冠状动脉内心电图在肥厚型梗阻性心肌病室间隔酒精消融术中的应用初探

The value of intracoronary electrocardiogram in alcohol septal ablation in patients with hypertrophic obstructive cardiomyopathy

目的初步探讨冠状动脉内心电图(IC-ECG)在肥厚型梗阻性心肌病(HOCM)室间隔酒精消融术(ASA)中的应用价值。方法 9例HOCM患者在无水酒精注射前进行了IC-ECG检测,其中7例完成了ASA术后即刻的复查;以左室流出道压力阶差(LVOTG)的下降幅度作为ASA术后即刻疗效的评价标准;并分别于术前及术后6、12、24、48、72 h检测血浆肌酸激酶(CK)和其同工酶CK-MB的水平。结果 7例患者无水酒精用量为(2.11±1.27)ml;IC-ECG检测显示,与酒精注射前比较,ASA术后ST段增幅达(6.36±3.54)倍(P<0.05);术后即刻静息LVOTG下降57%[(41±38.30)mmHg vs(85.71±43.53)mmHg,P<0.05];室性早搏激发LVOTG下降48%[(86±24.98)mmHg vs(163.75±31.46)mmHg,P<0.05]。术后血浆CK峰值为(917.54±327.86)IU/L;CK拟合曲线下面积为(32 544.17±13 723.28)IU·h/L;CK-MB峰值为(123.46±52.46)IU/L;CK-MB拟合曲线下面积为(4 125.78±1 964.95)IU·h/L。ST段增幅与CK-Area、CK-MB-Area及LVOTG降幅之间均无相关性(P>0.05);与酒精用量正相关(r=0.846,P<0.05);CK-MB峰值与无水酒精用量之间亦无明显相关性(P>0.05)。结论 IC-ECG在ASA术中检测准确可靠,操作方便,通过IC-ECG检测ST段升高与否,对术中即刻判断是否有心肌坏死发生有一定帮助。

Objective To evalute the effect of intracoronary electrocardiogram （IC-ECG） in alcohol septal ablation （ASA） in patients with hypertrophic obstructive cardiomyopathy （HOCM）. Methods IC-ECG were performed in ASA in seven pa- tients with HOCM. The decrease of left ventricular outflow tract gradient （LVOTG） in ASA were measured by pigtail catheter. The CK and CK-MB in plasma were assayed at 0, 6, 12, 24, 48, and 72 hours after ASA. Results The dosage of alcohol in 7 patients was （2. 11±1.27） ml; The elevation of ST-segment in IC-ECG immediately after ASA was （6.36±3.54） times higher than before （P〈0.05）. The LVOTG at rest before and after ASA were （85.71±43.53） mmHg and （41±38.30） mmHg respec- tively, which decreased by 57% （P〈0.05）. The evoked LVOTG before and after ASA were （163.75±31.46） mmHg and （86± 24.98） mmHg respectively, which decreased by 48% （P〈0.05）. The peak values of CK and CK-MB in plasma were （917.54± 327.86） IU/L and （123.46±52.46） IU/L respectively. The area under curve of CK （CK-Area） and CK-MB-Area were （32 544. 17±13 723.28） IU· h/L and （4 125.78±1 964.95） IU · h/L respectively. The correlation coefficients between the elevation of ST-segment and CK-Area, CK-MB-Area, the dosage of alcohol and the decrease of LVOTG were 0. 028（P〉0.05）, 0. 609 （P〉 0. 05）, 0. 846（P〈0.05） and O. 115 （P〉0.05） respectively. The correlation coefficient between the peak values of CK-MB and the dosage of alcohol was 0.582 （P〉0.05）. Conclusions IC-ECG may be helpful to estimate the myocardial necrosis inASA.