Tp-e离散度对变异型心绞痛患者恶性室性心律失常的预测作用

Prognostic value of Tpeak-Tend dispersion for malignant arrhythmia events in patients with vasospastic angina

目的:评价T波峰点到末端的间期(Tpeak-Tend interval,Tp-e间期)和其他心电图参数对变异型心绞痛(VA)患者恶性室性心律失常(MVAE)发生的预测作用。方法:60例单纯VA患者(无MVAE组)和18例VA合并MVAE的患者(MVAE组)入选本研究。使用t检验、Logistic回归分析和受试者工作曲线(ROC)分析ST段抬高时期心电图参数和MVAE(室性心动过速/心室颤动、晕厥和成功复苏的心源性猝死)发生的关系。结果:MVAE组比无MVAE组有更长的校正QT间期离散度[cQTd:(49.55±15.4)ms∶(39.98±7.4)ms;P=0.017]、校正的Tp-e间期[cTp-e:(162.07±24.8)ms∶(127.69±12.9)ms;P<0.001]和校正的Tp-e间期离散度[cTp-ed:(55.55±15.4)ms∶(39.98±7.4)ms;P<0.001],并且有更大的Tp-e/QT比值(0.355±0.05∶0.297±0.03;P<0.001)。血管痉挛缓解并且抬高的ST段和倒置的T波恢复至正常水平后,两组间QTc间期、cQTd、cTp-e间期、cTp-ed和Tp-e/QT比值均没有明显差异。单因素回归分析显示,cQTd(OR=1.117,95%CI:1.013~1.230,P=0.026)、cTp-e间期(OR=1.149,95%CI:1.057~1.248,P=0.001)、Tp-e/QT比值(OR=1.361,95%CI:1.136~1.630,P=0.002)和cTp-ed(OR=1.452,95%CI:1.150~1.832,P=0.001)均与MVAE的发生有关。多因素逐步回归分析显示,只有cTp-ed可以进入回归方程作为预测因子。ROC曲线下面积(AUC)cQTd为0.724,cTp-e间期为0.841,Tp-e/QT比值为0.924,cTp-ed为0.933(均P<0.05)。Z检验显示,cTp-ed(0.933)的AUC与cQTd(0.724)、cTp-e间期(0.841)、Tp-e/QT比值(0.924)的AUC相比均有显著差异(均P<0.05),Tp-e/QT比值的AUC与cQTd相比有显著差异(均P<0.05)。结论:cQTd、cTp-e间期、Tp-e/QT比值和cTp-ed在合并MVAE的VA患者中明显增高,均可预测MVAE的发生,其中cTp-ed是最敏感的独立预测因子。

Objective：To evaluate the value of Tpeak-Tend interval（Tp-e interval）and other ECG parameters as risk factors for recurrence of malignant ventricular arrhythmia events（MVAE）in patients with variant angina（VA）.Method：Sixty patients with VA and 18 patients with VA complicated with MVAE were enrolled.The relationship of ST-segment elevation phase and MVAE（defined as ventricular tachycardia/ventricular fibrillation,syncope,aborted sudden death）was analyzed by t test,Logistic regression analysis and receiver operating characteristic（ROC）curve analysis.Result：Patients in MVAE group showed greater corrected QT dispersion [cQTd：（49.55±15.4）ms vs.（39.98±7.4）ms;P=0.017）,corrected Tp-e interval[cTp-e：（162.07±24.8）ms vs.（127.69±12.9）ms;P0.001]）,and corrected Tp-e interval dispersion[cTp-ed：（55.55±15.4）ms vs.（39.98±7.4）ms;P0.001],and Tp-e/QT ratio（0.355±0.05 vs.0.297±0.03;P0.001）than those in non-MVAE group.After symptoms relieved and elevated ST-segment and reversed T waves were back to normal,there was no significant difference in QTc interval,cQTd,cTp-e interval,cTp-ed and Tp-e/QT ratio between the two groups.Univariate analysis showed that cQTd（OR=1.117,95%CI：1.013-1.230;P=0.026）,cTp-e（OR=1.149,95%CI：1.057-1.248,P=0.001）,Tp-e/QT（OR=1.361,95%CI：1.136-1.630,P=0.002）and cTp-ed（OR=1.452,95%CI：1.150-1.832,P=0.001）were significantly associated with MVAE.Multivariate analysis showed that cTp-ed remained as a predictor of MVAE.ROC curve analysis showed that AUC of cQTd was 0.724,cTp-e interval was 0.841,Tp-e/QT ratio was 0.924 and cTp-ed was 0.933（all P0.05）.The AUC of Tp-e/QT ratio was significant different with that of cQTd.Conclusion：cQTd,cTp-e interval,Tp-e/QT ratio and cTp-ed are significantly increased in VA patients with MVAE than those without MAE when coronary spasm is onset.Prolonged cTp-ed is the best discriminator and a strong independent predictor of MVAE in VA patients.