QT dynamicity and sudden death after myocardial infarction:: Results of a long-term follow-up study
QT dynamicity and sudden death after myocardial infarction:: Results of a long-term follow-up study
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DOI：
10.1046/j.1540-8167.2003.02431.x
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发表时间：
2003-03-01
影响因子：
2.7
通讯作者：
Touboul, P
中科院分区：
文献类型：
--
作者：
Chevalier, P;Burri, H;Touboul, P
心肌梗死后QT间期离散度与死亡率。前言：本研究的目的是确定QT间期对心率变化的适应性受损是否预示着急性心肌梗死后猝死的发生。方法和结果：L心肌梗死组试验是一项前瞻性的多中心研究，旨在评估心肌梗死的长期预后。通过分析心肌梗死后9~14天的24小时动态心电图，对265例患者进行QT间期动态分析。用专用的Holter算法计算QT间期与RR间期的线性回归斜率(QTE)。比较QT/RR与射血分数、心率变异性和晚电位对猝死和总死亡率的预测价值。平均随访81+/-27个月。有73人死亡，其中23人是突然死亡。在所有参数中，昼夜QTE/RR斜率增加(>；0.18)是猝死的最强独立预测因子(相对危险度6.07，可信区间1.48~24.95，P=0.01)。结论：昼夜QTE动态增加是心肌梗死患者猝死的独立预测因素。这个简单的参数可能有助于对风险进行分层，并选择可能受益于抗心律失常预防的患者。
QT Dynamicity and Mortality After Myocardial Infarction. Introduction: The aim of this study was to determine whether impaired adaptation of the QT interval to changes in heart rate predicts sudden death after an acute myocardial infarction.Methods and Results: The Groupe d'Etude du Pronostic de l'Infarctus du Myocarde (GREPI) trial was a prospective multicenter study designed to evaluate the long-term outcome of myocardial infarction. QT dynamicity was evaluated in 265 patients by analyzing 24-hour Holter recordings obtained 9 to 14 days after myocardial infarction. The linear regression slope of QT intervals measured to the apex and to the end of the T wave (QTe) plotted against RR intervals was calculated using a dedicated Holter algorithm. The value of QT/RR in predicting sudden death and total mortality was compared with those of ejection fraction, heart rate variability, and late potentials. Mean follow-up was 81 +/- 27 months. There were 73 deaths, of which 23 were sudden. Of all the parameters, an increased diurnal QTe/RR slope (>0.18) was the strongest independent predictor of sudden death (relative risk 6.07, confidence interval 1.48-24.95, P=0.01).Conclusion: Increased diurnal QTe dynamicity is independently predictive of sudden death among patients with myocardial infarction. This simple parameter may help to stratify risk and select patients who may benefit from antiarrhythmic prophylaxis.