摘要
目的:探讨QT离散度与充血性心力衰竭(CHF)患者心脏性猝死的关系。方法:分析163例CHF病人的QT离散度、血流动力学、心功能及室性心律失常。QT离散度以12导联体表心电图上最长和最短的QT和JT间期之差及其变异系数计算。结果:平均随访26±15个月,心脏性猝死34例,非猝死型心脏性死亡25例(心力衰竭19例,心肌梗塞6例),非心脏性死亡和接受心脏移植7例,存活97例。心脏性猝死组各QT离散度参数均显著高于存活组和非猝死组,而后两者之间无差异。多因素Cox模型分析示,QT离散度增加是心脏性猝死独立危险因素;JTc离散度≥85ms组和<85ms组3年非猝死生存率分别为30.8%和96.6%。结论:QT离散度增加是心脏性猝死独立危险因素,QT离散度检测有助于识别CHF心脏性猝死高危患者。
Objective:To test the hypothesis that increased QT dispersion is of prognostic value in identifying congestive heart failure patients due to either ischemic or idiopathic dilated cardiomyopathy at the risk of sudden cardiac death (SCD).Methods: In 163 cases of ischemic ( n =126) and idiopathic dilated ( n =37) cardiomyopathy with a left ventricular ejection fraction ≤40%,who were diagnosed by LV angiography,QT dispersions were quantified in terms of maximal-minimal QT/JT intervals (dispersion,d) and the coefficient of variation (cv) of QT and JT intervals.Results:During follow ups (26±15 months) 34 patients died suddenly,19 died from pump failure,6 died from acute myocardial infarction,and 97 survived.Bazett's formula rate corrected JT interval dispersion was found to be 109±23 ms in SCD patients,57±20 ms in survivors,and 55±20 ms in patients who died from pump failure or acute myocardial infarction.Cox′s proportional hazards multivariate analysis revealed that JTc d was the most important independent predictor of SCD.Kapalan Meier survival analysis showed that cumulative SCD free 3 year survival rates were 97.6% in patients with a JTc d<85 ms,and 30.8% in patients with JTc d≥85 ms respectively.Conclusion: Analysis of QT dispersion from the 12 leads surface ECG seems to be a useful screening method for identifying congestive heart failure patients at high risk for SCD.
出处
《浙江大学学报(医学版)》
CAS
CSCD
1999年第1期4-7,共4页
Journal of Zhejiang University(Medical Sciences)