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为探讨急性心肌梗死（ＡＭＩ）预后与心率变异（ＨＲＶ）的关系及ＨＲＶ与左室射血分数（ＬＶＥＦ）、心室晚电位（ＶＬＰ）联合应用对心律失常事件的预测价值，对８４例ＡＭＩ后两周的患者进行ＨＲＶ时域及频域分析和ＶＬＰ检测，并进行长期随访。平均随访１６．７５±７．７４（４～２９）个月（１２例失访）。结果表明：①发生严重心律失常事件的ＡＭＩ患者（１５例）的ＨＲＶ较无严重心律失常事件者（５７例）明显下降〔ＳＤ：３．８７９±０．３５５ｌｎ（ｍｓ）ｖｓ４．０７７±０．２８１ｌｎ（ｍｓ），Ｓｔ．Ｇｅｏｒｇｅｓ指数：３．６７７±０．５６９ｖｓ３．９２９±０．３５８，ＬＦ：４．３９９±１．１７９ｌｎ（ｍｓ２／Ｈｚ）ｖｓ５．０４１±０．９１２ｌｎ（ｍｓ２／Ｈｚ），Ｐ均＜０．０５〕。②ＨＲＶ对严重心律失常事件预测的敏感性为４６．７％，高于ＬＶＥＦ（３３．３％）及ＶＬＰ（２６．７％）；阳性预测值为３０．４％，与ＬＶＥＦ（３１．２％）及ＶＬＰ（３０．８％）相近。③ＨＲＶ分别与ＬＶＥＦ、ＶＬＰ合用，可明显提高阳性预测值（依次为６０％和５０％）。提示ＡＭＩ后心律失常事件的发生及心脏性猝死与ＨＲＶ有密切关系。
To investigate the relationship between the prognosis of acute myocardial infarction (AMI) and heart rate variability (HRV) and the predictive value of HRV combined with left ventricular ejection fraction (LVEF) and ventricular late potentials (VLP) in arrhythmia events, Two-week HRV time-domain and frequency domain analysis and VLP detection, and long-term follow-up. The average follow-up was 16.75 ± 7.74 (range, 4 to 29) months (12 patients lost to follow-up). The results showed that: ①The HRV of AMI patients (15 cases) with severe arrhythmia was significantly lower than that without severe arrhythmia (57 cases) (SD: 3.879 ± 0.355ln (ms) vs 4.077 ± 0). 281ln (ms), St. Georges index: 3.677 ± 0.569 vs 3.929 ± 0.358, LF: 4.399 ± 1.179ln (ms2 / Hz) vs5.041 ± 0.912ln (ms2 / Hz) ]. (2) The sensitivity of HRV to predicting severe arrhythmia was 46.7%, higher than that of LVEF (33.3%) and VLP (26.7%); the positive predictive value was 30.4% ) And VLP (30.8%). ③ HRV combined with LVEF and VLP, respectively, can significantly improve the positive predictive value (followed by 60% and 50%). It is suggested that the incidence of arrhythmic events and sudden cardiac death after AMI are closely related to HRV.