%可信区间=1.1 - 6.48；p = 0.023）。EF和CVA的敏感性、特异性、阳性预测值和RR分别为65、78、21%、6.5和64、66、10%、3.4。前壁心肌梗死患者中46%存在STA异常，下壁心肌梗死患者中42%存在STA异常（无显著性差异）。前壁心肌梗死的敏感性、特异性和RR分别为88%、58%和7.95（p = 0.015），下壁心肌梗死的敏感性、特异性和RR分别为5