肥厚性心肌病患者检测跨室壁复极离散度的意义

摘要

Objective To explore the changes and clinical significance of transmural dispersion of repolarization (TDR) in patients with hypertrophic cardiomyopathy (HCM). Methods Seventy-two patients with HCM (observation group) and 72 healthy subjects (control group) in Shengjing Hospital of China Medical University were selected from January 2015 to October 2017. The 12-lead conventional electrocardiogram was performed on enrolled personnel in 2 groups to measure T-peak T-end (TpTe), correct the QT interval (QTc), QT interval dispersion (QTd) and TpTe/QTc. The observation group underwent 24 h dynamic electrocardiography. The patients were divided into ventricular arrhythmia subgroup and non- ventricular arrhythmia subgroup according to the results of 24 h dynamic electrocardiography, and the TpTe, QTc, QTd and TpTe/QTc were compared. Results The TpTe, QTc, QTd and TpTe/QTc in observation groups were significantly higher than those in control group:(112.5 ± 11.2) ms vs. (105.6 ± 9.2) ms, (396.5 ± 13.5) ms vs. (385.3 ± 12.5) ms, (36.5 ± 6.4) ms vs. (32.4 ± 5.4) ms and 0.289 ± 0.016 vs. 0.262 ± 0.015, and there were statistical differences (P＜0.05). In observation group, the 24 h dynamic electrocardiogram result showed that 47 patients had ventricular arrhythmia (ventricular arrhythmia subgroup) and 25 patients had not ventricular arrhythmia (non-ventricular arrhythmia subgroup). The TpTe, QTc, QTd and TpTe/QTc in ventricular arrhythmia subgroup were significantly higher than those in non-ventricular arrhythmia subgroup: (114.4 ± 14.5) ms vs. (110.3 ± 12.2) ms, (402.5 ± 15.2) ms vs. (392.0 ± 12.1) ms, (37.5 ± 6.2) ms vs. (35.4 ± 6.5) ms and 0.292 ± 0.016 vs. 0.285 ± 0.015, and there were statistical differences (P＜0.05). Conclusions The values of TpTe, QTc, QTd and TpTe/QTc reflect the increase of transmural dispersion of repolarization in patients with HCM, and have a certain predictive effect on ventricular arrhythmia.%目的 探讨跨室壁复极离散度在肥厚性心肌病(HCM)患者中的变化及临床意义.方法 选择中国医科大学附属盛京医院2015年1月至2017年10月72例HCM患者(观察组)和72例健康体检者(对照组).两组均行12导联常规心电图检查,测量T波峰末间期(TpTe)、校正QT间期(QTc)、QT间期离散度(QTd)和TpTe/QTc.观察组行24 h动态心电图检查,根据结果分为室性心律失常亚组和无室性心律失常亚组,并比较TpTe、QTc、QTd和TpTe/QTc.结果 观察组 TpTe、QTc、QTd 和 TpTe/QTc 均明显高于对照组[(112.5 ± 11.2)ms 比(105.6 ± 9.2)ms、(396.5 ± 13.5)ms 比(385.3 ± 12.5)ms、(36.5 ± 6.4)ms 比(32.4 ± 5.4)ms 和 0.289 ± 0.016 比0.262 ± 0.015],差异有统计学意义(P<0.05).观察组患者24 h动态心电图检查结果显示,有室性心律失常47例(有室性心律失常亚组),无室性心律失常患者25例(无室性心律失常亚组).室性心律失常亚组TpTe、QTc、QTd和TpTe/QTc明显高于无室性心律失常亚组[(114.4 ± 14.5)ms比(110.3 ± 12.2)ms、(402.5 ± 15.2)ms 比(392.0 ± 12.1)ms、(37.5 ± 6.2)ms 比(35.4 ± 6.5)ms和 0.292 ± 0.016 比 0.285 ± 0.015],差异有统计学意义(P< 0.05).结论 TpTe、QTc、QTd 和TpTe/QTc反映了HCM患者跨室壁复极离散度的增大,对室性心律失常有一定的预测作用.