JOURNAL OF 108 - CLINICAL MEDICINE AND PHARMACY
Nguy CO* r6i loan nhjp tim 6^ benh nhan benh dong mach vanh man tinh
Risk of arrhythmias in chronic coronary artery disease patients
Ph?m Thai Giang Benh vien Trung ucmg Qudn dgi IOS
l\/luc tiiu: Danh gia cac nguy cd roi loan nhjp tim d benh nhan mac benh ddng mach vanh man tinh.
Ddi tugng va phuang phdp: Nghien cdu tien cdu, m6 ta, c i t ngang gdm 97 benh nhan chup dong mach vanh CO hep > 50% dUdng kinh, dugc lam Holter dien tim 24 gid. Kit qud: Benh nhan tudi > 60 hoac co tang huyet ap nguy co lam tang rdi loan nhjp tim, tuy nhien sU khac biet chua cd y nghla thdng ke. Nhoi mau cd tim cu lam tang nguy cO rdi loan nhip that len 2,5 l l n (p<0,05), rdi loan nhjp that phUc tap len 6,1 lan (p<0,001). Hep da than dong mach vanh lam tang nguy cd rdi loan nhjp tren that len 3,4 lan (p<0,05), rdi loan nhip that len 7,3 lan (p<0,001), rdi loan nhip that phUc tap len 6,6 lan (p<0,001). Benh nhan co EF
< 50% lam tang nguy co rdi loan nhjp tren that len 3 lan, rdi loan nhjp that len 14,6 l i n va rdi loan nhip that phUe tap len 7,5 lan. Kit lugn: 6 benh nhan benh dgng mach vanh man tfnh, nhdi mau cd tim cu, hep da than ddng mach vanh, EF < 50% la cac yeu t d lam tang nguy co rdi loan nhip tren that, roi loan nhjp that va rdi loan nhip that phUc tap.
Tdkhoa: Rdi loan nhip tim, benh d6ng mach vanh.
Summary
Objective: To estimate the risk of arrhythmias in chronic coronary artery disease patients. Subject and method: The cross-sectional descriptive and prospective study, 24-hour ambulatory electrocardiographic monitoring was used to analyse the arrythmias in 97 patients with angiographic coronary artery stenosis of
> 50% in diameter. Result: Age over 60 years old or hypertension increased the risk of arrhythmias but not statistically significant. Previous myocardial infarction increase ventricular arrhythmias up to 2.5 times (p<0.05) and of complex ventricular anhythmias up to 6.1 times (p<0.001). Multivessel coronary artery disease increase the risk of supraventricular arrhythmias, ventricular arrhythmias, complex ventricular arrhythmias were 3.4 (p<0.05); 7.3 (p<0.001) and 6.6 fold (p<0.001) respectively. Heart failure (EF < 50%) increase riskof supraventricular arrhythmias up to 3.0 fold, of ventricular arrhythmias up to 14.6 fold and complex ventricular arrhythmias up to 7.5 times, respectively. Conclusion: The old myocardial infarction, multi-vessel disease and patients with EF < 50% increase the risk of supraventricular arrhythmias, ventricular arrhythmias, complex ventricular arrhythmias in chronic coronary disease patients.
Keywords: Arrhythmias, chronic coronary disease.
Ngdy nhdn bdi: 05/7/2017, ngdy chdp nh^n ddng-12/7/2017
Nguaiphdn hoi: Phgm Thdi Giang, Email: [email protected] - Benh vien TWQD 108
TAP CHl Y Dl/OC LAM SANG 101 T5pl2-S6 8/2017
1 . Oat van de
Benh ddng maeh vanh (DMV) la mdt benh tim maeh thUdng gap va ngay cang gia tang nhanh tren the gidi cung nhU d Viet Nam. Benh DMV la mdt yeu t d nguy cd quan trpng gay rdi loan nhjp tim (RLNT) va dot t d tim mach. Hau q u i cua qua trinh thieu mau cd t i m , rdi loan chuyen hda te bao co t i m , thay ddi cac hoat ddng dien hpc, dan truyen, hinh thanh eae vdng vao lai va cac 6 phat nhjp ngoai lai d^n den RLNT [3], [4].
RLNT d benh nhan benh DMV lam tien luong benh nang hon, anh hUdng tdi chat luong cudc sdng cua benh nhan, tham chi t d vong. Cd nhieu yeu t d anh hUdng tdi su hinh thanh va phat trien cac RLNT. Vi vay viec danh gia cac nguy ca rdi loan nhjp d benh DMV la van de cd y nghTa trdn lam sang. Do dd, chung tdi tien hanh de tai nay vdi muc tieu:
Ddnh gid cdc nguy ca rdi loan nhip tim d binh nhdn mdc benh dgng mgch vdnh mgn tinh.
2. Ddi taong va phUOng phap 2.1.06itdgng
Gdm 97 benh nhan (BN) dugc dieu trj npi tru tai Khoa Ndi Tim mach, Benh vien Trung uong Quan ddi 108 Xd thang 9 nam 2014 den thang 6 nam 2015.
Benh nhan da dugc ehan doan benh nhan da ehup DMV vdi t o n thUOng hep > 50% khi chup DMV.
Tiiu chudn loai trd
Benh nhan dang cd rdi loan nang can phai cap cdu, dieu trj kjp thdi. Benh nhan cd ket qua dien tim Holter tin hieu nhieu nhieu tap, thdi gian deo Holter dudi 22 gid. Benh nhan dang dung thudc anh hUdng den nhjp tim nhU: Digoxin, atropin, amidarone...
Benh nhan khdng ddng y tham gia nghien edu.
2.2. Phddng phap
Thiit ke nghien cdu: Nghien cdu tien cdu, m d ta, c^t ngang.
Ndi dung nghiin cdu
Tat ca cac benh nhan dugc hdi benh, khai thac tien sd va eac yeu t d nguy cd benh DMV theo cac thdng sd cua mau benh i n nghien edu. Xet nghiem mau t h u d n g quy: Cdng thde mau, sinh hda mau.
Dien t i m , sieu am t i m qua thanh ngUc, chup donq mach vanh qua da, ghi Holter ECG 24 gid.
2.3. Cac tiiu chudn siJfdung trong nghiin cdu Chan doan dai thao dUdng typ 2: Theo tieu chuan cua Hiep hdi Dai thao dUdng Hoa Ky (American Diabetes Association - ADA) 2013 [5].
Hut thude la: La ngudi dang cd hut thudc la va da hut It nhat 100 dieu t r d len dugc xem la ngUdi cd hut thudc la.
Chan doan tang huyet ap: Theo Hdi Tim mach hpc Vidt Nam 2010.
Chan doan benh dpng mach vanh man tinh khi cd hep DMV > 50% tren chup DMV can quang.
Chan doan EF% giam theo Hdi Tim mach chau A U E F % < 5 0 % [ 7 ] .
2.4. Cdc roi logn nhjp trin Holter dien tim 24 gid Rdi logn nhip trin thdt
Cdn nhjp nhanh kich phat tren that: QRS thanh manh, deu, tan sd 180 - 220ck/phut.
Ngoai tam thu (NTT) tren that: Sdng P ed hinh dang bat thudng, den sdm va sau do la khoang nghi bu khdng hoan toan. Nhip khdng deu khi cd NTT.
Rung nhT: Tren dien tim dd sdng P dUgc thay bang sdng f tan sd 250 - 600ek/phut khdng deu. QRS eung khdng deu ve thdi khoang va bien dp.
Cudng ddng nhT: Mat sdng P, thay b i n g sdng F tan sd dudi 350ck/phut.
Rdi logn nhip thdt
Ngoai tam thu that (NTTT): QRS gian rdng, hinh dang bien ddi so vdi nhat eo ban, den sdm, tiep theo ia k h o i n g nghi bu. Khdng thay sdng P, sdng T ngUOc chieu vdi phdc bd QRS, nhjp deu, trU khi ed ngoai tam thu.
D i n h gia mUc dp loan nhip ngoai tam thu that tren Holter 24 gid theo phan loai Lown.
Do 0: Khdng cd NTTT.
Dp 1: NTTT ddn dang < 30 NTTT/gid.
Dd 11: NTTT ddn dang > 30 NTTT/gid.
Dd ill: NTTT nhieu dang nhieu 6.
Dd IVa: Cd 2 NTTT di lien nhau (NTTT chum ddi).
Do IVb: > 3 NTTT di lien nhau (con nhanh that ngan).
Do V: NTTT rdi vao sdng T (NTTT dang R/T).
Phan chia mufc dp nang va nhe cua rdi loan nhjp that:
15
JOURNAL OF 108 - CLINICAL MEDICINE AND PHARMACY Vol.12-N''8/20]7
Lown do 0 - II: Rdi loan nhjp that mdc dp nhe.
Lown do III - V: Rdi loan nhip that mdc dp nang (RLN that phdc tap).
Nhjp nhanh that: PhUc bd QRS gian rdng, sdng T t r i i chieu vdi QRS. Nhip deu tan sd khoang 200ck/ph va cd 3 NTTT trd len lien nhau lien tiep, nhung cdn nhan ra phdc bg QRS gpi la nhanh that.
2.5.Xii'/yso/j^u;Sddung phan mem SPSS 16.0.
3. Ket quit
Bdng 1. Mot sd dac diem chung
Dac diem Tuoi > 60 Gidi nam Tang huyet ap Bai tiiao discing Roi loan lipid mau Beo pill Hutthuocia Uong ruou Nhoi mau cdtim cu EF < 50%
Hep 1 than BIMV Hep da thSn DIVIV
n = 97 S6BN
78 81 64 22 67 29 40 45 33 51 67 30
T y l e % 82,35 84,31 65,9 22,7 69,1 29,9 41,2 46,4 34 52,6 69,1 30,9
Nhdn xit: Nhdm tudi gap chO yeu la tren 60 tudi chiem 82,35% va ty le nam chidm tren 84,31%. Cat yeu t d nguy co (YTNC) nhu tang huyet ap, rdi loar lipid mau gap vdi ty le k h i cao la 65,9% va 69,1%.
Being 2. Roi loan nhjp tim d benh nhan benh dpng mach vanh man tinh Cac thong so
So luong NTTTT 24 gid So luong NTTT 24 gid
n = 97 479 ±1029 1030 ±3047 Rdi loan nhjp tren that
T^le NTTtren that (n,%) Con nhip nhanh tren that (n, %)
70(72,2%) 8 (8,2%) R6i loan nhjp that
Tyle NTT that (n,%) Phan do Lown Do 0 (n, %) Bo 1 - 2 (n, %) B p 3 - 5 ( n , % )
72 (74,2%)
25 (25,8%) 39 (40,2%) 33 (34%) Nhdn xit Sd lUdng NTT tren that, NTTT trung binl 24 gid lan luot la 479 ± 1029 va 1030 ± 3047. J^ It NTT tren that, NTTT tCr 72,2% - 74,2%; RLN that phiJi tap chiem 34%.
BSng 3. Nguy ccf rdi loan nhjp tim d nhom co tuoi ^ 60
Cac thong sd
RLN tren that
RLN that
RLN thJt phijrctap
Tudi > 6 0
Cd Khdng Cd Khdng Cd Khdng
Co n 58 20 58 20 28 50
T y l e % 74,4 25,6 74,4 25,6 35,9 64,1
Khdng n 12 7 14 5 5 14
T y l e % 63,2 36,8 73,7 26,3 26,3 73,7
OR
1,69
1,1
1,6 95% Cl
0,6-5,1
0,3-3,2
0,5 - 4,8
>0,05
>0,05
>0,05
Nhdn xet: Nguy co rdi loan nhip tim d benh nhan > 60 tudi cd tang nhUng SU khac biSt chua that ro rang
TAP CHl Y DUOC LAM SANG 108 Tap 12-568/2017
Being 4. Nguy cor rdi loan nhjp tim or benh nhan cd tang huyet ap
^ ~ ~ — — - — _ C o tang huyet ap Cac thdng sd ~"~-——__^^
RLN tren that
RLN that RLN that phufc tap
Cd Khdng Cd Khong Cd Khdng
Cd n 50 14 49 15 23 41
T J I e % 78,1 21,9 76,6 23,4 35,9 64,1
Khdng n 20 13 23 10 10 23
T y l e % 60,6 39,4 69,7 30,3 30,3 69,7
OR
2,3
1,4
1,3 95% Cl
0,9 - 5,8
0,6 - 3,6
0,5-3,1 P
>0,05
>0,05
>0,05
Nhdn xet: Nguy co rdi loan nhjp t i m d benh nhan tang huyet i p cd tang nhung su khac biet ehUa cd y nghla thdng ke (p>0,05).
Cdc thdng sd
RLN tren that
RLN that RLN that phufc tap
Bang 5. Nguy CO rdi loan nhjp tim 6 nhom CO nhdi NMCTcu
Cd Khdng Cd Khdng Cd Khdng
Cd n 27 6 28 5 20 13
T > l c % 81,8 21,2 84,8 15,2 60,6 39,4
Khdng n 43 21 44 20 13 51
T y l d % 67,2 31,3 68,7 31,3 20,3 79,7
mau c a t i m CU
OR
2,2
2,5
6,1 95% Cl
0,9 - 4,5
1,1-7,5
2,4 -15 P
>0,05
<0,05
<0,001
W/idn xef; Nhdi mau c d t i m cu lam tang nguy cd RLN that len 2,5 lan (p<0,05), RLN that phUctap len 6,1 lan(p<0,001).
Cacthdngsd
RLN tren that
RLN that RLN that phijfc tap
Bdng 6. Nguycofrdi loan nhjp tim d b e n h nhan hep 6a mach Hep da OIUV
Cd Khong Cd Khdng Co Khdng
Cd n 26 4 28 2 19 11
TJIc%
86,7 13,3 93,3 6,7 63,3 36,7
Khdng n 44 23 44 23 14 53
T y l e % 65,7 34,3 65,7 34,3 20,9 79,1
OR
3,4
7,3
6,6 vanh
95% Cl
1,1 -10,9
1,6-33
2,5-16,8 P
<0,05
<0,001
<0,001
Nhdn xet: Benh nhan hep da than DMV lam tang nguy cd RLN tren that len 3,4 lan, RLN that len 7,3 lan, dac biet RLN that phdc tap len 6,6 lan so vdi benh nhan hep 1 than dpng mach vanh.
JOURNAL OF 108 - CLINICAL MEDICINE AND PHARMACY
Bdng 7. Nguy ccr rdi loan nhjp tim d b^nh nhan cd EF% gidm
Cac thong sd RLN tren that
RLN that RLN that phtjfctap
Cd EF gidm
Cd Khdng Cd Khdng Cd Khdng
Cd n 42 9 48 3 27 24
T y l e % 80,4 19,6 94,1 5,9 52,9 47,1
Khdng n 28 18 24 22 6 40
TJIe%
60,9 39,1 52,2 47,8 13,0 87,0
OR
3
14,6
7,5
95% Cl
1,2-7,6
3,9-53
2,7 - 20 P
<0,01
<0,001
<0,001 Whdn xet: Bdnh nhan e d E F % g i i m lam tang nguy cd RLN trdn that Idn 3 lan, RLN that len 14,6 lan va RLN that phdc tap len 7,5 lan so vdi benh nhSn cd EF% binh thudng.
4.1. Ddc di4m ve tuoi, gidi va cdcyeu to nguy ca Trong nghien cdu nay phan Idn BN Idn tudi, benh nhan > 60 tuoi chiem 82,35%, tuong tU nhU ket qua nghien cUu eua Tran Thai Ha, cic benh nhan cd dp tudi trung binh la 64,2 tudi [2]; nghien cdu cua Bui Thuy DUdng nhan thay tuoi trung binh d benh nhan thieu mau cd tim cue bd la 63,3 trong dd BN >
60 tudi ehidm 76,4% [1 ]. Nhin chung cic nghien cUu deu nhan thay, nam gidi chiem ty le kha cao trong benh DMV. Ket qua nghien cdu nam gidi chiem ty- le 84,31%, nU chiem t^ le 15,69% cung phu hpp vdi nghien cufu cua Tran Thai Ha nam chiem 82,8% va n d chiem 17,2% [2]; cua Bui Thuy DUdng nam gidl chiem 83,6% [1].
d bdnh nhan benh DMV man tfnh yeu t d nguy CO hay gap nhUt la tang huyet ap chiem 65,9%, rdi loan lipid mau 69,1%, nhdi m i u ed tim eu chiem 34%, hep da than DMV 30,9%. Ket qua nay cung phu hpp vdi nghien cdu cCia Bui Thuy DUdng, tang huyet ap chiem 49,1 va hep 1 than DMV chiem 52,7% [1 ].
4.2. Roi loan nhip tim d benh dgng mgch mgn tinh
Benh nhan mac benh DMV lam te bao cd tim bj thieu m i u , kem theo qua trinh t i i cau true cd that da t i c ddng tdi cac thu the hoa hoc, thy the i p luc cua tim va he tuan hoan da gay ra sU thay ddi than kinh giao cam, phd giao cam trong chdc nang dieu hoa tim maeh. Vi vay, cic rdi loan nhjp tim thUdng gap d
c i c BN benh DMV. Rdi loan nhjp that d cac BN NMCT la mdt trong nhCfng nguydn nhan thudng gap nhat gay dot t d do t i m . Sd lupng NTT tren that trung binh 24 gid la 479 ± 1029 va NTTT trung binh 1030 ± 3047.
Ty- le RLN tren that, RLN that t d 72,2% - 74,2%; RLN that phUc tap chiem 34%. Ket q u i nay cCing phu hop vdi nghien cufu cda Bui Thuy Duong tren benh nhan hep DMV man tfnh, tac gici n h i n thay nhan thay NTT tren that trung binh 24 gid 439 ± 524, t / Id RLN tren that 78,2%; NTT that trung binh 24 gid 675 + 1725, ty le RLN that 65,5%, trong dd RLN that phdc tap 20,1% [1].
4.3. Nguy cd roi logn nhjp tim cf benh nhan >
60 tuoi hoac BN tdng huyit dp
Ket qua nghien edu cho thay, benh nhan tuoi >
60 hoac benh nhan tang huyet ap nguy ed RLN tim nhieu hdn va phdc tap hon, tuy nhien sU khac biet chua cd y nghTa thdng ke, cd the do sd lUpng benh nhan nghien cUu chUa du Idn.
4.4. Nguy ca roi logn nhip tim d benh nhdn c6 nhoi mdu catim cu
NhOng nghien cdu ve RLN that dUpc dUa tren c i c nghien cdu d benh nhan ed benh ddng mach vanh hoae thUe nghiem tren ddng vat bj nhdi mau ed t i m . Cae qua trinh benh ly gay ra bdi thieu mciu cue bd hay nhdi mau dan den te bao cd tim bj chet hinh thanh cac vung seo nhdi mau. Roi loan nhip c6 vdng vao lai thudng xay ra trong khu vUc cCia nhoi mau CO tim ma nam lien kd vdi ndi cd tim cd nhieu
TAP CHI Y DUOC LAM SANG 108 Tap 12-So 8/2017
vet seo. Sdi eo tim cdn sdng sdt trong t i m , ed the la do tudi m i u tu" budng that hoac tUdi m i u ngupc thdng qua tuan hoan bang hd. Cae te bao ed t i m cdn sdt lai t r d nen pho bien trong cac khu vUc cua vung xd hda hay vet seo tao thanh chat nen cho nhufng dan truyen bat t h u d n g khdng ddng dang, khdng dang hUdng, thudng ed nghen dan truyen va lam ngan chan sU lan truyen dan den hinh thanh vdng vao lai. Do dien tam do thudng ghi nhan d c i c vung ven nhdi mau ghi nhan dan truyen bat thudng, khdng dang hudng va khdng ddng deu. Dien the mudn duoc p h i t hien bang tin hieu dien tam dd trung binh da cd lien quan den vung dan truyen cham trong te bao eO tim. Ket qua nghien cUu cho thay benh ddng maeh vanh, neu da cd nhdi mau cd tim cu nguy cd RLN tren that cd tang nhUng chUa that sy ro ret, nguy cd RLN that tang 2,5 lan (OR = 2,5; 95%CI 1,1 - 7,5; p<0,05) va RLN that phdc tap tang 6,1 lan so vdi nhdm benh nhan chUa cd nhdi m i u Cd tim cu (OR = 6,1; 95%CI 2,4 - 15; p<0,001).
Tran Thai Ha cung nhan thay nhdi mau co tim cu lam RLN tim nhieu hon va tram trpng hdn [2].
4.5. Nguy caroi logn nhip tim it benh nhdn hep da thdn dgng mgch vanh
Benh nhan hep da than DMV lam tang nguy cd RLN tren that len 3,4 lan; RLN that len 7,3 lan va RLN that phdc tap len 6,6 lan so vdi benh nhan hep 1 than DMV (p<0,01-0,001). Mdt so tac gia cCing nhan thay sU xuat hien cCia rdi loan nhip that nguy hiem tang hon d nhQng BN cd tdn thUdng da than mach vanh. Nghien cdu cua Bui Thuy Duong nhan thay, ty le benh nhan cd NTT that hep da than cd sd lupng va ty le RLN tren that nhieu hdn mot each cd y nghTa so vdi nhdm hep 1 than DMV. D i e biet la RLN that d benh nhan hep 3 than, 2 than va 1 than lan lUpt la 100%, 94,4% va 37,9%; sU khae biet cd y nghla thdng ke (p<0,0001}. Trong do, NTT that day va phUe tap (Lown 11, III, IV, V) 6 nhdm hep da than DMV ehiem 65,4%; d nhdm hep mdt than DMV ch? chiem 17,2%
p<0,001 [1].
4.6. Nguy ca roi logn nhjp tim d binh nhdn co EF<50%
Giam phan sd t d n g mau, mat can bang dien g i i i , gia tang hoat ddng than kinh giao cam, giam
hoat ddng than kinh phd giao cam va tinh trang roi loan he than kinh the djch nhU tang ndng dp eatecholamin huyet thanh, tang hoat ddng cda he Renin-Angiotensin-Aldosterone va cac hormon chdng bai nieu... thudng thay d eac BN suy t i m . Chinh nhdng thay ddi nay da lam eho hoat ddng co bdp cua tim vdn da bj suy g i i m lai cang giam va roi loan nhieu hon, day chfnh la nhQng nguy cO lam gia tang cic nguy cd RLN tim va dot td. Khi phan tich nguy CO RLNT d benh nhan suy tim, ket qua eho thay benh nhan cd EF < 50% lam tang nguy ca RLN tren that len 3 lan, RLN that len 14,6 lan va RLN that phUe tap len 7,5 lan so vdi benh nhan cd EF% > 50%. NhUvay BN suy tim tam thu do benh DMV la mot trong nhQng yeu t d dan tdi sU xuat hien eae RLNT nhat la RLN that chiem ty le cao va phQc tap hon. Tran Thai Ha cho thay r i n g rdi loan nhip NTTT d nhQng BN sau nhdi mau cd tim ed suy tim vdi EF < 40% cd ty le NTTT phUc tap cao hon mdt c i c h cd y nghTa so vdi nhdm BN cd EF > 40% [2], Nghien cQu cua Alfred EB nhan thay, benh nhan bj benh DMV cd EF < 30% theo doi sau 5 nam cd ty le nhanh that dan den tQ vong cao hon 1 each ro ret so vdi nhom cd EF > 30% (HR 1,62;
p=0,0001)[6].
5. Ket luan
Qua nghien eUu dac diem rdi loan nhip tim bting Holter dien tim 24 gid tren 97 benh nhan benh ddng mach vanh, chung tdi rut ra ket luan: d BN benh ddng mach vanh man tfnh, nhdi m i u c o t i m cu lam tang nguy cd RLN that 2,5 lan va RLN that phQe tap tang 6,1 lan. Hep da than DMV lam t i n g nguy cd RLN tren that len 3,4 lan; RLN that len 7,3 lan va RLN that phUc tap len 6,6 lan. EF < 50% lam tang nguy cO RLN tren that len 3 lan, RLN that len 14,6 lan va RLN that phQc tap len 7,5 lan. NhU vay, vdi BN hep OMV can lam Holter dien tim 24 gid de cd the phat hien va dieu tri cac RLN phQc tap gdp phan dU phdng cac bien cd nguy hiem cho BN.
Tai lieu tham khdo
1. Bui Thuy DQdng (2011) Nghiin cdu bien ddi dogn ST vd rdi logn nhip tim trin Holter diin tim 24 gid d binh nhdn binh tim thieu mdu cue bg man tinh.
Luan van Thac sy y hpc, Hpc vien Quan y.
19
JOURNAL OF 108 - CLINICAL MEDICINE AND PHARMACY Vo!.12-N°8/2017
Tran Thai Ha (2012) Nghiin cdu bien thien nhip tim bdng Holter diin tim 24 gid d binh nhdn sau nhdi mdu ca tim cdp vd sau theo doi mot ndm. Luan an tien sT, Vien NCKH Y DUdc Lam sang 108.
Td Van Hai (2004) Cdc rdi logn nhip tim d ngudl benh nhoi mdu ca tim cdp diiu tri tgi Binh viin Thanh Nhdn trong 3 ndm (2000 - 2002). Y hpc thUe hanh, sd 2,472, tr. 78-82.
Nguyen Lan Viet (2007) ThUc hdnh binh tim mgch.
Nha Xuat bSn Yhoc.
American Diabetes /tesociation (2013) Standards of medical care In Diabetes 2013. Diabetes care 36:11-25.
Alfred EB, Kerry LL, Gail EH et al (2002) Relational ejection fraction and inducible ventricular tachycardia to mode of death in patients with coronary artery disease. Circulation 106:2466-2472.
European Society of Cardiology (2012) ESCguideline for the diagnosis and treatment of acute and chronk heart failure 2012: The task force the diagnosis and treatment of acute and chronic heart failure 2012 of the European Society of Cardiology. Developed in collabaration with the heart failure associaton (HFAI ofthe ESC (2012) 33(14): 1787-1847.
