摘要
目的 :分析总结无创性心电学检查诊断心肌淀粉样变(CA)的特点。方法 :回顾分析2008-08至2013-12我院诊断为CA的60例患者的临床及其心电学特征。结果 :60例CA患者中男性48例,女性12例。初诊率低,确诊平均年龄(54.5±14.2)岁。60例患者中:(1)合并心力衰竭32例(53.3%),胸腔或心包积液12例(20%),房性心律失常20例(33.3%),室性心律失常8例(13.3%),窦房阻滞4例(6.7%),房室阻滞15例(25%),左束支阻滞4例(6.7%),右束支阻滞5例(8.3%),室内阻滞8例(13.3%)(;2)合并肢体导联低电压32例(53.3%),胸前导联假性Q波52例(86.7%),ST-T改变48例(60%),其中30例同时合并肢体导联低电压和假性Q波(;3)合并胸腔或心包积液、胸前假性Q波患者出现肢体导联低电压比例显著升高,但仍有22例(45.8%)不存在胸腔或心包积液的患者出现肢体导联低电压(;4)QRS间期为(104±26)ms,QT间期为(404±34)ms,QTc为(462±35)ms。aV R导联最小负向R波电压均值为0.17 mV、QRS波电压均值为0.30 mV,肢体导联和V1~3导联R波电压均值均〈0.5 m V,V1~3的Q或S波电压均值分别为0.62 m V、1.61 m V及1.56 m V。V1~3导联R/S的比值分别为0.19、0.12和0.20。结论:CA患者胸前导联假性Q波发生率最高,同时合并肢体导联低电压、胸前导联假性Q波伴深Q或S波以及ST-T改变有助于CA的鉴别诊断。
Objective: To study the diagnostic characteristics of cardiac amyloidosis (CA) by non-invasive electrocardiography (ECG) in relevant patients. Methods: We retrospectively analyzed 60 CA patients diagnosed in our hospital from 2008-08 to 2013-12 for their clinical and ECG characteristics. Results: There were 48 male and 12 female patients with the ratio of 4: 1. The first time diagnosis rate was low and the average age for confirmed diagnosis was at (54.5±14.2) years. ① There were 32 (53.3%) cases combining heart failure, 12 (20%) with pleural effusion, 20 (33.3%) with atrial arrhythmia, 8 (13.3%)with ventricular arrhythmia, 4 (6.7%)with sino- atrial block, 15 (25%)with atrio-ventricular block, 4 (6. 7%) with left bundle branch block (LBBB), 5 (8.3%)with RBBB and 8 (13.3%)with intra-ventricular block. ② There were 32 (53.3%) cases with low voltage on limb leads, 52 (86. 7%) with pseudo-infarct pattern, 48 (60%) with ST-T abnormality and 30 (50%) combining low voltage on limb leads with pseudo-infarct pattern.③ The patients combining pleural effusion and with pseudo-infarct pattern had the increased ratio of low voltage on limb leads, while there were still 22 (45. 8%) cases without pleural effusion had low voltage on limb leads. ④ ECG characteristics for 60 CA patients were as follows: QRS duration (104±26) ms, QT interval (404±34) ms, QTc (462±35)ms; the R wave ofavR 0. 17 mV, QRS wave 0.30 mV; the R wave of limb leads and V1-3 were all〈0.5mV, the S wave of V1-3 were 0. 62mV, 1. 61mV, 1.56mV; the R/S ratio of V1-3 were 0. 19, 0. 12, 0. 20 respectively. Conclusion: CA patients had the highest incidence of pseudo-infarct pattern; meanwhile, combining with low voltage on limb leads, pseudo-infarct with long Q or S wave and ST-T abnormality but normal QRS duration was helpful for differential diagnosis of CA in clinical practice.
出处
《中国循环杂志》
CSCD
北大核心
2016年第6期596-600,共5页
Chinese Circulation Journal
基金
北京市自然科学基金青年项目(7154232)
关键词
心电描记术
淀粉样变性
心肌
Electrocardiography
Amyloidosis
Myocardium