J波对急性心肌梗死后恶性室性心律失常预测价值的研究

Significance of J wave in the prediction of malignant ventricular arrhythmia in patients with acute myocardial infarction

目的研究急性心肌梗死(AMI)后出现J波的患者跨壁复极离散度变化及其与恶性室性心律失常的关系,评价J波预测AMI后恶性室性心律失常的临床价值。方法回顾性分析130例急性ST段抬高型心肌梗死(STEMI)患者的心电图(ECG)及相关临床资料,根据ECG结果分为J波组(21例)和无J波组(109例),比较两组临床情况、心肌梗死部位、恶性室性心律失常发生率、QT离散度(QTd)、T波峰-末间期(TpTe)。再将J波组分为恶性室性心律失常亚组(6例)和无恶性室性心律失常亚组(15例),并比较两组的QTd及TpTe。结果 AMI后J波的出现率为16.15%。J波组下壁梗死发生率(52.38%)明显高于无J波组(26.61%,P<0.05),恶性室性心律失常的发生率(28.57%)也明显高于无J波组(1.83%,P<0.01),且QTd、TpTe(分别为76±19、121±33ms)较无J波组(分别为47±199、9±26ms)明显延长(P<0.01)。与TpTe的正常值(92ms)相比,J波组的TpTe明显延长(P<0.01);J波组发生恶性室性心律失常者的QTd及TpTe(分别为97±151、57±27ms)均比无恶性室性心律失常者(分别为68±13、107±22ms)明显延长(P<0.01)。结论心电图J波提示心室跨壁复极离散度增加,可作为AMI患者恶性室性心律失常的预测指标。出现J波且伴随心室跨壁复极离散度显著增加者为AMI后恶性室性心律失常的高危人群。

Objective To evaluate the significance of J wave in the prediction of malignant ventricular arrhythmia （MVA） after acute myocardial infarction （AMI） by studying the changes in transmural dispersion of repolarization （TDR） and the relationship between J wave and malignant ventricular arrhythmia. Methyls ECG and clinical data were analyzed retrospectively in 130 patients with ST segment elevation myocardial infarction （STEMI）, and they were divided into J wave group and non J wave group on the basis of the presence or not of J wave. The sites of AMI, the incidence of MVA, QT dispersion （QTd） and Tpeak Tend interval （TpTe） between J wave group and non J wave group were compared. The J wave group was further divided into MVA subgroup and non MVA subgroup, and the QTd and TpTe of the both subgroups were then compared. Results The J wave appeared among 16. 15% of patients with AMI, and the incidence of inferior myocardial infarction was higher in J wave group （52. 38%） than in non-J wave group （26. 61%, P〈0. 05）. The incidence of MVA was significantly higher in J wave group （28. 57%） than in non-J wave group （1.83%, P〈0. 01）. Five patients in J wave group suffered from ventricular tachycardia, and one patient suffered from ventricular fibrillation. The values of QTd and TpTe were apparently higher in J wave group （76±19ms and 121±33ms） than in non-J wave group （47±19ms and 99±26ms, P〈0. 01）, and the value of TpTe was apparently higher in J wave group （121±33ms） than normal value （92ms, P〈0. 01）. In the J wave group, the values of QTd and TpTe were also significantly higher in the patients with MVA （97± 15ms and 157±27ms） than those without MVA （68± 13ms and 107±22ms, P〈0. 01）. Conclusion J wave indicates increased TDR and is a significant index for predicting MVA after AMI. AMI patients combined with J wave and increased TDR are the high risk population of developing MVA.