MỐI LIÊN QUAN GIỮA KHOẢNG TPEAK-TEND VÀ TỈ LỆ TPEAK TEND/QT VÀ MỘT SỐ CÁC RỐI LOẠN NHỊP THẤT Ở BỆNH NHÂN NHỒI MÁU CƠ TIM CẤP CÓ ST CHÊNH LÊN ĐƯỢC CAN THIỆP ĐỘNG MẠCH VÀNH THÌ ĐẦU

Abstract

Objective: To evaluate the relationship between Tpeak-Tend interval and Tpeak-Tend/QT ratio with ventricular arrhythmias in patients with acute ST-elevation myocardial infarction before and after primary percutaneous coronary intervention. Methods: A prospective, cross-sectional study with longitudinal follow-up of 93 patients at the Vietnam National Heart Institute - Bach Mai Hospital from August 2021 to September 2022. Results: The mean age of patients was 64.7 ± 11.9 years, with males accounting for 73.4%. Anterior MI with left anterior descending artery (LAD) as the culprit vessel occurred in 56.4% of patients, while inferior MI with right coronary artery (RCA) as the culprit vessel occurred in 40.4%. Ventricular arrhythmias occurred in 29 patients (30.9%). Of these, 11 patients (11.7%) had premature ventricular contractions, 15 patients (16.0%) had ventricular tachycardia, and 3 patients (3.2%) had ventricular fibrillation. The heart rate at admission was higher in the ventricular arrhythmia group (87.4 ± 18.1 bpm) compared to the non-arrhythmia group (79.7 ± 15.1 bpm) (p = 0.034). Left ventricular ejection fraction (EF) was lower in the arrhythmia group (42.4 ± 10.3%) compared to the non-arrhythmia group (49.4 ± 8.6%) (p = 0.001). Killip class was higher in the arrhythmia group (2.1 ± 1.4) versus the non-arrhythmia group (1.2 ± 0.7) (p = 0.003). TIMI score was higher in the arrhythmia group (5.4 ± 2.5) compared to the non-arrhythmia group (3.9 ± 1.8) (p = 0.002). Serum sodium at admission was higher in the arrhythmia group (140.00 ± 2.22 mmol/l) versus the non-arrhythmia group (138.32 ± 2.84 mmol/l) (p = 0.006). Multivariate logistic regression analysis showed that post-intervention Tp-e interval was associated with ventricular arrhythmic events: post-intervention Tp-e (OR = 0.129, p = 0.007), post-intervention cTp-e (OR = 5.784, p = 0.007), post-intervention Tp-e/QTc (OR very large, p = 0.004), post-intervention Tp-e/QT (OR = 0.000, p = 0.007). Conclusion: The post-intervention Tp-e/QT ratio was the most valuable predictor of ventricular arrhythmias in the study group, independent of other indices. A post-intervention Tp-e/QT ratio >0.2236 predicted ventricular arrhythmias with 69.0% sensitivity, 87.7% specificity, 71.4% positive predictive value, 86.4% negative predictive value, and 84.2% diagnostic accuracy (p <0.001).