扩心病患者T波电交替与心功能的关系

Investigation about the relation of MTWA with cardiac functional parameters in patients with dilated cardiomyopathy

目的研究扩张型心肌病患者T波电交替(T-wave alternans,TWA)的发生与左室大小、射血分数等心功能状况的关系。方法 31例扩张型心肌病患者,男30例,女1例,年龄50.06±7.14(40~61)岁。对所有患者用Cambridge Heart.Heartwave TM system心脏诊断系统,以频谱法检测MTWA(Microvolt T-wave alternans,微伏级T波电交替)。对所有患者进行体检、超声心动图等检查。超声心动图测量左室舒张末内径(LVEDD)、左室射血分数(LVEF)等。分析MTWA的发生与左室大小、左室射血分数等的关系。结果扩张型心肌病MTWA阳性组的左室舒张末径大于MTWA阴性组(p<0.01),左室射血分数低于MTWA阴性组(p<0.01)。扩张型心肌病LVEDD≥65mm组MTWA阳性率高于LVEDD<65mm组(p<0.01),LVEF≤40%组MTWA阳性率高于LVEF>40%组(p<0.01)。结论扩张型心肌病患者MTWA阳性者左室末径大于阴性者,射血分数低于阴性者;左室舒张末径大(≥65mm)和/或射血分数低(≤40%)的扩张型心肌病患者MTWA阳性率高,支持TWA是一项新的判断预后指标,值得临床进一步研究。

Objective To investigate relation of MTWA with the cardiac functional parameters including left ventricular end- diastolic dimension( LVEDD)and left ventricle ejection fraction(LVEF). Methods 31 patients with dilated cardiomyopathyincluding 30 men and 1 woman agingfrom 40 to 61(50.06±7.14) years were selected. MTWA was assessed for all the patients with dilated cardiomyopathy with spectral method using Cambridge Heart. HeartwaveT M system. Physical examination and ultrasonic cardiogram were conducted for all the patients with dilated cardiomyopathy.LVEDD, LVEF, et al were measured by way of ultrasonic cardiogram. The relation of MTWA with LVEDD,LVEF, et al was analyzed. Results The LVEDD was larger in positive MTWA than in negative MTWA( p<0.01) and the LVEF in positive MTWA was lower than in negative MTWA(p<0.01)for patients with dilated cardiomyopathy. The MTWA positive rate was higher in patients with LVEDD≥65mm than in patients with LVEDD<65mm(p<0.01) and also higher in patients with LVEF≤40% than in patients with LVEF>40%(p<0.01) for patients with dilated cardiomyopathy. Conclusions The LVEDD is larger in positive MTWA than in negative MTWA and the LVEF in positive MTWA is lower than in negative MTWA for patients with dilated cardiomyopathy. The MTWA positive rate is high in patients with cardiomyopathy with LVEDD≥65mm and/or LVEF≤40%, which sport that TWA is a new prognostic indicator which is worthy of further clinical research.