ELECTRICAL ALTERNANS AND CARDIAC ELECTRICAL INSTABILITY
ELECTRICAL ALTERNANS AND CARDIAC ELECTRICAL INSTABILITY
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DOI：
10.1161/01.cir.77.1.110
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发表时间：
1988-01-01
期刊：
影响因子：
37.8
通讯作者：
COHEN, RJ
中科院分区：
文献类型：
--
作者：
SMITH, JM;CLANCY, EA;COHEN, RJ
我们在一系列20只狗的实验和一项初步临床研究中调查了电交替和心脏电稳定性之间的关系。采用一种新的多维频谱技术检测QRS波群和ST-T波的电交替。交替的幅度表示为交替心电图形态指数（AEMI），表示为波形能量的百万分之几。通过室颤阈值测量评估犬制剂的电稳定性，并在临床研究中通过程控刺激评估。在10只狗的实验中，全身低温导致心室纤颤阈值（VFT）降低60%（p <0.0001），并且两个AEMI（QRS）从3.7 ± 0.01显著增加。3.0 1448 .+-. 548（p < .0001），AEMI（ST-T）从43.9 ±. 18.4至19，178.+-. 5579（p < .0001）。在10只狗的实验中，短暂的冠状动脉结扎也导致VFT降低60%（p <0.0001），从76.3 . ±. 46.5至245 .+-。11例AEMI（QRS）（p < .05），从842 . ±. 505到1365 .+-. AEMI（ST-T）392例（p < .002）。在20个动物实验的119个观察结果中，VFT和AEMI（QRS）之间的等级相关性为-0.30（p < .001），VFT和AEMI（ST-T）之间的等级相关性为-0.55（p < .001）。在一项包括19名患者的23项研究的双盲初步临床试验中，电生理学测试的结果被用作心脏电稳定性的独立测量。波形形态的改变以92%的敏感性、70%的阳性预测性和50%的特异性鉴定了可诱导的患者群体（p <0.05）。我们的结论是，心电图形态学的微妙的心跳到心跳的变异性分析，可以提供一个非侵入性措施的心脏电稳定性。
We investigated the relationship between electrical alternans and cardiac electrical stability in a series of 20 dog experiments and in a pilot clinical study. Electrical alternans was detected in both the QRS complex and the ST-T wave by use of a novel multidimensional spectral technique. The magnitude of the alternation was expressed as the alternating electrocardiographic morphology index (AEMI), expressed as parts per million of waveform energy. Electrical stability in the dog preparations was assessed via the ventricular fibrillation threshold measurement, and in the clinical studies via programmed stimulation. In 10 dog experiments, systemic hypothermia resulted in a 60% decrease in ventricular fibrillation threshold (VFT) (p < .0001) and a significant increase in both AEMI(QRS) from 3.7 .+-. 3.0 to 1448 .+-. 548 (p < .0001) and AEMI(ST-T) from 43.9 .+-. 18.4 to 19,178 .+-. 5579 (p < .0001). In 10 dog experiments, transient coronary artery ligation also resulted in a 60% decrease in VFT (p < .0001), an increase from 76.3 .+-. 46.5 to 245 .+-. 11 in AEMI(QRS) (p < .05), and an increase from 842 .+-. 505 to 1365 .+-. 392 in AEMI(ST-T) (p < .002). In 119 observations in 20 animal experiments, the rank correlation between VFT and AEMI(QRS) was -.30 (p < .001), with that between VFT and AEMI(ST-T) being -.55 (p < .001). In a double-blind pilot clinical trial consisting of 23 studies in 19 patients, the result of electrophysiologic testing was used as an independent measure of cardiac electrical stability. Alternation in waveform morphology identified the inducible patient population with a sensitivity of 92%, a positive predictivity of 70%, and a specificity of 50% (p < .05). We conclude that analysis of subtle beat-to-beat variability in electrocardiographic morphology may provide a noninvasive measure of cardiac electrical stability.