CAJ | 학술논문

目的探讨微伏级T波电交替(MTWA)对恶性室性心律失常(MVA)及心性猝死(SCD)的预测价值,探索时域法MTWA检测的正、异常值范围.方法连续选取2002年1月至2007年10月到昆明医学院第一附属医院就诊或健康体检者545例(男285例,女260例,平均年龄52岁),其中105例健康受检者设为对照组,既往有室性心动过速、心室颤动发作史或确诊为器质性心脏病且左室射血分数(LVEF)≤45%的138例设为SCD高危组.两组均成功检测MTWA、LVEF、心率变异性、非持续性室速、QRS、QTc等指标并完成随访,动态随访比较组间死亡及死因、MVA、再次住院、晕厥等事件的发生情况及其与MTWA等观测指标的相关性.结果时域法MTWA检测95%的正常参考值范围为MTWA<37μV.平均(12.0±1.3)个月的随访期内,对照组无心血管事件发生;高危组死亡11例中SCD 7例(MTWA阳性率分别为81.8%、85.7%),发生MVA的17例中MTWA阳性率88.2%,发生晕厥的9例中MTWA阳性率77.8%,随访期住院的21例中MTWA阳性率85.7%.多因素回归分析预测MVA的危险因素依次为MTWA阳性、LVEF≤35%、有心肺复苏史、有晕厥史.仅MTWA阳性与SCD显著相关.MTWA阳性、LVEF≤35%分别是预测MVA的独立指标(P<0.01).MTWA与LVEF≤35%联合预测MVA的敏感性91%、特异性66%、阳性预测价值27%、阴性预测价值98%,优于二者单独使用.41例埋藏式自动复律除颤器(ICD)患者,MTWA阳性率68.3%.随访中发生MVA并被ICD自动电除颤者的MTWA阳性率87.5%.结论 (1)国人时域法MTWA正常参考值为<37μV.(2)MTWA与LVEF一样对MVA有独立预测价值且其预测SCD的价值优于LVEF,二者联合可进一步提高预测价值.(3)MTWA阳性似可成为ICD置入的初筛指标之一.(4)时域法检测MTWA具有无创、简便、高效、易重复、经济等优点,有良好的推广应用前景.
목적 탐토미복급T파전교체(MTWA)대악성실성심률실상(MVA)급심성졸사(SCD)적예측개치,탐색시역법MTWA검측적정、이상치범위.방법 련속선취2002년1월지2007년10월도곤명의학원제일부속의원취진혹건강체검자545례(남285례,녀260례,평균년령52세),기중105례건강수검자설위대조조,기왕유실성심동과속、심실전동발작사혹학진위기질성심장병차좌실사혈분수(LVEF)≤45%적138례설위SCD고위조.량조균성공검측MTWA、LVEF、심솔변이성、비지속성실속、QRS、QTc등지표병완성수방,동태수방비교조간사망급사인、MVA、재차주원、훈궐등사건적발생정황급기여MTWA등관측지표적상관성.결과 시역법MTWA검측95%적정상삼고치범위위MTWA<37μV.평균(12.0±1.3)개월적수방기내,대조조무심혈관사건발생;고위조사망11례중SCD 7례(MTWA양성솔분별위81.8%、85.7%),발생MVA적17례중MTWA양성솔88.2%,발생훈궐적9례중MTWA양성솔77.8%,수방기주원적21례중MTWA양성솔85.7%.다인소회귀분석예측MVA적위험인소의차위MTWA양성、LVEF≤35%、유심폐복소사、유훈궐사.부MTWA양성여SCD현저상관.MTWA양성、LVEF≤35%분별시예측MVA적독립지표(P<0.01).MTWA여LVEF≤35%연합예측MVA적민감성91%、특이성66%、양성예측개치27%、음성예측개치98%,우우이자단독사용.41례매장식자동복률제전기(ICD)환자,MTWA양성솔68.3%.수방중발생MVA병피ICD자동전제전자적MTWA양성솔87.5%.결론 (1)국인시역법MTWA정상삼고치위<37μV.(2)MTWA여LVEF일양대MVA유독립예측개치차기예측SCD적개치우우LVEF,이자연합가진일보제고예측개치.(3)MTWA양성사가성위ICD치입적초사지표지일.(4)시역법검측MTWA구유무창、간편、고효、역중복、경제등우점,유량호적추엄응용전경.
Objective To explore the predict value of microvoh level T-wave ahemans (MTWA) for malignant ventricular arrhythmia (MVA) and sudden cardiac death (SCD) in hish risk patients.Methods A total of 105 healthy subjects (control group) and 138 patients with history of VT or VF or patients with LVEF≤45%(SCD hish risk group)were included in this study (meau age 52 years old).MTWA.LVEF,HRV,NSVT,QRS,QTc values and MACE data (death,causes of death,MVA,re-hospitalization,syncope) during follow up (12.0±1.3) months were obtained.Results ,The normal reference value of MTWA was defined as<37 μV.Positive rate in SCD high risk group was significantly higher than that in control group (45.7% vs.4.8%,P<0.01).There was no cardiovascular event report in contrel group.In SCD high risk group,there were 11 deaths (MTWA positive rate 81.8%) including 7 SCD (MTWA positive rate 85.7%),17 MVA (MTWA positive rate 88.2%),9 cases of syncope (MTWA positive rate 77.8%),21 cases of re-hospitalization during the follow up (MTWA positive rate 85.7%).Logistic regression analysis revealed that positive MTWA,a history of myocardial infarction and LVDd≥60 mm were risk factors for all cause of death and positive MTWA was the only factor to predict SCD.The factors related to MVA in tum were positive MTWA.LVEF≤35%,a history of cardiopulmonary resuscitation and a history of syncope.Positive MTWA and LVEF≤35% are the independent risk factors for predicting MVA(P<0.01).The sensitivity was 91% and specility was 66% by combined use of positive MTWA and LVEF≤35% to predict MVA.MTWA positive rates were 68.3% and 87.5% respectively in 41 ICD patients and ICD patients with automatic shock during follow up.Conclusion Non-invasive MTWA measurement could be used as a screening tool to predict SCD or MVA in hish risk patients.