Predictive Value Of Multiple Noninvasive Early Warning Indexes For MACE Events In Patients With Coronary Heart Disease

Objective: To investigate the degree of autonomic nerve dysfunction,abnormal repolarization and changes of cardiac structure and function in patients with different types of coronary heart disease(CHD)by using multiple non-invasive warning indicators,and to analyze its predictive value for major adverse cardiovascular events(MACE).Methods: Patients with ischemic cardiomyopathy(ICM),acute myocardial infarction(AMI)or angina pectoris(AP)hospitalized in a third-grade A general hospital from July2019 to may 2020 were selected as CHD group,and healthy subjects who underwent physical examination during the same period were randomly selected as the control group.All participants completed 24-hour dynamic electrocardiogram to record the standard deviation of the NN intervals(SDNN)and standard deviation of mean NN intervals in 5-minute recordings(SDANN)of Heart rate variability(HRV),turbulence onset(TO),turbulence slope(TS)of heart rate turbulence(HRT),heart rate deceleration capacity of rate(DC),QT interval dispersion(QTd);The left ventricular ejection fraction(LVEF)and left ventricular end diastolic diameter(LVEDd)were recorded by echocardiography.At the same time,the age,gender and other general information of the participants and MACE events of CHD patients during hospitalization and within 1year after discharge were recorded.CHD patients were divided into MACE group and non-MACE group according to the occurrence of MACE events.The differences of several indexes between CHD group and control group,ICM,AMI and AP subgroups were analyzed and compared,and the predictive ability of multiple indicators for MACE events was discussed.Results:(1)A total of 163 patients with CHD and 62 healthy people were included in the study as CHD and control group.The non-invasive indexes of the two groups were analyzed and the results were as follows:The DC、SDNN、SDANN and LVEF of CHD group smaller than that of control group,while LVEDd larger than that of control group,there was a statistical difference(P<0.05).(2)In CHD group,there were 43 patients with ICM,61 patients with AMI and 59 patients with AP.The noninvasive indexes among the three subgroups were analyzed and obtained: The values of DC,SDNN,SDANN and LVEF in AP group were higher than those in ICM group,while the positive rate of HRT,QTd and LVEDd were lower;The values of SDNN,SDANN and LVEF in AP group were higher than those in AMI group,while the positive rate of HRT and QTd were lower;The LVEF value of AMI group was higher than that of ICM group,and the values of QTd and LVEDd were lower.The difference was statistically significant(P <0.05).(3)Among 163 CHD patients,there were 13 patients with loss of follow-up and non cardiac death,28 cases with MACE events and 122 cases without MACE events.CHD patients were divided into MACE group and non-MACE group.The noninvasive indexes between the two groups were compared,and the following results were obtained:SDNN,SDANN and LVEF in MACE group were lower than those in and non-MACE group,while QTd and LVEDd were higher than those in non-MACE group(P < 0.05).Multivariate logistic regression analysis showed that SDNN(or: 2.13;95%CI: 1.07-4.25)and LVEF(or: 12.34;95% CI: 2.47-61.61)were independent risk factors for MACE events in patients with CHD during follow-up(P < 0.05).(4)The area under the ROC curve predicted by SDNN and LVEF was greater than 0.6(P < 0.05),and the specificity was 42.86% and 55.56% respectively,while the area under the ROC curve predicted by LVEF and SDNN was greater than 0.7(P < 0.05),and the specificity was77.78%.Conclusion:(1)Compared with the control group,the autonomic nerve function in CHD group was impaired,and the patients in ICM and AMI group were significantly higher than those in AP group;SDNN is more sensitive to reflect the changes of autonomic nerve function than SDANN,DC and HRT.(2)QTd was significantly prolonged in ICM group,which was related to abnormal ventricular repolarization.(3)The left heart structure and function of patients in ICM were significantly changed,and the left heart function of patients in AMI group was decresed compared with that in AP,while there was no significant in left heart structure between the two groups.(4)SDNN and LVEF are independent predictors of MACE events,and the joint prediction value is higher.