心率变异性与急性心肌梗死预后关系

目的 研究心率变异性时域指标与急性心肌梗死患者预后的关系,探讨评价急性心肌梗死患者预后的有效方法.方法 该试验为随访研究,对入选的急性心肌梗死患者分为两组,心率变异性中度降低组（窦性R-R间期的总体标准差〈50ms）和心率变异性轻度降低及正常组（窦性R-R间期的总体标准差≥50ms）.主要终点是180d随访时死亡,心肌梗死的复合终点,次要终点是180d随访时死亡、心肌梗死、心力衰竭、难治性心肌缺血.结果 共有384例患者入选,180d随访时,主要终点事件发生率心率变异性中度降低组5.9%,心率变异性轻度降低及正常组0.5%（P=0.01）,次要终点事件发生率心率变异性中度降低组30.2%,心率变异性轻度降低及正常组10.2%（P=0.00）.180d随访时心力衰竭发生率心率变异性中度降低组14.8%,心率变异性轻度降低及正常组5.6%（P=0.01）.结论 急性心肌梗死后,心率变异性降低患者心血管事件发生率升高.心率变异性降低是急性心肌梗死后心力衰竭的预测指标.

Associations between Heart Rate Variability and Prognosis of Acute Myocardial Infarction

Objective To study the associations between the heart rate variability（HRV） changes in time domain and prognosis of acute myocardial infarction,and to discover an effective method of evaluate prognosis of acute myocardial infarction. Methods In this follow-up study,patients diagnosed as acute myocardial infarction were assigned to HRV midrange decrease（SDNN〈50ms,n=169） or HRV slightly decrease and normal（SDNN≥50ms,n=215）.The primary outcome was a composite of death, myocardial infarction at 180 days.The secondary outcome was death,myocardial infarction,heart failure,refractory ischemia at 180 days. Results Baseline clinical characteristics were comparable between two groups.Incidence of both primary（5.9% vs.0.5%,P=0.01） and secondary（30.2% vs. 10.2%,P=0.00） endpoints were significantly lower in HRV slightly decrease and normal group than in HRV midrange decrease group.Incidence of heart failure was significantly lower in HRV slightly decrease and normal group than in HRV midrange decrease group（14.8% vs.5.6%,P=0.01） at 180 days. Conclusion The HRV decreased associated with the cardiovascular events aiter acute myocardial infarction.HRV decrease is a useful tool to predict heart failure after acute myocardial infarction.