Relationship between 24 h Holter Electrocardiogram Findings and Ventricular Remodeling in Patients with Acute Myocardial Infarction

YAN Wenqin; CHEN Zuqian; ZHAO Jianjun

doi:10.12102/j.issn.1672-1349.2025.05.018

Abstract：Objective: To investigate the 24-hour ambulatory electrocardiographic findings in patients with acute myocardial infarction (AMI) and their relationship with ventricular remodeling. Methods: A total of 220 AMI patients who underwent percutaneous coronary intervention (PCI) treatment at our hospital from June 2020 to April 2022 were selected as the study subjects. They were divided into a remodeling group (77 cases) and a non-remodeling group (143 cases) based on whether left ventricular remodeling (LVR) occurred within one year after surgery. Clinical data, laboratory indicators, and 24-hour ambulatory electrocardiographic parameters were compared between the two groups. A logistic regression model was used to analyze the risk factors for LVR after PCI in AMI patients. Receiver operating characteristic (ROC) curves were drawn to evaluate the predictive efficacy of 24-hour ECG parameters for LVR. Results: There was a statistically significant difference in the number of coronary artery lesions between the remodeling group and the non-remodeling group (P < 0.05). The 24-hour QT interval variability (24 h QTV), 24-hour standard deviation of normal R-R intervals (SDNN), 24-hour average of standard deviation of normal R-R intervals over 5 minutes (SDNN-index), and 24-hour standard deviation of normal R-R intervals over 5 minutes (SDANN-index) were significantly lower in the remodeling group than in the non-remodeling group (P < 0.05). Multivariate logistic regression analysis showed that the number of coronary artery lesions was positively correlated with LVR after PCI in AMI patients (P < 0.05); whereas the values of 24 h QTV, SDNN, SDNN-index, and SDANN-index were negatively correlated with LVR after PCI in AMI patients (P < 0.05). ROC curve analysis showed that the areas under the curve (AUC) for predicting LVR after PCI in AMI patients using 24 h QTV, SDNN, SDNN-index, and SDANN-index were 0.643 [95% CI (0.518, 0.768)], 0.618 [95% CI (0.492, 0.744)], 0.605 [95% CI (0.477, 0.733)], and 0.607 [95% CI (0.477, 0.736)], respectively. The combination of the four parameters had the highest AUC, sensitivity, and specificity (P < 0.001). Conclusion: When LVR occurs after PCI in AMI patients, the 24-hour QTV, SDNN, SDNN-index, and SDANN-index are significantly reduced. 24-hour ambulatory electrocardiography can serve as an important indicator for predicting LVR after PCI in AMI patients.