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首页> 外文期刊>Europace: European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology >Non-invasive risk stratification for sudden cardiac death by heart rate turbulence and microvolt T-wave alternans in patients after myocardial infarction.
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Non-invasive risk stratification for sudden cardiac death by heart rate turbulence and microvolt T-wave alternans in patients after myocardial infarction.

机译：心肌梗死后患者因心率湍流和微伏T波交替而导致的心源性猝死的非侵入性危险分层。

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To evaluate the predictive value of heart rate turbulence (HRT) and microvolt T-wave alternans (mTWA) for sudden cardiac death (SCD) in patients after myocardial infarction (MI).We studied 111 patients with MI in the previous 60 days (median, 27 [9;84] months) before inclusion (84 men, mean age 64.1 ± 10.5 years, mean left ventricular ejection fraction 46.6 ± 12.2%). Heart rate turbulence and mTWA were evaluated using 24 h ambulatory electrocardiogram monitoring. The primary endpoint was SCD, and the secondary endpoint was all-cause mortality and non-sudden death from cardiovascular causes. During follow-up of 12 months, 15 SCD and 8 non-sudden cardiovascular deaths (including five fatal MI and three fatal strokes) occurred. Non-survivors had significantly higher mTWA values (83 [74;165] vs. 79 [78;94] mcV, P= 0.002), absolute turbulence onset (TO) values (0 [-0.005;0.01] vs. -0.01 [-0.013;-0.004], P= 0.004), and significantly lower absolute turbulence slope (TS) values (3.34 [2.10;4.83], vs. 3.82 [4.48;7.27], P< 0.001) compared with survivors. In patients with SCD, mTWA, and TO were significantly higher (92 [72;213] vs. 74 [65;86] mcV, P= 0.004 and 0 [-0.001;0.01] vs. -0.01 [-0.03;0.01], P= 0.007, respectively) and TS values were significantly lower (2.14 [1.10;4.56] vs. 4.41 [2.1;7.18], P= 0.005) than in patients with non-sudden death. All parameters were significantly worse in non-survivors than in survivors. We defined cut-off values for increased risk of SCD: for TO = -0.005, relative risk (RR) was 12.4 [95% confidence interval (CI) 2.6-38.2, P< 0.001; positive predictive value (PPV) 28.3%, negative predictive value (NPV) 96.9%], and for mTWA > 53.5 mcV at 100 b.p.m., RR was 5.01 (95% CI 1.5-17.0, P= 0.005; PPV 24.4%, NPV 93.9%). Notably, mTWA > 18.5 mcV at 05.00 AM significantly increased all-cause mortality [RR 7.5 (95% CI 1.4-38.7), P= 0.01; PPV 19.6%, NPV 90.8%].In patients who died from cardiovascular causes, mTWA, and TO values were significantly higher and TS values were significantly lower than in survivors, and the subgroup with SCD was characterized by significantly increased mTWA and TO values and decreased TS values. mTWA > 53.5 mcV at 100 b.p.m. was an independent significant predictor of SCD and increased risk of SCD by five-fold.
机译：为了评估心率湍流（HRT）和微伏T波交替蛋白（mTWA）对心肌梗死（MI）患者心源性猝死（SCD）的预测价值。我们研究了过去60天的111例MI患者（中位数） ，在纳入之前27（9; 84）个月（84名男性，平均年龄64.1±10.5岁，平均左心室射血分数46.6±12.2％）。使用24小时动态心电图监测评估心率湍流和mTWA。主要终点为SCD，次要终点为全因死亡率和心血管原因引起的非猝死。在12个月的随访期间，发生了15例SCD和8例非猝死性心血管疾病死亡（包括5例致命MI和3例致命中风）。非存活者的mTWA值（83 [74; 165] vs. 79 [78; 94] mcV，P = 0.002）显着更高，绝对湍流开始（TO）值（0 [-0.005; 0.01] vs --0.01 [0] -0.013; -0.004]，P = 0.004），并且与幸存者相比，绝对湍流斜率（TS）值明显更低（3.34 [2.10; 4.83]，而3.82 [4.48; 7.27]，P <0.001）。在SCD患者中，mTWA和TO显着更高（92 [72; 213] vs. 74 [65; 86] mcV，P = 0.004和0 [-0.001; 0.01] vs -0.01 [-0.03; 0.01] ，分别为P = 0.007）和TS值显着低于非猝死患者（2.14 [1.10; 4.56]与4.41 [2.1; 7.18]，P = 0.005）。在非幸存者中，所有参数均显着低于幸存者。我们定义了增加SCD风险的临界值：TO = -0.005时，相对风险（RR）为12.4 [95％置信区间（CI）2.6-38.2，P <0.001;阳性预测值（PPV）28.3％，阴性预测值（NPV）96.9％]，并且对于100 bpm时mTWA> 53.5 mcV，RR为5.01（95％CI 1.5-17.0，P = 0.005; PPV 24.4％，NPV 93.9 ％）。值得注意的是，在05.00 AM，mTWA> 18.5 mcV显着增加了全因死亡率[RR 7.5（95％CI 1.4-38.7），P = 0.01; PPV为19.6％，NPV为90.8％]。在因心血管原因死亡的患者中，mTWA和TO值明显高于存活者，TS值明显低于幸存者，SCD亚组的特征在于mTWA和TO值显着升高， TS值降低。 100 b.p.m时mTWA> 53.5 mcV是SCD的独立重要预测因子，SCD风险增加了五倍。

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