频发流出道室性早搏患者左心室壁应力及其相关因素分析

The ventricular wall stress and associated factors in patients with frequent premature ventricular contractions originating from the ventricular outflow tract

目的探讨频发流出道室性早搏(简称室早)患者左心室壁应力及其相关危险因素,从而为临床早期干预提供新的思路。方法收集2012年1月至2016年12月频发流出道室早患者139例;心脏超声测量并计算周收缩末期室壁应力(cESS)。根据cESS中位数115kdyne/cm^2将入选的室早患者分成2组:(cESS≥115kdyne/cm2为A组及cESS<115kdyne/cm2为B组)。比较两组间临床特征、实验室检查指标、心电图、动态心电图及心脏超声相关参数。结果两组间高血压病、血钾、血镁、及脑钠肽氨基酸前体(NT-ProBNP)水平、室早QRS波宽度、室早数、室早负荷有统计学差异(P均<0.05)。cESS与饮酒、高血压史、血钾、血镁、NT-proBNP、QT间期、室早QRS波宽及室早负荷成显著正相关(P<0.05)。多元线性逐步回归分析发现,仅室早QRS波宽度、室早负荷及饮酒史是cESS增高的独立相关因素。结论部分频发流出道室早患者左室壁应力增高,室早QRS波宽度、室早负荷及饮酒史是其独立相关因素。有效控制室早负荷及戒酒对频发室早患者可能有很重要的临床意义。

Objective To investigate the ventricular wall stress and associated factors in patients with frequent premature ventricular contractions （VPC） originating from the ventricular outflow tract, thereby looking for a new approach to intervene VPC. Methods A cross-sectional sample of 139 patients with frequent VPC originating from the ventricular outflow tract was included in this study from January 2012 to December 2016. Echocardiography was used to measure and calculate circumferential end-systolic wall stress （cESS）. Participants were divided into two groups by median cESS （cESS≥115 kdyne/cm^2 versus cESS〈 115 kdyne/cm^2 ）. Clinical characteristics, laboratory data, parameters of surface ECG, Holter and echocardiography were compared between groups. Results There were significant differences between the two groups in hypertention history, serum K^＋ , serum Mg^2＋ , N-terminal proBNP（NT-ProBNP） levels, VPC QRS duration, VPC numbers and VPC burden（all P 〈0.05）. Moreover, cESS was positively correlated with alcohol abuse, hypertention history, serum K^＋ , serum Mg^2＋ , NT-proBNP levels, QT intervals, VPC QRS duration, VPC numbers and VPC burden（ all P〈0.05 ）. Multiple linear regression analysis showed that only VPC QRS duration,VPC burden and alcohol abuse were independent risk factors for increased tESS. Conclusions Ventricular wall stress increases in some patients with frequent VPC originating from the ventricular outflow tract. VPC QRS duration,VPC burden and alcohol abuse are independent risk factors for the rise of ventricular wall stress.