微伏级T波电交替及窦性心律震荡对扩张型心肌病患者猝死预测价值.docVIP

微伏级T波电交替及窦性心律震荡对扩张型心肌病患者猝死预测价值 　　【摘要】目的评价窦性心律震荡（HRT）和微伏级T波电交替（mTWA）对扩张型心肌病患者猝死的预测价值。 　　方法选取扩张型心肌病患者87例，健康体检者60例，根据24小时动态心电图（Holter）记录资料，计算HRT的两个参数震荡初始（TO）和震荡斜率（TS），采用时域法检测mTWA，比较两组的差别；同时对扩张型心肌病患者随访2年，主要终点为心源性猝死，次要终点为全因死亡及非猝死性心血管死亡，评估死亡组与存活组，死亡各亚组之间HRT及mTWA的差异性。 　　结果死亡组mTWA及HRT2明显升高。其中心源性猝死亚组mTWAmax和HRT2异常较非猝死组明显升高；而06：00 mTWA（WF1/8）则以非心源性猝死组为高。COX回归分析发现，LVEDD、HRT2、mTWA （06：00 AM）为最有意义的独立致死因子；LVEDD、HRT2、mTWA（100次/分）和室性早搏数量为心源性猝死的危险因素。异常TO/TS联合mTWA（100次/分）大于64.5 mcV则显著增加全因死亡率[RR， 28.5 （95% CI 4.2～1385）， P0.001]及心源性猝死风险[RR，62.5 （95% CI 6.2～516.5 ）， P0.001]。当三个危险因素均出现时其增加全因死亡率及心源性猝死风险居中。LVEDD大于60 mm和HRT2能更好地预测全因死亡率及心源性猝死风险。 　　结论当患者HRT和mTWA异常时总病死率及心源性猝死风险明显增加。 　　【关键词】T波电交替；窦性心律震荡；扩张型心肌病；猝死 　　中图分类号：R542.2 文献标识码：ADOI：10.3969/j.issn2016.01.014 　　【Abstract】ObjectiveTo evaluate the predictive value of heart rate turbulence （HRT） and microvolt Twave alternans （mTWA） for sudden cardiac death（SCD） in patients with dilated cardiomyopathy. 　　Methods87 patients with dilated cardiomyopathy and 60 healthy people were selected. Then， data were recorded， turbulence onset（TO） and turbulence slope （TS） of HRT were calculated according to 24 h ambulatory electrocardiogram monitoring（Holter）. mTWA was tested by time domain method and compared between groups. Patients with dilated cardiomyopathy were given followup visit for 2 years， primary endpoint was SCD， secondary endpoint was allcause death and non SCD. In addition， HRT and mTWA of death group， survival group and each death subgroup was evaluated. 　　Results mTWA and HRT2 of the death group significantly increased， among which abnormal mTWA and HRT2 of SCD subgroup increased more significantly than those of the non SCD subgroup. And non SCD group had highest mTWA（WF1/8）at 6：00 AM. Coxregression analysis showed that LVEDD， HRT2 and mTWA（06：00 AM）were the most significant independent lethal factors. And risk factors for SCD were LVEDD， HRT， mTWA （100 bpm） and the number of premature ventricular beats. Combination of a