冠状动脉慢性完全闭塞性病变患者心电复极指标的变化研究

Changes of Electrocardiographic Repolarization Indices in Patients with Coronary Chronic Total Occlusion after Successful Revascularization

背景既往研究认为冠状动脉慢性完全闭塞性病变(CTO)患者行经皮冠状动脉介入治疗(PCI)后可以改善临床症状,而临床症状的改善与哪种心电复极指标改变相关,目前研究较少,且对其的认识处于初级阶段。目的本研究旨在了解单支及多支血管CTO患者CTO-PCI后心电复极指标变化情况,从而为不同类型CTO患者进行CTO-PCI提供更多电生理方面的客观证据。方法选取2017年5月—2019年5月于中国科学技术大学附属第一医院心内科住院并成功行PCI(PCI成功的标准:CTO-PCI后血管残余狭窄<30%,前向血流TIMI>3级)的CTO患者249例。按照主要冠状动脉(前降支、回旋支、右冠状动脉)CTO的血管支数分为单支CTO组(n=192例);多支(两支或三支)CTO组(n=57例)。比较两组患者心率、侧支循环Rentrop分级、校正QT间期(QTc)、QT离散度(QTd)、T波尖峰-T波末尾时限(Tp-Te)、T波改善比例以及所有患者随访6个月,比较纽约心功能分级及主要心血管不良事件(MACE)发生率。结果单支CTO组和多支CTO组的侧支循环Rentrop分级比较,差异无统计学意义(P>0.05)。术后多支CTO组QTc小于单支CTO组,T波改善比例高于单支CTO组(P<0.05)。术后随访6个月,单支CTO组MACE发生率高于多支CTO组(P<0.05)。结论CTO患者血运重建后,复极指标均有改善,多支CTO患者复极指标改善更为明显,临床受益可能来自于细胞活力增强和复极离散指标的双重改善。

Background Previous studies have pointed out that the improvement of clinical symptoms of patients with coronary chronic total occlusion(CTO)can be achieved after the percutaneous coronary intervention(PCI).However,which ECG repolarization index is associated with the improvement,is still less known,and relevant studies are rare.Objective To investigate the changes of ECG repolarization indices after PCI for CTO between patients with single-vessel and multivessel CTO,providing objective electrophysiological evidence for CTO-PCI in patients with different types of CTO.Methods We enrolled 249 patients with successful CTO-PCI(residual coronary stenosis after CTO-PCI<30%and antegrade coronary flow>TIMI grade 3)from Cardiovascular Department,the First Affiliated Hospital of USTC during May 2017 to May 2019,including 192 with single-vessel CTO and 57 with multi-vessel(two-or three-vessel)CTO divided by the number of occluded main coronary artery(including the anterior descending branch,circumflex branch and the right coronary artery).Heart rate,Rentrop's classification for coronary collaterals,corrected QT interval(QTc),QT dispersion,T wave peak-to-end interval,the number of patients with improved T-wave,and post-PCI 6-month follow-up NYHA class as well as the incidence of major adverse cardiac events(MACEs)were compared between the groups.Results There was no predominant difference in Rentrop's classification for coronary collaterals between the groups(P>0.05).Patients with multi-vessel CTO had shorter average QTc and higher rate of having improved T-wave than those with single-vessel CTO(P<0.05).Postoperative follow-up showed that there was statistically significant difference in MACEs incidence between the groups(P<0.05).Conclusion After revascularization,improvement was obtained in the repolarization indices in all patients with CTO,which was more obvious in those with multi-vessel CTO.The clinical benefit may derive from the dual improvement of increased cell viability and dispersion indices of repolarization.