左心室肥厚并急性心肌梗死室性电风暴心电图对预后的影响

Changes in ECG features and clinical prognosis of ventricular electrical storm in patients with left ventricular hypertrophy and acute myocardial infarction

目的探讨沿海居民高血压性左室肥厚（left ventricular hypertrophy，LVH）并急性心肌梗死（acute myocardial infarction，AMI）后心电图特征性改变，评估室性电风暴与临床预后危险分层。方法选择急诊住院有高血压性LVH并AMI室性电风暴（室速或室颤）317例（Ⅱ组），另选无高血压性LVH室性电风暴AMI109例（Ⅰ组）进行心电图检查和持续心电监护，分析心电图特征与临床高危特点。结果室性电风暴组以高血压LVH并AMI患者心电图指标心房终末电势异常、∑ST段抬高振幅、ST段抬高导联数、QTc间期延长、对应导联ST段振幅下移等特征，梗死部位以前壁或复合前壁，并以左前降支合并回旋支或／和右冠脉完全闭塞多支病变为主，与Ⅰ组比较差异有统计学意义（P〈0．05或P〈0．01），临床并发泵衰竭、AMI扩展、住院病死率、室性电风暴AMI发病后6h内发生率明显增多（P〈0．01）。结论高血压性LVH并AMI室性电风暴患者，心电图多项指标异常对临床预后有预测作用。

Objective To investigate changes in ECG feature and clinical prognosis of ventricuiar electrical storm （ VES ） in patients with left ventricular hypertrophy （ LVH ） and acute myocardial infarction （AMI）. Methods Three hundred and seventeen cases of left ventricular hypertrophy induced by hypertension and combined with AMI （ Group Ⅱ） from emergency inpatients, and another 109 patients without LVH induced by hypertension and accompanied with AMI （Group Ⅰ） were chosen to have sustained ECG monitoring, analyze ECG features and clinical high risks. Results Clinical features, such as abnormality in PTFvl, ∑ ST segment elevation amplitude, ST segment elevation leads, ST segment reduction amplitucle leads, QTc interval prolongation could be noted in the VES group.Infarction could be seen at sites of anterior and complex anterior walls, and dominant clinical signs were mainly at left descending branches accompanied by circumflex arteries and/or complete block of right coronary arteries and pathological changes in multiple branch arteries. Statistical significance could be seen when compared with those of Group Ⅰ （P 〈 0.05 or P 〈 0.01 ）. Clinical occurrence of complications, such as pump failure, infarction extension, angina pectoris, mortality rate of inpatients, and ventricular electrical storm increased obviously 6 hours after AMI （P 〈 0. 01 ）. Conclusions For those patients with left ventricular hypertrophy and acute myocardial infarction, abnormalities in ECG data could predict clinical prognosis of those acute cases.