Metrika članka

  • citati u SCindeksu: [1]
  • citati u CrossRef-u:0
  • citati u Google Scholaru:[=>]
  • posete u poslednjih 30 dana:4
  • preuzimanja u poslednjih 30 dana:4
članak: 2 od 2  
Back povratak na rezultate
Srpski arhiv za celokupno lekarstvo
2006, vol. 134, br. 11-12, str. 482-487
jezik rada: srpski
vrsta rada: članak
doi:10.2298/SARH0612482M
Rani prediktori rizika za nastanak iznenadne srčane smrti posle infarkta miokarda - rezultati ispitivanja 881 bolesnika
aUniverzitet u Beogradu, Medicinski fakultet, KBC 'Bežanijska kosa'
bUniverzitet u Beogradu, Medicinski fakultet, Institut za socijalnu medicinu

e-adresa: branislav_milovanovic@rvkds.net

Sažetak

Uvod: Istraživanja su pokazala da su poremećaji repolarizacije leve komore, autonomna disfunkcija i poremećaj sistolne funkcije leve komore povezani sa nastankom iznenadne smrti posle infarkta miokarda. Cilj rada: Cilj rada je bio da se ispita prognostički značaj najvažnijih prediktora rizika tokom prve nedelje od nastanka infarkta miokarda. Metod U studiju je uključe n 881 bolesnik, koji je nadgledan od jednog meseca do 57 meseci. U toku prve nedelje posle infarkta urađeni su EKG sa standardnim i X, Y i Z ortogonalnim odvodima i vektorkardiogram, određeni su QT interval i kasni potencijali, urađena je kratkotrajna spektralna analiza RR varijabiliteta, nelinearna (Poincare plot) analiza i ehokardiografski pregled srca. Analiza preživljavanja je rađena primenom Koksovog hazardnog modela (Cox Proportional Step Wise Hazards Model). U ovom modelu analize uključene su sve varijable koje su pokazale značajnu povezanost u univarijantnoj analizi. Rezultati U univarijantnoj analizi su sledeći parametri mereni prvog dana bili značajni prediktori smrtnosti: male vrednosti odnosa niske i visoke frekvencije - LF/HF (p=0,000), inverzija T u X odvodu (p=0,000), visok P talas u D2 odvodu (p=0,030) i smanjena sistolna funkcija (p=0,000). U multivarijantnoj analizi su sledeći parametri izdvojeni kao značajni prediktori rizika: inverzija T talasa u X odvodu, smanjen odnos LF/HF, pozitivni kasni potencijali i smanjena sistolna funkcija leve komore. Zaključak Parametri koji odražavaju poremećaj sistolne funkcije leve komore sa simpatovagusnim disbalansom i električnom nestabilnošću predstavljaju ključne prediktore rizika tokom prvih nekoliko dana posle infarkta miokarda.

Ključne reči

faktori rizika; infarkt miokarda; kasni potencijali; RR varijabilitet

Reference

Bigger, J.T., Fleiss, J.L., Rolnitzky, L.M., Steinman, R.C. (1993) The ability of several short-term measures of RR variability to predict mortality after myocardial infarction. Circulation, 88(3): 927-34
Breithardt, G., Borggrefe, M., Fetsch, T., Bocker, D., Makijarvi, M., Reinhardt, L. (1995) Prognosis and risk stratification after myocardial infarction. Eur Heart J, 16 Suppl G: 10-9
Brouwer, J., Veldhuisen, D.J., Man, V.A.J., Haaksma, J., Dijk, W.A., Visser, K.R., Boomsma, F., Dunselman, P.H. (1996) Prognostic value of heart rate variability during long-term follow-up in patients with mild to moderate heart failure. The Dutch Ibopamine Multicenter Trial Study Group. J Am Coll Cardiol, 28(5): 1183-9
Chevalier, P., Burri, H., Adeleine, P., Kirkorian, G., Lopez, M., Leizorovicz, A., Andre-Fouet, X., Chapon, P., Rubel, P., Touboul, P., Groupe d'Etude du Pronostic de l'Infarctus du Myocarde (2003) QT dynamicity and sudden death after myocardial infarction: Results of a long-term follow-up study. J Cardiovasc Electrophysiol, 14(3): 227-33
Dabrowski, A., Kramarz, E. (2002) Fused TU complexes as a new electrocardiographic marker of poor prognosis after myocardial infraction. Pol Arch Med Wewn, 108(2): 731-7
Farrell, T.G., Odemuyiwa, O., Bashir, Y., Cripps, T.R., Malik, M., Ward, D.E., Camm, A.J. (1992) Prognostic value of baroreflex sensitivity testing after acute myocardial infarction. Br Heart J, 67(2): 129-37
Gaita, F., Giustetto, C., Bianchi, F., Riccardi, R., Grossi, S., Richiardi, E., Short, Q.T. (2003) A new electrocardiographic pattern related to familial sudden death. J Am Coll Cardiol, 14(Suppl 6), str. 818-23
Garcia, G.J., Serrano, S.J.A., Castillo, A.S., Cantalapiedra, A.J.L., Villacastin, J., Almendral, J., Arenal, A., Gonzalez, S., Delcan, D.J.L. (2000) Predictors of sudden death in coronary artery disease. Rev Esp Cardiol, 53(3): 440-62
Haapalahti, P., Makijarvi, M., Montonen, J., Korhonen, P., Salorinne, Y., Oikarinen, L., Viitasalo, M., Toivonen, L. (2000) Effects of cardiovascular autonomic function tests on QT dispersion in the 12-lead electrocardiogram of healthy patients. J Electrocardiol, 33(4): 321-7
Hintze, U., Vach, W., Burchardt, H., Videbaek, J., Moller, M. (2002) DIAMOND Study Group. QT interval dynamics predict mortality in high-risk patients after myocardial infarction. Scand Cardiovasc J, 36(5): 276-81
Homs, E., Marti, V., J., Laguna, P., Vinolas, X., Caminal, P., Elosua, R., Bayes, L.A. (1997) Automatic measurement of corrected QT interval in Holter recordings: Comparison of its dynamic behavior in patients after myocardial infarction with and without life-threatening arrhythmias. Am Heart J, 134(2 Pt 1): 181-7
Huikuri, H.V., Makikallio, T.H., Peng, C.K., Goldberger, A.L., Hintze, U., Moller, M. (2000) Fractal correlation properties of R-R interval dynamics and mortality in patients with depressed left ventricular function after an acute myocardial infarction. Circulation, 101(1): 47-53
Katz, A., Liberty, I.F., Porath, A., Ovsyshcher, I., Prystowsky, E.N. (1999) A simple bedside test of 1-minute heart rate variability during deep breathing as a prognostic index after myocardial infarction. Am Heart J, 138(1 Pt 1): 32-8
Klingenheben, T., Credner, S., Gronefeld, G., Zabel, M., Li, Y., Hohnloser, S.H. (1999) Cardiac autonomic tone in risk stratification after myocardial infarct: Results of a prospective long-term study of 411 consecutive patients. Z Kardiol, 88(6): 400-9
la Rovere, M.T., Pinna, G.D., Hohnloser, S.H., Marcus, F.I., Mortara, A., Nohara, R., Bigger, J.T., Camm, A.J., Schwartz, P.J., ATRAMI.Investigators. Autonomic Tone and Reflexes After Myocardial Infarcton (2001) Baroreflex sensitivity and heart rate variability in the identification of patients at risk for life-threatening arrhythmias: Implications for clinical trials. Circulation, 103(16): 2072-7
Liu, P., Tsai, W., Lin, L., Li, Y., Chao, T., Tsai, L., Chen, J. (2003) Time domain heart rate variability as a predictor of long-term prognosis after acute myocardial infarction. J Formos Med Assoc, 102(7): 474-9
Lombardi, F. (2000) Chaos theory, heart rate variability, and arrhythmic mortality. Circulation, 101(1): 8-10
Makikallio, T.H., Hoiber, S., Kober, L., Torp-Pedersen, C., Peng, C.K., Goldberger, A.L., i dr. (1999) Fractal analysis of heart rate dynamics as a predictor of mortality in patients with depressed left ventricular function after acute myocardial infarction. TRACE Investigators. TRAndolapril Cardiac Evaluation. Am J Cardiol, 83(6), str. 836-9
Malik, M. (2001) Problems of heart rate correction in assessment of drug-induced QT interval prolongation. J Cardiovasc Electrophysiol, 12(4): 411-20
Malik, M. (1996) If Dr. Bazett had had a computer. Pacing Clin Electrophysiol, 19(11 Pt 1): 1635-9
Molnar, J., Weiss, J., Zhang, F., Rosenthal, J.E. (1996) Evaluation of five QT correction formulas using a software-assisted method of continuous QT measurement from 24-hour Holter recordings. Am J Cardiol, 78(8): 920-6
Molnar, J., Zhang, F., Weiss, J., Ehlert, F.A., Rosenthal, J.E. (1996) Diurnal pattern of QTc interval: How long is prolonged? Possible relation to circadian triggers of cardiovascular events. J Am Coll Cardiol, 27(1): 76-83
Myrtek, M., Brugner, G., Fichtler, A. (1990) Diurnal variations of ECG parameters during 23-hour monitoring in cardiac patients with ventricular arrhythmias or ischemic episodes. Psychophysiology, 27(6): 620-6
Naccarella, F., Lepera, G., Rolli, A. (2000) Arrhythmic risk stratification of post-myocardial infarction patients. Curr Opin Cardiol, 15(1): 1-6
Odemuyiwa, O., Farrell, T.G., Malik, M., Bashir, Y., Millane, T., Cripps, T., Poloniecki, J., Bennett, D., Camm, A.J. (1992) Influence of age on the relation between heart rate variability, left ventricular ejection fraction, frequency of ventricular extrasystoles, and sudden death after myocardial infarction. Br Heart J, 67(5): 387-91
Odemuyiwa, O., Poloniecki, J., Malik, M., Farrell, T., Xia, R., Staunton, A., Kulakowski, P., Ward, D., Camm, J. (1994) Temporal influences on the prediction of postinfarction mortality by heart rate variability: A comparison with the left ventricular ejection fraction. Br Heart J, 71(6): 521-7
Pedretti, R., Etro, M.D., Laporta, A., Braga, S.S., Caru, B. (1993) Prediction of late arrhythmic events after acute myocardial infarction from combined use of noninvasive prognostic variables and inducibility of sustained monomorphic ventricular tachycardia. Am J Cardiol, 71(13): 1131-41
Pedretti, R.F., Catalano, O., Ballardini, L., Bono, D.P., Radice, E., Tramarin, R. (1999) Prognosis in myocardial infarction survivors with left ventricular dysfunction is predicted by electrocardiographic RR interval but not QT dispersion. Int J Cardiol, 68(1): 83-93
Sagie, A., Larson, M.G., Goldberg, R.J., Bengtson, J.R., Levy, D. (1992) An improved method for adjusting the QT interval for heart rate (the Framingham Heart Study). Am J Cardiol, 70(7): 797-801
Singh, J.P., Sleight, P., Kardos, A., Hart, G. (1997) QT interval dynamics and heart rate variability preceding a case of cardiac arrest. Heart, 77(4): 375-7
Steinbigler, P., Haberl, R., Bruggemann, T., Andresen, D., Steinbeck, G. (2002) Postinfarction risk assessment for sudden cardiac death using late potential analysis of the digital Holter electrocardiogram. J Cardiovasc Electrophysiol, 13(12): 1227-32
Tavernier, R., Jordaens, L., Haerynck, F., Derycke, E., Clement, D.L. (1997) Changes in the QT interval and its adaptation to rate, assessed with continuous electrocardiographic recordings in patients with ventricular fibrillation, as compared to normal individuals without arrhythmias. Eur Heart J, 18(6): 994-9
Viitasalo, M., Karjalainen, J., Makijarvi, M., Toivonen, L. (1998) Autonomic modulation of QT intervals in post-myocardial infarction patients with and without ventricular fibrillation. Am J Cardiol, 82(2): 154-9
Voss, A., Kurths, J., Kleiner, H.J., Witt, A., Saparin, P., Dietz, R., Fiehring, H., Wessel, N. (1994) New methods for the detection of high risk patients in cardiology. Biomed Tech (Berl), 39(6): 134-43
Yi, G., Guo, X.H., Reardon, M., Gallagher, M.M., Hnatkova, K., Camm, A.J., Malik, M. (1998) Circadian variation of the QT interval in patients with sudden cardiac death after myocardial infarction. Am J Cardiol, 81(8): 950-6
Zabel, M., Acar, B., Klingenheben, T., Franz, M.R., Hohnloser, S.H., Malik, M. (2000) Analysis of 12-lead T-wave morphology for risk stratification after myocardial infarction. Circulation, 102(11): 1252-7
Zabel, M., Klingenheben, T., Franz, M.R., Hohnloser, S.H. (1998) Assessment of QT dispersion for prediction of mortality or arrhythmic events after myocardial infarction: Results of a prospective, long-term follow-up study. Circulation, 97(25): 2543-50