肥厚型心肌病患者标准12导联体表心电图J点抬高与心脏骤停的关系

The relationship of J-point elevation on routine 12-lead electrocardiograms and sudden cardiac arrest in patients with hypertrophic cardiomyopathy

目的：探讨肥厚型心肌病（HCM）患者标准12导联体表心电图（ECG）J点抬高（J波）与心脏骤停（SCA）之间的关系。方法：入选北京7家三级甲等医院345例HCM患者,采集所有入选者静息标准12导联体表心电图。J波定义为在下壁（Ⅱ、Ⅲ和aVF）、侧壁（V4~V6导联）或高侧壁（Ⅰ和aVL）连续2个及以上导联出现J点较基线抬高≥0.1mV。SCA包括心脏性猝死（SCD）、有证据的心室颤动（VF）、由VF或快室性心动过速（VT,〉200次/min）导致的植入式心脏复律除颤器（ICD）放电。结果：在（47.9±46.6）个月的随访期间,共14例HCM患者发生SCA事件。在发生SCA的HCM患者中,J点抬高的检出率为43%（6/14）,在无SCA的HCM患者中,J点抬高的检出率为10%（34/331）,J波的存在显著增加HCM患者发生SCA风险（OR：5.67,95%CI：2.38~13.50,P〈0.001）。在SCA组和无SCA组之间,J点抬高的形态（包括顿挫和光滑延续）和ST段的形态（包括水平/下斜型压低和弓背向下抬高/快速抬高）在所有导联均无统计学差异。结论：HCM患者ECG存在J波与SCA的发生相关。

Objective：To determine whether J-point elevation is associated with sudden cardiac arrest （SCA） in patients with hypertrophic cardiomyopathy （HCM）. Method： Three hundred and forty-five consecutive patients （male： 22%; age： 49.9±10.7 years） who enrolled in the Beijing HCM Registry were included. Resting 12-lead electrocardiograms were analyzed. J-point elevation was defined as〉0.1 mV from baseline present in 2 or more of the inferior （ Ⅱ , Ⅲ , and aVF）, lateral （V4 to V6） or high lateral （ Ⅰ , avL） leads. SCA included sudden cardiac death （SCD）, documented ventricular fibrillation （VF） and appropriated ICD shock triggered by VF or rapid ven- tricular tachycardia （VT）. Result：During the mean follow-up of 47.9 ±46.6 months, 14 HCM patients suffered SCA. In the HCM group, J-point elevation was present in 43% （6/14） of 14 patients suffered SCA. In contrast, only 10% （34/331） of those without SCA showed J-point elevation （odds ratio： 5.67, 95% confidence interval： 2.38 to13. 503 P（0. 001）. However, the J wave types （including notch and slur） and ST segment types （inclu- ding horizontal/descending and ascending/upsloping） between SCA group and non-SCA group were not differentsignificantly in all leads examined. Conclusion：J-point elevation is associated with SCA in patients with HCM.