南方医科大学学报

南方医科大学学报 ›› 2023, Vol. 43 ›› Issue (3): 400-404.doi: 10.12122/j.issn.1673-4254.2023.03.09

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心肌梗死后室壁瘤患者的静息心率与主要不良心脑血管事件相关：基于227例回顾性队列研究

卢丽萍，钟嘉鑫，吴锡林，陈 琴，林慧中，陈良龙，罗育坤   

  1. 福建医科大学附属协和医院心内科，福建 福州 350001；福建省心血管病医学中心，福建 福州 350001；福建省冠心病研究所，福建 福州 350001；福建医科大学附属协和医院神经内科，福建 福州 350001
  • 出版日期:2023-03-20 发布日期:2023-03-20

Resting heart rate correlates with major adverse cardiovascular and cerebrovascular events in patients with post-myocardial infarction ventricular aneurysms: a retrospective cohort study

LU Liping, ZHONG Jiaxin, WU Xilin, CHEN Qin, LIN Huizhong, CHEN Lianglong, LUO Yukun   

  1. Department of Cardiology, Fujian Medical University Union Hospital, Fuzhou 350001, China; Fujian Heart Medical Center, Fuzhou 350001, China; Fujian Institute of Coronary Artery Disease, Fuzhou 350001, China; Department of Neurology, Fujian Medical University Union Hospital, Fuzhou 350001, China
  • Online:2023-03-20 Published:2023-03-20

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摘要： 目的 分析静息心率（RHR）高低与心肌梗死后室壁瘤患者不良预后的关系。方法 回顾性收集2017~2019年入住我院的心梗后室壁瘤患者资料，最终共227例纳入研究，随访24月，随访期间任何主要不良心脑血管事件（MACCEs）的发生都是终点事件。根据基线RHR测量值高低分为RHR<10%、10%~90%和>90%三组，使用Cox比例风险模型、限制性立方样条（RCS）模型来研究RHR对MACCEs的影响，结果以风险比（HR）的95%置信区间（CI）表示。结果 在24月的随访中，90例（39.6%）患者发生MACCEs。RCS曲线显示RHR与MACCEs发生之间存在非线性“U”型相关性。与RHR在10%~90%组的个体相比，RHR>90%组的MACCEs风险增加了3.01倍（HR=4.01，95% CI：2.07-7.76，P<0.001）。患者在RHR<10%组，10%~90%组和91%~100%组的MACCEs发生率分别为39.1%、36.6%、66.7%（P=0.027），其中，室性心动过速/心室颤动（VT/VF）的发生率分别为17.4%、2.7%、4.8%（P=0.005），心衰再入院的发生率为8.7%、26.8%、42.9%（P=0.036）。结论 持续监测和管理心率范围可为心梗后室壁瘤患者的预后提供指导。

关键词: 心肌梗死后室壁瘤；静息心率；主要不良心脑血管事件

Abstract: Objective To analyze the association of resting heart rate (RHR) with the prognosis of patients with post-infarction ventricular aneurysms. Methods We retrospectively analyzed the clinical data of 227 patients with post-infarction ventricular aneurysms admitted to our hospital during 2017-2019. The endpoint event was the occurrence of any major adverse cardiovascular and cerebrovascular events (MACCEs) during the follow-up for 24 months. According to RHR measurements, the patients were divided into 3 groups with baseline RHR <10%, 10%-90%, and >90%. The Cox proportional risk model and restricted cubic spline (RCS) model were used to analyze the effect of RHR on MACCEs. Results During the 24-month follow-up, 90 patients (39.6% ) experienced MACCEs. The fully adjusted RCS curves showed a nonlinear "U" shaped correlation between RHR and the occurrence of MACCEs. In the fully adjusted model, the risk of MACCEs increased by 3.01-fold (Hazard ratio [HR]=4.01, 95% CI: 2.07-7.76, P<0.001) in patients with RHR>90%, as compared with patients with RHR of 10%-90%. In patients with RHR in 1-9th percentile, 10th-90th percentile and 91st-100th percentile, the incidences of MACCEs were 39.1%, 36.6% and 66.7% (P=0.027), the incidences of ventricular tachycardia/ventricular fibrillation (VT/VF) were 17.4%, 2.7% and 4.8% (P=0.005), and the incidences of readmission for heart failure were 8.7%, 26.8% and 42.9% (P=0.036), respectively. Conclusion Continuous monitoring and management of heart rate range may provide guidance for prognosis prediction in patients with post-infarction ventricular aneurysms.

Key words: post-myocardial infarction ventricular aneurysms; resting heart rate; major adverse cardiovascular and cerebrovascular events