急性心肌梗死患者PCI术后心率变异性对主要不良心脏事件的评估价值

doi:10.13481/j.1671-587x.20180416

摘要/Abstract

摘要： 目的：探讨急性心肌梗死（AMI）患者经皮冠状动脉介入治疗（PCI）术后心率变异性（HRV）对评估短期主要不良心脏事件（MACE）的临床价值。方法：选择接受PCI的AMI患者160例，根据术后3个月内是否发生MACE分为对照组126例（术后3个月内未发生MACE）和研究组34例（术后3个月内发生MACE）。比较2组患者全部正常窦性心搏间期标准差（SDNN）、平均正常窦性心搏间期标准差（SDANN）、每5min正常窦性心搏间期标准差的平均值（SDNNIDX）、相差50ms以上相邻窦性心搏间期数占窦性心搏间期总数的百分比（PNN50）、全程相邻正常窦性心搏间期差的均方根值（rMSSD）、低频（LF）和高频（HF）等HRV主要指标的差异。计算每个患者的冠脉Gensini评分，分析冠脉Gensini评分与HRV主要指标的相关性。随访3个月，应用多元Logistic回归分析HRV主要指标与MACE发生的危险程度。结果：研究组患者的SDNN、SDANN、SDNNIDX、PNN50、RMSSD和HF水平低于对照组（P<0.05），而LF水平高于对照组（P<0.05）。患者冠脉Gensini评分与SDNN、SDANN和SDNNIDX均呈负相关关系（r=-0.827，r=-0.789，r=-0.698，P<0.05），但冠脉Gensini评分与rMSSD、pNN50、LF和HF无相关关系（P>0.05）。多元Logistic回归分析，SDNN、SDANN和SDNNIDX为MACE发生的保护因素（P<0.05）。结论：AMI患者PCI术后反映交感神经系统功能的HRV指标能反映冠脉病变程度并对术后短期预后结局判断有预测价值。

关键词: 急性心肌梗死, 心率变异性, 主要不良心脏事件, 预后, 经皮冠状动脉介入治疗术

Abstract: Objective:To evaluate the clinical value of heart rate variability (HRV) in evaluation on the short-term major adverse cardiac events (MACE) in the patients with acute myocardial infarction (AMI) after percutaneous coronary intervention (PCI). Methods:A total of 160 AMI patients received PCI were collected and divided into control group (126 cases,there was no MACE during 3 months after PCI) and research group (34 cases,there was MACE during 3 months after PCI) according to the occurrence of MACE after operation. The main HRV indexes including SDNN,SDANN,SDNNIDX,PNN50,RMSSD,LF and HF of the patients in two groups were compared. The Gensini scores of coronary artery of each patient were calculated. The relationships of the main HRV indexes and the Gensini scores of coronary artery were analyzed. After 3 months of follow-up,the risk factors of the main HRV indexes to the occurrence of MACE were confirmed by multivariate Logistic analysis. Results: The main HRV indexes including SDNN,SDANN,SDNNIDX,PNN50,RMSSD and HF of the patients in research group were lower than those in control group (all P<0.05),but LF in research group was higher than that in control group (P<0.05).The negative relationships between SDNN,SDANN,SDNNIDX and the Gensini scores were confirmed (r=-0.827,r=-0.789,r=-0.698, P<0.05),but rMSSD,pNN50,LF and HF had no relationship with the Gensini scores (P>0.05). The multivariant Logistic analysis showed that SDNN,SDANN,SDNNIDX were the independent protective factors to the occurrence of MACE (P<0.05). Conclusion:The HRV indexes indicating the sympathetic nervous system function can inflect the degree of coronary artery stenosis and assess the short-term prognosis in the AMI patients after PCI.

Key words: acute myocardial infarction, major adverse cardiac event, prognosis, percutaneous coronary intervention, heart rate variability

中图分类号:

R654.2

朱涛, 张国明, 严飞, 刘正, 霍强. 急性心肌梗死患者PCI术后心率变异性对主要不良心脏事件的评估价值[J]. 吉林大学学报(医学版), 2018, 44(04): 780-785.

ZHANG Tao, ZHANG Guoming, YAN Fei, LIU Zheng, HUO Qiang. Values of evaluation of heart rate variability in major adverse cardiac events in patients with acute myocardial infarction after PCI[J]. Journal of Jilin University Medicine Edition, 2018, 44(04): 780-785.

参考文献

[1] Ernst G,Watne LO,Frihagen F,et al. Decreases in heart rate variability are associated with postoperative complications in hip fracture patients[J].PLoS One,2017,12(7):e0180423.
[2] Erdogan E,Akkaya M,Bacaksiz A,et al.Short-term effect of percutaneous recanalization of chronic total occlusions on QT dispersion and heart rate variability parameters[J].Med Sci Monit,2013,19:696-702.
[3] Heldeweg ML,Liu N,Koh ZX,et al.A novel cardiovascular risk stratification model incorporating ECG and heart rate variability for patients presenting to the emergency department with chest pain[J].Crit Care,2016,20(1):179.
[4] Hamm W,Stülpnagel L,Vdovin N,et al.Risk prediction in post-infarction patients with moderately reduced left ventricular ejection fraction by combined assessment of the sympathetic and vagal cardiac autonomic nervous system[J].Int J Cardiol,2017,249:1-5.
[5] 王银,刘悦,莫钟铃,等.三维斑点追踪技术在评价急性心肌梗死经皮冠状动脉治疗术后近期左室壁运动和收缩功能中的应用及其价值[J].吉林大学学报:医学版,2017,43(2):429-434.
[6] Chen J,Zhang Y,Liu J,et al.Role of lipoprotein (a) in predicting the severity of new on-set coronary artery disease in type 2 diabetics:A Gensini score evaluation[J].Diab Vasc Dis Res,2015,12(4):258-264.
[7] Yuan MJ,Pan YS,Hu WG,et al.A pilot study of prognostic value of non-invasive cardiac parameters for major adverse cardiac events in patients with acute coronary syndrome treated with percutaneous coronary intervention[J].Int J Clin Exp Med,2015,8(12):22440-22449.
[8] Muhadi,Nasution SA,Putranto R,et al.The ability of detecting heart rate variability with the photoplethysmography to predict major adverse cardiac event in acute coronary syndrome[J].Acta Med Indones,2016,48(1):48-53.
[9] 中华医学会心血管病分会.急性ST段抬高型心肌梗死诊断和治疗指南[J].中华心血管病杂志,2015,43(5):380-393.
[10] 孙瑞龙,吴宁,杨世豪,等.心率变异性检测临床应用的建议[J].中华心血管病杂志,1998,26(4):12-15.
[11] Sookan T,McKune AJ.Heart rate variability in physically active individuals:reliability and gender characteristics[J].Cardiovasc J Afr,2012,23(2):67-72.
[12] Schäfer D,Nil M,Herzig D,et al.Good reproducibility of heart rate variability after orthostatic challenge in patients with a history of acute coronary syndrome[J].J Electrocardiol,2015,48(4):696-702.
[13] Yiadom MY,Baugh CW,McWade CM,et al.Performance of emergency department screening criteria for an early ECG to identify ST-segment elevation myocardial infarction[J].J Am Heart Assoc,2017,6(3):e003528.
[14] Moses DA,Johnston LE,Tracci MC,et al.Estimating risk of adverse cardiac event after vascular surgery using currently available online calculators[J].J Vasc Surg,2018,67(1):272-278.
[15] Heldeweg ML,Liu N,Koh ZX,et al.A novel cardiovascular risk stratification model incorporating ECG and heart rate variability for patients presenting to the emergency department with chest pain[J].Crit Care,2016,20(1):179.
[16] Zhang J,He S,Wang X,et al.Effect of trimetazidine on heart rate variability in elderly patients with acute coronary syndrome[J].Pak J Med Sci,2016,32(1):75-78.
[17] Compostella L,Lakusic N,Russo N,et al.Functional parameters but not heart rate variability correlate with long-term outcomes in St-elevation myocardial infarction patients treated by primary angioplasty[J].Int J Cardiol,2016,224:473-481.
[18] Compostella L,Lakusic N,Compostella C,et al.Does heart rate variability correlate with long-term prognosis in myocardial infarction patients treated by early revascularization[J]. World J Cardiol,2017,9(1):27-38.
[19] Harris PR,Stein PK,Fung GL,et al.Heart rate variability measured early in patients with evolving acute coronary syndrome and 1-year outcomes of rehospitalization and mortality[J].Vasc Health Risk Manag,2014,10:451-464.
[20] Princip M,Scholz M,Meister-Langraf RE,et al.Can illness perceptions predict lower heart rate variability following acute myocardial infarction?[J]. Front Psychol,2016,7:1801.
[21] Yaghini Bonabi S,El-Hamad F,Müller A,et al.Recording duration and short-term reproducibility of heart rate and QT interval variability in patients with myocardial infarction[J].Physiol Meas,2016,37(11):1925-1933.
[22] Harris PR,Sommargren CE,Stein PK,et al.Heart rate variability measurement and clinical depression in acute coronary syndrome patients:narrative review of recent literature[J].Neuropsychiatr Dis Treat,2014,10:1335-1347.
[23] Liu Y,Syed Z,Scirica BM,et al.ECG morphological variability in beat space for risk stratification after acute coronary syndrome[J].J Am Heart Assoc,2014,3(3):e000981.
[24] Aires R,Pimentel EB,Forechi L,et al.Time course of changes in heart rate and blood pressure variability in rats with myocardial infarction[J].Braz J Med Biol Res,2017,50(1):e5511.
[25] Compostella L,Lakusic N,Russo N,et al.Functional parameters but not heart rate variability correlate with long-term outcomes in St-elevation myocardial infarction patients treated by primary angioplasty[J].Int J Cardiol,2016,224:473-481.