扩张型心肌病心电图随病程进展的变化

The serial electrocardiogram changes in idiopathic dilated cardiomyopathy (IDC)

目的:探讨扩张型心肌病心电图随病程进展的变化.方法:采用回顾分析的方法,选取具有2年以上病史资料并未采取规范治疗的扩张型心肌病病人,统计其临床表现、治疗方法、实验室检查、心电图及超声心动图资料的变化,共两次,间隔2年以上.结果:共分析35例病例,其中缺血性14例,原发性21例.男性20例,女性15例,平均年龄(62.7±9.4)岁.从出现充血性心力衰竭临床症状至第一次检查的平均时间是(5.6±14.9)年,从第一次检查至第二次检查平均间隔时间是(3.5±2.1)年.两次检查心功能(NYHA分级)分别为(2.7±0.9)和(2.5±0.7)(P＞0.05),左室射血分数由(0.45±0.21)降低至(0.37±0.34)(P=0.24),左房内径(cm)由(4.12±0.78)增加至(4.79±0.87)(P=0.0012),左室舒张末内径(cm)由(6.77±1.29)增加至(7.65±1.5)(P=0.0105),左室收缩末内径(cm)由(5.05±1.45)增加至(5.97±1.33)(P=0.0073).心电图PR间期(ms)由(166±52)增加至(198±51)(P=0.0115),分别有7/35例(20.0%)和9/35例(25.7%)超过200 ms,QRS间期(ms)由(110±44)增加至(159±49)(P＜0.0001).35例病人中23例出现双峰P波,两次检查P波宽度(ms)分别为(128±46)和(141±59)(P=0.27),随访前后心电图V1～V6导联QRS高度(mm)分别(162±93)和(152±79)(P=0.65),均明显高于正常范围,QT间期及心律失常发生比例没有明显变化.结论:随着扩张型心肌病心脏的扩大,可出现严重的传导障碍,不同程度地累及心房、房室传导系统和左心室.心电图表现为PR间期延长、QRS间期加宽,可出现双峰P波及P波增宽.这些变化可造成左心电和机械的不同步而影响心脏收缩功能.

Objective: To study the serial electrocardiogram changes in idiopathic dilated cardiomyopathy (IDC). Methods: Retrospective study of the clinical manifestation, treatment, laboratory test, electrocardiogram and echocardiogram in IDC patients with history more than two years. Results: Thirty - three patients were studied, 20 males and 15 females, the average age was 62. 7 ±9.4 years. Duration of symptoms of cardiac dysfunction to the first analysis was 5.6 ±14.9 years, duration of first to second analysis was 3. 5 ±2. 1 years. Cardiac function ( NYHA function class) has no changes (2. 7 ±0. 9 and 2. 5 ±0. 7 , P>0.05). Left ventricular ejection fraction (LVEF) decreased from 0.45 ±0.21 to 0.37 ±0.34 (P=0.24). Left atrium internal diameter (cm) increased from 4. 12 ±0. 78 to 4. 79±0. 87 (P =0. 0012) , Diastolic left ventricular internal diameter ( cm) increased from 6. 77 ± 1. 29 to 7. 65± 1. 5 (P=0.0105), Systolic left ventricular internal diameter (cm) increased from 5.05 ± 1. 45 to 5. 97 ± 1. 33 (P=0.0073). Electrocardiogram PR interval ( ms) lengthened from 166 ±52 to 198 ±51 (P=0.0115),QRS duration ( ms) increased from 110± 44 to 159 ± 49 (P <0.0001 ). Twenty - three patients had double peak P wave, the P wave duration ( ms) had no changes (from 128±46 to 141 ±59, P=0.27) , but was longer than normal patients. The QRS (V1 -6) amplitude (mm) had no changes (from 162 ±93 to 152 ± 79, P =0. 65) , but was higher than normal patients. No changes in QT interval and cardiac arrhythmias. Conclusions: With the enlargement of heart in IDC patients, conduction abnormality were occurred in atrium, AV conduction systems and left ventricular. Electrocardiogram showed PR interval increased, QRS duration and P wave duration lengthened and double peak P waves. These changes can decrease cardiac systolic function.