科研之友
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摘要
Background: Many patients who survive a myocardial infarction (MI) remain at risk of sudden cardiac death despite revascularization and optimal medical treatment. We used the modified moving average (MMA) method to assess the utility of T-wave alternans (TWA) and heart rate turbulence (HRT) as risk markers in MI patients with or without diabetes mellitus (DM). Methods: We prospectively enrolled 248 consecutive patients: 96 with MI (post-MI patients); 77 MI with DM (post-MI + DM patients); 75 controls without cardiovascular disease (group control). Both TWA and HRT were measured on ambulatory electrocardiograms (AECGs). HRT was assessed by two parameters - turbulence onset (TO) and turbulence slope (TS). HRT was considered positive when both TO >= 0% and TS <= 2.5 ms/R-R interval were met. The endpoint was cardiac mortality. Results: TWA values differed significantly between MI and controls. Post-MI + DM patients had higher TWA values than post-MI patients (58 +/- 21 mu V VS 52 +/- 18 mu V, P = 0.029). Impaired HRT-increased TO and decreased TS were observed in MI patients with or without DM. During follow-up of 578 +/- 146 days, cardiac death occurred in ten patients and three of them suffered sudden cardiac death (SCD). Multivariate analysis determined that a HRT-positive outcome [HR (95% CI): 5.01, 1.33-18.85; P = 0.017], as well as the combination of abnormal TWA (>= 47 mu V) and positive HRT had significant association with the endpoint [HR (95% CI): 9.08, 2.21-37.2; P = 0.002)]. Conclusion: This study indicates that AECGs-based TWA and HRT can predict cardiac mortality in MI patients with or without DM. Combined analysis TWA and HRT may be a convenient and useful method of identifying patients at high risk for cardiovascular death.
