Original Articles Korean Circulation J 2001;3112:1281-1289 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 LF0.030.15 Hz and high frequency HF0.150.4 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 1.9410.101 and 1.5560.114 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 2.2310.135 vs 1.3550.131 and 2.3410.161 vs 1.3460.145 respectively, p0.0005. 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;3112:1281-1289 KEY WORDSMyocardial infarctionelectrocardiography, ambulatory. 1281
서론 1282 대상및방법 대상 Korean Circulation J 2001;3112:1281-1289
자료획득및전처치 기본틀 (template) matching 방법을이용한 QT 간격의측정 Idioventricular QT interval variability index의계산 1283
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. 1284 Korean Circulation J 2001;3112:1281-1289
통계방법 임상특성 결 Table 1. Clinical characteristics 과 NQMI n=12 QMI n=28 Sex Male 8 67% 17 60% NS Age years 63.7 1.8 56.62.2 0.05 LVEF 60.516.7 59.92.0 NS Peak CK-MB 148.143.8 445.8174.9 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
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 1.8540.151 2.0130.119 1.5560.114* 1.9410.101* 6AM6PM 2.1040.208 2.3100.172 1.7600.158 2.3840.169 6PM6AM 1.6320.214 1.7800.164 1.3740.163 1.5950.119 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 2.3410.161 1.3460.145 2.2310.135 1.3550.131 6AM6PM 2.5570.219 1.7990.265 2.6620.218*, 1.8100.247*, 6PM6AM 2.1710.230 1.0020.149, 1.8900.165, 1.0090.123, 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% 0 1 3 1 2 2 2 2 8 3 1 2 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;3112:1281-1289
관동맥촬영소견 고찰 1287
1288 요약 배경및목적 : 방법 : 결과 : Korean Circulation J 2001;3112:1281-1289
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