心肌淀粉样变心电学特征研究

Electrocardiographic Characteristics in Patients With Cardiac Amyloidosis

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.