肥厚性心肌病患者左心室形态学改变与QT间期离散度的关系

Relation between QT dispersion and left ventricular morphology in patients with hypertrophic cardiomyopathy

目的探讨体表心电图上QT间期离散度(QTd)与肥厚性心肌病(HCM)左心室形态学改变的关系。方法43例HCM患者,均经二维超声心动图确诊。根据心室肥厚的部位不同,将患者分为4组:A组(室间隔肥厚)16例、B组(室间隔肥厚及左室前壁肥厚)10例、C组(室间隔肥厚、左室前壁肥厚及左室侧壁肥厚)10例、D组(室间隔肥厚及广泛左室壁肥厚)7例。在安静状态下记录同步12导联心电图(ECG),人工测量各导联的QT间期、QRS波时间,并计算QT及QRS离散度(QTd及QRSd)。结果超声心动图检查D组的左室后壁厚度(PWT)明显大于A、B、C组,D组的室间隔厚度(IVST)/PWT明显小于A、B、C组。A、B组的QTd明显大于C、D组,差异有显著性意义。结论QTd不仅反应了左心室复极的不均一性,也反应了左心室肥厚的形态学改变的不均性。

AIM To evaluate the relation between QT dispersion and disproportion of ventricular wall hypertrophy in patients with hypertrophic cardiomyopathy （HCM）. METHODS Retrospective analysis of the results of echocardiography and electrocadiography of 43 patients with HCM. The 43 patients with HCM were divided into four groups according to the distribution of left ventricular wall hypertrophy on cross sectional echocardiography： group A： 16 patients, hypertrophy confined to the interventricular septurn ; group B： 10 patients, hypertrophy confined to the interventricular septum and left ventricular anterior wall ; group C ： 10 patients, hypertrophy confined to the interventricular septum, left ventricular anterior wall and lateral free wall; group D： 7 patients, involving all the portions of the left ventricular. The 12 lead synchrony electrocardiograms of the 43 patients with HCM were recorded at 25 mm/s. QT interval and QRS duration were measured by one observer with a caliper, and QT and QRS dispersion were derived. RESULTS There was no signification difference in the maximum left ventricular wall thickness and heart rate （HR） among the four groups and the maximum and minimum QT and QRS were not significantly different. QT dispersion increased significantly in group A and group B compared with that in group C and group D （ P 〈 0.01 ）. CONCLUSION QT dispersion may be affected not only by electrical inhomogeneity but also by morphological inhomogeneity of the left ventricular in patients with HCM.