扩张型心肌病的心电图分析

Analysis on ECG of dilated cardiomyopathy

目的探讨心电图对扩张型心肌病的诊断价值。方法选择102例扩张型心肌病患者常规12导联同步心电图,分析心律失常、传导阻滞、ST-T改变、异常Q波、肢导联低电压、胸前导联R波递增不良及左胸导联高电压等指标。结果心律失常的发生率为46.08%,以室性早搏和心房颤动最常见;传导阻滞发生率为42.16%,以一度房室阻滞和完全性左束支阻滞常见;ST-T改变发生率高达94.12%;异常Q波发生率为21.57%;肢导联低电压的发生率为13.73%;胸前导联R波递增不良的发生率为67.65%。R_(V5)+S_(V1)≥3.5 mV或R_(V6)≥3.5mV的发生率为36.27%;R_(V6)/R_(V5)>1的发生率为61.76%;连续三个心搏的R波和S波电压之和为QRS总电压V_6>V_5的发生率为36.27%;R_(V6)/R_(max)≥3的发生率为31.37%。结论扩张型心肌病常出现多种异常心电图表现,常规12导联心电图对扩张型心肌病的诊断有一定的实用价值。

Objective To investigate the clinical value of electrocardiogram（ECG） in diagnosing dilated cardiomyopathy（ DCM）. Methods The routine 12 lead synchronous ECGs of 102 DCM patients were selected. ECG abnormalities were analyzed among those cases,including arrhythmia,conduction block,ST-T changes,abnormal Q waves,low voltage in limb leads,poor progression of R wave in precordial leads and high voltage in left chest leads,etc. Results The incidence of arrhythmia was 46.08% while premature ventricular contraction and atrial fibrillation was the most common. The incidence of conduction block was 42.16%,with the first degree atrioventricular block and complete left bundle branch block accounting for the highest proportion. The incidence of ST-T changes was as high as 94.12%. The occurrence rate of abnormal Q waves,low voltage in limb leads and poor progression of R wave in precordial leads was 21. 57%,13. 73% and 67. 65%,respectively. The incidence was 36. 27% when R_（V5）＋ S_（V1）≥3. 5 mV or R_（V6）≥3.5 mV,and that of R_（V6）/ R_（V5） 〉1 was 61. 76%. The occurrence rate was 36. 27% when the voltage sum of of R waves and S waves in three successive heart beats equalled to the total voltage of QRS complex（ V_6 〉V_5）;the rate of R_（V6）/ R_（max）≥3 was 31. 37%. Conclusion A variety of abnormal ECG performances usually appear in patients with dilated cardiomyopathy. Routine 12 lead ECG proves to be practically valuable in diagnosing the disease.