Heart Rate Shock, The Predictive Value Of High-risk Patients After Acute Myocardial Infarction

Objective To obtain heart rate turbulence(HRT) predicting high-risk patientsafter acute myocardial infarction(AMI) by comparing between AMI patients andhealth persons also among the AMI patients themselves.Methods 50 patientshave been diagnosed exactly as AMI in 3--4 weeks, at the same time 50 healthpersons are collected as control. We collect the basic information, dynamicelectrocardiogram(DCG)and the Ultrasonic Cardiogram (UCG) of thosesubjects, and draw out basic information;heart electrophysiology indexsigns:HRT including turbulence onset(TO) and turbulence slope(TS),Heart ratevariability(HRV),QT interval Variability(QTV)and coefficient of QT intervalvariation(QTCV);heart function signs:Left Ventricular Eject Fraction(LVEF).AMI patients are divided into high-risk patients(28 patients:10 patients wereventricular malignant arrhythmias and 1 was cardiogenic shock in hospital;1was dead,11 were second infarction and 5 were second or multiplehospitalization during follow-up period)and low-risk patients(22 patients)according to basic information, DCG and end-point accident during follow-upperiod.Result (1)The TS of the AMI patients are significantly lower than thoseof the control group(P<0.01);(2)The TS of the high-risk patients are lower thanthose of the low-risk patients after AMI;(3)There is no correlation betweenTO,TS, HRV, QTV,QTCV and LVEF in AMI control group (P>0.05). (4)In theunivariate analysis, TS,QTV ,LVEF and combination of TO and TS providedthe most significant difference in high-risk and low-risk patients after AMI(P<0.05);(5) In the multivariate analysis, LVEF(RR=0.958) ,TS(RR=0.896), andQTCV are sensitive predictors when TO and TS as separate variables.WhenCox-regression analysis on a combination of TO and TS ,the combination ofabnormal TO and an abnormal TS(RR=2.147) is the more powerful multivaeiaterisk stratifier than LVEF(RR=0.154).Conclusion The HRT is significantdifference between the AMI and the control group also among the high-risk andlow-risk patients after AMI. Furthermore, survival analysis show that HRT is apredictor stronger than other traditional factors.So we maybe draw out aconclusion that HRT will be the newly independent predictor of high-riskpatients after AMI.