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Srpski arhiv za celokupno lekarstvo
2007, vol. 135, br. 1-2, str. 15-20
jezik rada: srpski
vrsta rada: članak
doi:10.2298/SARH0702015M
Prognostički značaj Poincare plot kao nelinearnog parametra teorije haosa kod bolesnika s infarktom miokarda
aUniverzitet u Beogradu, Medicinski fakultet, KBC 'Bežanijska kosa'
bUniverzitet u Beogradu, Medicinski fakultet, Institut za socijalnu medicinu

e-adresa: anibran@yubc.net

Sažetak

Uvod: Postoje različiti nalazi o povezanosti disfunkcije autonomnog nervnog sistema, posebno nelinearnih parametara sa povećanim mortalitetom posle infarkta miokarda. Cilj rada Cilj rada je bio da se oceni prediktivna vrednost Poincare plot kao nelinearnog matematičkog parametra i uporedi sa drugim značajnim standardnim prediktorima: ejekcionom frakcijom leve komore, kasnim potencijalima, ventrikularnim aritmijama i QT intervalom. Metod rada U studiju je uključen 1.081 bolesnik koji je u proseku nadgledan 28 meseci (raspon 0-80 meseci). Kod svih bolesnika su druge nedelje posle infarkta miokarda primenjeni sledeći dijagnostički metodi: 1) EKG sa komercijalnim softverom Schiller AT-10; 2) kratkotrajna spektralna analiza RR varijabiliteta s analizom Poincare plot kao nelinearnog parametra i kasni potencijali (najmanje dva parametra pozitivna); 3) Holter EKG monitoring (24 časa): QT interval, RR interval, odnos QT i RR intervala, ventrikularne aritmije (Lown>II); 4) ehokardiografski pregled sa procenom sistolne funkcije (disfunkcija definisana kao ejekciona frakcija manja od 40%). Kao siguran klinički događaj definisan je kardiovaskularni mortalitet. Rezultati Tokom ispitivanja umrla su 103 bolesnika (9,52%). U univarijantnoj analizi sledeći parametri su bili značajno povezani sa mortalitetom: prosečan RR interva l manji od 800 ms, prostorni odnos QT i RR intervala (RR<800 ms i QT>350 ms), pozitivni kasni potencijali, oslabljena sistolna funkcija, Poincare plot kao tačka, ventrikularne aritmije (Lown>II). U multivarijantnoj Koksovoj regresivnoj analizi samo su pojava Poincare plot u obliku tačke i prosečan RR interval manji od 800 ms bili značajni prediktori mortaliteta. Zaključak Poincare plot u nelinearnoj kratkotrajnoj analizi kao tačka i prosečan RR interval tokom 24 časa manji od 800 ms su značajni multivarijantni prediktori rizika dve nedelje posle infarkta miokarda.

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