扩张型心肌病和缺血性心肌病的区域性QT间期差比较及临床意义探讨

摘要

目的探讨区域性QT间期差值(QTrd)能否作为鉴别扩张型心肌病和缺血性心肌病引起的ST-T改变的一项指标.方法将64例因体表心电图出现ST段异常改变,经冠状动脉造影确诊为缺血性心肌病或扩张型心肌病的患者分为缺血性心肌病组和扩张型心肌病组,把体表心电十二导联的心电图分为Ⅰ、AVL,Ⅱ、Ⅲ、AVF,V2～4,V5～6四个区域测量QTrd并进行分析比较.结果在Ⅰ、AVL区域,各组都有部份QTrd≥40 ms;Ⅱ、Ⅲ、AVF,V2～4,V5～6三个区域,有一个区域的QTrd≥40 ms的百分比,在扩张型心肌病组为81%,缺血性心肌病组无一例大于40 ms.结论扩张型心肌病时,如心电图出现ST异常改变,在Ⅱ、Ⅲ、AVF,V2～4,V5～6这三个区域中,有一区域的QTrd>40 ms,则心肌扩张引起缺血的可能性大,如这三个区域中的QTrd都小于40 ms,可能为冠状动脉病变引起心肌缺血的表现.%Objective:To analyze whether regional QTrd could be an index to identify ST segment changes caused by dilated cardiomyopathy or ischemic cardiomyopathy. Methods:According to the changes of ST segement in ECG and coronary arteriography, 64 cases were divided into two groups: ischemic group (IM) and dilated cardiomyopathy group. QTrd was measured and compared in four regions (leadⅠand AVL, lead Ⅱ、Ⅲand AVF, Lead V2～4 and V5～6) in ECG of each group.Results:QTrd≥40 ms was seen in both groups in the regions of lead Ⅰ and AVL. The rate of QTrd≥40 ms in one of the other three regions was 81% and 0% in group DM and IM, respectively.Conclusions:In dilated cardiomyopathy,ischemia from myocardial dilation was highly possible if there was QTrd≥40 ms in any of the three regions (ⅡⅢ and AVF, V2～4 and V5～6); if the QTrd≤40 ms in all the three regions,myocardial ischemia may be caused by coronary diseases.