LATE POTENTIALS AFTER ACUTE MYOCARDIAL-INFARCTION PERFORMANCE OF DIFFERENT CRITERIA FOR THE PREDICTION OF ARRHYTHMIC COMPLICATIONS
LATE POTENTIALS AFTER ACUTE MYOCARDIAL-INFARCTION PERFORMANCE OF DIFFERENT CRITERIA FOR THE PREDICTION OF ARRHYTHMIC COMPLICATIONS
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DOI：
10.1093/oxfordjournals.eurheartj.a060222
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发表时间：
1992-05-01
影响因子：
39.3
通讯作者：
CAMM, AJ
中科院分区：
文献类型：
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作者：
MALIK, M;ODEMUYIWA, O;CAMM, AJ
为比较心肌梗死后晚电位的不同定义标准，对332例急性心肌梗死存活者随访6个月以上，对其中12例猝死，14例有症状性持续性室性心动过速患者进行了3种信号平均心电图参数：信号平均QRS波群时程(QRS)、终末均方根电压(RMS-40)和低幅度信号时程及40μV(LASD-40)的测定。分析这三个变量与心律失常事件在总人群、梗死部位和特定年龄亚组中的相关性。计算预测心律失常事件的敏感度和特异度(对于所有二分点)，并与基于相同三个变量的9个已发表的晚电位标准进行比较。分析表明：(A)总信号平均QRS持续时间比其他两个变量更好地预测心律失常事件，(B)对于前梗塞情况下的心律失常事件，需要比下壁梗塞情况下更高的RMS-40二分限和更低的QRS和LASD-40二分限，(C)基于所有三个变量的心律失常事件的多变量分层在前梗死组中比在下梗死组中表现得更好，(D)定义晚电位的策略要求两个变量达到临界值，比要求任何一个或所有三个变量达到临界值的策略更好，(E)所有晚电位的定义在前壁和下壁心肌梗死人群中的表现不同；为了识别具有相似心律失常事件风险的人群，应该在这些亚群中使用不同的标准来定义晚电位。
In order to compare different criteria for the definition of late potentials in patients after myocardial infarction, three signal averaged ECG variables, duration of the signal-averaged QRS complex (QRS), root-mean-square voltage of the terminal 40 ms (RMS-40), and the duration of low amplitude signals <40 μV (LASD-40), were assessed in 332 survivors of acute myocardial infarction who were followed-up for at least 6 months, during which 12 patients died suddenly and 14 suffered symptomatic sustained ventricular tachycardia. The associations of the three variables with arrhythmic events were analysed in the total population, in infarct site and age-specific subgroups. The sensitivity and specificity for the prediction of arrhythmic events was computed (for all dichotomy points) and compared with nine published criteria for late potentials based on the same three variables. Analysis showed that (a) the total signal averaged QRS duration was a better predictor of arrhythmic events than the other two variables, (b) for arrhythmic events in cases of anterior infarctions, higher RMS-40 dichotomy limits and lower QRS and LASD-40 dichotomy limits were needed than for cases of inferior infarction, (c) a multivariate stratification of arrhythmic events based on all three variables performed better in the anterior infarction population than in the inferior infarction population, (d) the strategy defining late potentials, which requires that two variables reach critical values, is better than the strategies that require that any one or all three variables reach critical values, (e) all the definitions of late potentials performed differently in the populations with anterior as compared to inferior infarctions; to identify groups at similar risk of arrhythmic events, different criteria defining late potentials should be used in these subpopulations.