频发室性期前收缩并心脏扩大患者的临床特点及预测因素

Characteristics and predictors of patients with frequent premature ventricular complexes and left ventricular dilation

目的观察频发室性期前收缩伴心脏扩大的发生率、临床特点及可能的预测因素。方法本研究对2012年1月至2013年1月来阜外医院行射频消融术的频发室性期前收缩患者共300例进行分析,术前均行N末端脑钠肽前体(N-terminal pro-brain natriuretic peptide,NT-proBNP)、心电图、动态心电图及超声心动图检查,根据超声心动图检查结果,男性左心室舒张末期内径>55 mm,女性>50 mm诊断为心脏扩大,并排除伴有器质性心脏病患者,分成心脏扩大组及心脏正常组,比较两组的临床特点,探讨心脏扩大的预测因素。结果7%(21/300)的频发室性期前收缩患者出现心脏扩大,两组间有差异的参数有男性(71.4%vs.29.6%,P=0.0035)、室性期前收缩次数[(32742±14106)次/24 h vs.(21740±10089)次/24 h,P=0.0031]、室性期前收缩负荷(27.46%±12.36%vs.20.42%±9.15%,P=0.03)、术前左心室射血分数(57.48%±6.47%vs.62.07%±3.10%,P=0.005)。术前NT-proBNP、室性期前收缩QRS宽度、室性期前收缩起源位置、室性期前收缩形态及有无间位室性期前收缩两组间比较,差异无统计学意义(P>0.05)。结论男性患者更容易出现心脏扩大,心脏扩大患者室性期前收缩次数及室性期前收缩负荷心脏扩大组患者的明显升高,左心室射血分数亦明显下降。

Objectives To determine the incidence,clinical and electrophysiologic characteristics and the predictors of patients with frequent premature ventricular complexes(PVC)and left ventricular(LV)dilation.Methods Three hun⁃dreds patients who underwent radiofrequency catheter ablation(RFCA)for frequent PVCs with no significant structural heart disease from January 2012 to January 2013 in Fuwai Hospital were included.All patients underwent N-terminal pro-brain natriuretic peptide(NT-proBNP)test,12-lead surface echocardiography(ECG),Holter monitoring and trans⁃thoracic echocardiograms.LV dilation was defined as LV end-diastolic dimension(LVEDD)>55 mm for male and>50 mm for female.According to LVEDD,all patients were divided into two groups.Characteristics were compared between the two groups to determine the possible predictors of PVC and LV dilation.Results Twenty-one(7%)patients were included in LV dilation group.Male(71.4%vs.29.6%,P=0.0035),PVC frequency[(32742±14106)24 h vs.(21740±10089)24 h,P=0.0031],PVC burden(27.46%±12.36%vs.20.42%±9.15%,P=0.03),left ventricular ejection fraction(LVEF)prior to ablation(57.48%±6.47%vs.62.07%±3.10%,P=0.005)were significantly different between the two groups.Concentration of NT-proBNP prior to ablation,PVC QRS width,PVC morphology,origin sites of PVCs and pres⁃ence of PVC interpolation were not significantly different between the two groups(P>0.05).Conclusions Males with PVCs are more prone to develop ventricular dilation.The mean PVC burden and PVC frequency are significantly greater in those patients with LV dilation and with lower LVEF.