長時間心電図に基づく心臓突然死リスク評価：複数指標の併用による分類精度の向上

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This study proposes a method of cardiac risk assessment based on the long term Holter ECG recordings. The risk assessment is important to prevent the sudden cardiac death incidents which are one of the major cause of death worldwide, e.g. 70,000 in Japan and 400,000 in the U.S. annually. Conventional risk assessment indices are obtained by short term ECG record recorded at the clinical laboratory in the hospital. Such practice tend to miss important symptoms because of the short observation period. For that reason, characterization of the long term ECG record draw a considerable attention. This research adopted several such indices based on the long term ECG record for the cardiac risk assessment. Namely, Indices based on QT and RR intervals, such as cRRI-QT, RRI-Amplitude, QT-Amplitude, QTc-Amplitude, SDNN and those based on T wave morphology as AR or ARP are introduced and examined. Logistic regression analysis is applied to those indices obtained from 11 cardiac high risk (SCD-H), 14 low-risk (SCD-L) patients and 25 control subjects (Control). It has been shown that the combination of RRI-amplitude, ARP and cRRI-QT yielded the best classification accuracy. Sensitivity and specificity were larger than 0.8 except for SCD-L sensitivity being 0.7. The number of cases should be increased to validate the result. Key Words : SCD risk assessment, Holter ECG, T-wave alternans, Heart rate variability, QT-RR interval co-variability, Logistic regression analysis.

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