서론 1282 대상및방법 대상 Korean Circulation J 2001;3112:

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1 Original Articles Korean Circulation J 2001;3112: Q- 및비 Q- 파심근경색증에서표준화 QT 간격변이 김순길 1 염명걸 2 이철범 3 이재웅 1 이상 1 김경수 1 김정현 1 임헌길 1 이방헌 1 이정균 1 Normalized Idioventricular QT Interval Variability in Patients with Q- and Non-Q Wave Myocardial Infarction Sun Gil Kim, MD 1, Myung Kul Yum, MD 2, Chul Burm Lee, MD 3, Jae Ung Lee, MD 1 Sang Lee, MD 1, Kyung Soo Kim, MD 1, Jeong Hyun Kim, MD 1, Heon KiL Lim, MD 1, Bang Hun Lee, MD 1 and Chung Kyun Lee, MD 1 1 Department of Internal Medicine, 2 Pediatrics, 3 Thoracic Surgery, College of Medicine, Hanyang University, Seoul, Korea ABSTRACT Background and ObjectivesThe aim of the study was to evaluate the difference of temporal lability in myocardial repolarization between acute non-q NQMI and Q-wave myocardial infarction QMI, and to discern whether the locations of myocardial infarction influence such temporal lability. Subjects and MethodsTwelve patients with NQMI and 28 with QMI, including 16 anterior AMI and 12 inferior MI IMI patients were enrolled. Twenty four-hour ambulatory ECG recordings of each patient were analyzed, and the digitized data was partitioned into 30-min sections. The QT intervals were measured using a template matching strategy. We then calculated the low LF Hz and high frequency HF Hz power of the QT interval variability using an algorithm capable of removing the influence of the RR-interval on QT interval variability Normalized Idioventricular QT variability IndexIV-QT. ResultsFor patients with QMI, the low frequency IV QT LF IV-QT was higher than that of NQMI and respectively, p0.05. No difference was seen in the high frequency IV QT HF IV-QT of the two groups. For QMI patients, both the LF IV-QT and HF IV-QT were higher in day time 6AM-6PM than in night time 6PM-6AM. Comparing the differences of these indices by the location of QMI, both the LF IV-QT and HF IV-QT of AMI were higher than those of IMI patients vs and vs respectively, p Both indices of each group also demonstrated a circadian change. ConclusionIn cases of QMI, the temporal lability in myocardial repolarization is larger than that seen in NQMI. Moreover, it was worse in AMI than IMI. Finally, such temporal repolarization lability tends to have a circadian pattern in QMI. Korean Circulation J 2001;3112: KEY WORDSMyocardial infarctionelectrocardiography, ambulatory. 1281

2 서론 1282 대상및방법 대상 Korean Circulation J 2001;3112:

3 자료획득및전처치 기본틀 (template) matching 방법을이용한 QT 간격의측정 Idioventricular QT interval variability index의계산 1283

4 Fig. 1. The procedure to calculate normalized idioventricular QT interval variability of a patient with non-q myocardial infarction. Anormalized RRI time series, Bnormalized QTI time series, Cnormalized RRI power spectral density function, SRRI f. Dnormalized QT power spectral density function, SQTI f. There were peaks at low-frequency range solid arrow and high frequency range dotted arrow in the spectral density functions of both RRIs and QTIs. Esquared cross coherence function between the normalized QTI and RRI, K2QT,RR f. Fnormalized idioventricular QTI power spectral function, SIVQT f. Note SIVQT f=sqt f1-k2qt,rrf. At the range near the lowfrequency peak, the coherence is large, and consequently, the fluctuation of QTIs at the frequency range is largely dependent on the fluctuation of RRIs. Therefore, the amplitude of low-frequency peak in idioventricular power density decreased significantly F, solid arrow. In contrast, at the range of the high-frequency peak, the coherence is low, and the fluctuation of QTIs are less influenced by the fluctuation of the power of RRIs F, dotted arrow. RRIRR interval, QTIQT interval. See text Korean Circulation J 2001;3112:

5 통계방법 임상특성 결 Table 1. Clinical characteristics 과 NQMI n=12 QMI n=28 Sex Male 8 67% 17 60% NS Age years LVEF NS Peak CK-MB NS Smoking 23 83% 8 67% NS Thrombolytic Tx 5 42% 15 54% NS Medications Beta blockers 9 75% 19 64% NS ACE inhibitors 3 25% 12 43% NS Aspirin 11 92% 27 96% NS Nitrates 11 95% 21 75% NS PTCA 1 8% 10 36% 0.01 Diabetes mellitus 5 42% 6 21% NS QMIQ-wave myocardial infarction, NQMInon-Q-wave myocardial infarction, LVEFleft ventricular ejection fraction, PTCApercutaneous transluminal coronary angioplasty, NSnot significant, CK-MBcreatine kinase-mb, ACEangio-tensin converting enzyme, Txtherapy p 1285

6 Table 2. Normalized idioventricular high- HF IV-QT and low-frequency variability indices LF IV-QT of NQMI and QMI patients HF IV-QT LF IV-QT NQMI n=12 QMI n=28 NQMI n=12 QMI n=28 24 hr mean * * 6AM6PM PM6AM NQMInon-Q-wave myocardial infarction, QMIQ-wave myocardial infarction, HF IV-QThigh frequency normalized idioventricular QT variability index, LF IV-QTlow frequency normalized idioventricular QT variability index, p0.05, p0.005, [p0.05 Table 3. Normalized idioventricular high- HF IV-QT and low-frequency variability indices LF IV-QT of AMI and IMI patients HF IV-QT LF IV-QT AMI n=16 IMI n=12 AMI n=16 IMI n=12 24 hr mean AM6PM *, *, 6PM6AM , , , AMIanterior myocardial infarction, IMIinferior myocardial infarction, HF IV-QThigh frequency normalized idioventricular QT variability index, LF IV-QTlow frequency normalized idioventricular QT variability index, p0.05, p0.0005, p0.05 QT 간격의파워스펙트랄분석 Table 4. Coronary angographic findings of NQMI and QMI patients NQMI n=12 QMI n=28 CAG performed 6 16 Culprit artery LAD 4 6 RCA 1 6 LCx 1 3 LMCA 0 1 No. of vessel with obstruction 50% LMCA 0 1 NQMInon-Q-wave myocardial infarction, QMIQ-wave myocardial infarction, LADleft anterior descending coronary artery, RCAright coronary artery, LCxleft circumflex, LMCAleft main coronary artery 1286 Korean Circulation J 2001;3112:

7 관동맥촬영소견 고찰 1287

8 1288 요약 배경및목적 : 방법 : 결과 : Korean Circulation J 2001;3112:

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10 ion potential duration. Cardiovas Res ) Marron K, Whaton J, Sheppard MN, Fagan D, Royston D, Kuhn DM, de Leval MR, Whitehead BF, Anderson RH, Polak JM. Distribution, morphology, and neurochemistry of endocardial and epicardial nerve terminal arborations in the human heart. Circulation ) Theres H, Romberg D, Leuthold T, Borges AC, Stangle K, Bauman G. Autonomic effects of dipyridamole stress testing on frequency distribution of RR and QT interval variability. Pacing Clin Electrophysiol ) Sarma JS, Singh N, Schoenbaum MP, Venkataraman K, Singh BN. Circadian and power spectral changes of RR and QT intervals during treatment of patients with angina pectoris with nadolol providing evidence for differential autonomic modulation of heart rate and ventricular repolarization. Am J Cardiol ) Browne KF, Prystowsky E, Heger JJ, Chilson DA, Zipes DP. Prolongation of the QT interval in man during sleep. Am J Cardiol Korean Circulation J 2001;3112:

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012임수진 Received : 2012. 11. 27 Reviewed : 2012. 12. 10 Accepted : 2012. 12. 12 A Clinical Study on Effect of Electro-acupuncture Treatment for Low Back Pain and Radicular Pain in Patients Diagnosed with Lumbar