肥厚型心肌病患者发生室性心律失常的相关危险因素分析

Risk factors of ventricular arrhythmias in patients with hypertrophic cardiomyopathy

目的探讨肥厚型心肌病(hypertrophic cardiomyopathy,HCM)患者室性心律失常发生的相关性因素及特点。方法回顾性分析95例经临床及超声心动图检查确诊的HCM患者的临床资料,并与80例无心脏病对照组进行比较。结果室性心动过速(室速)组与非室速组的晕厥发生率(61.74%vs.11.76%,P<0.05)、家族史(38.9%vs.11.7%,P<0.05)、Q-Tc间期[(448.83±28.22)ms vs.(427.38±25.55)ms,P<0.05]、T波峰-末(T-peak-end,Tp-e)间期[(108.33±6.85)ms vs.(100.00±11.32)ms,P<0.05]、经心率校正后T波峰-末(Tp-ec)间期[(126.33±12.13)ms vs.(95.95±12.15)ms,P<0.05]、射血分数(53.03%±14.31%vs.71.00%±8.63%,P<0.05)比较,差异有统计学意义。Logistic回归分析结果显示,Tp-e间期、Tp-ec间期、Q-T间期延长、左心室流出道梗阻与HCM恶性室性心律失常的发生相关。结论HCM患者的心肌结构排列紊乱和心电紊乱严重,易发生快速性心律失常。Tp-e间期、Tp-ec间期、Q-T间期延长、左心室流出道梗阻与恶性室性心律失常的发生关系密切。Tp-e间期、Tp-ec间期可能具有预测室性心律失常发生的价值。

Objectives To explore the correlation factors and characteristics of ventrieular arrhythmias in patients with hypertrophic cardiomyopathy （HCM）. Methods We retrospectively analyzed the clinical data of 95 patients diagnosed as HCM by clinic and eehoeardiography and eompared them with those of 80 patients with no heart disease. Results Syncope rates（61.74% vs. 11.76%,P〈0.05）, family history（38.9% vs. 11.7%,P〈0.05）, Q-Tc interval[（448.83 ± 28.22） ms vs.（427.38± 25.55） ms,P〈0.05], T-peak-end（Tpe） interval[ （108.33± 6.85）ms vs.（100.00± ll.32）ms, P〈0.05J, Tp-ec interval [ （ 126.33 ± 12.13）ms vs. （95.95 ± 12.15）ms,P〈0.05], ejection fraction（53.03% ± 14.31% vs.71.00% ± 8.63%,P〈0.05）showed significant differences between ventricular taehycardia group and non-ventrieular taehycardia group. Logistic analysis indicated that prolongation of Tp-e interval, Tp-ee interval and Q-T interval, and obstruction in left ventrieular outflow tract correlated with malignant ventrieular arrhythmias. Conclusions Patients with HCM are prone to tachyarrhythmias for their disordered myocardial structure and serious cardiac electrical instability. Prolongation of Tp-e interval, Tp-ec interval and Q-T interval, and obstruction in left ventrieular outflow tract may cause malignant ventricular arrhythmias. Tp-e interval and Tp-ee interval may help predicting ventricular arrhythmia.