原发性扩张型心肌病心衰患者心电图PR间期昼夜变化特性的研究

目的:探讨扩张型心肌病(DCM)窦性心律心衰患者PR间期昼夜变化规律及其意义,为A-V间期合理调整及心脏再同步化治疗(CRT)的优化方案提供依据。方法:入选原发性DCM患者58例(DCM组),其中NY-HAⅡ级20例、Ⅲ级19例、Ⅳ19例;另选体检正常者20例(正常对照组),测量各组24h动态心电图指标。结果:与正常对照组相比,DCM组(NYHAⅡ级组)昼间PR间期(142±40.33)ms比(163±48.9)ms]、夜间PR间期(186±49.91)ms比(195±51.72)ms]均显著增加(P均<0.05),夜昼PR间期差值(44±15.37)ms比(32±15.72)ms]明显减少(P<0.05);且随心功能的恶化,昼间PR间期、夜间PR间期更加延长,夜昼PR间期差值更加减少(P<0.05或<0.01)。结论:扩张型心肌病窦性心律心衰患者昼间、夜间PR间期显著增加,夜昼PR间期差值明显减少,且随着心功能恶化更加显著,表明此时迷走神经损害更重,针对这一特点对NY-HAⅣ级患者优化心脏再同步化治疗,可能会明显改善患者的疗效。

Diurnal variation features of PR intervals in patients with dilated cardiomyopathy and heart failure

Objective： To study diurnal variation features of PR interval in dilated cardiomyopathy （DCM） patients with sinus rhythm and heart failure to provide evidence for reasonable regulating A-V interval and optimizing cardiac resynchronization therapy （CRT）. Methods： A total of 58 DCM patients were enrolled as DCM group, including 20 cases with NYHA cardiac function class Ⅱ, 19 cases with class Ⅱ and 19 cases with class Ⅳ ; Another 20 normal subjects undergoing physical examination were regard as normal control group. Indexes of 24h dynamic elec- trocardiogram were measured in two groups. Results： Compared with normal control group, there were significant increase in daytime PR interval （142 ± 40.33） ms vs. （163 ± 48.9） ms] and nighttime PR interval （186 ± 49.91） ms vs. （195 ± 51.72） ms], and significant decrease in difference of PR interval between day and night （44 ± 15.37） ms vs. （32± 15.72） ms] in DCM group （NYHA class ]] group as example）, P〈0.05 all; As cardiac function aggravated, there were significant increase in daytime and nighttime PR interval, and significant decrease in difference of PR interval between day and night （P〈0.05 or 〈0.01）. Conclusion： In DCM patients with sinus rhythm and heart failure, there are significant increase in daytime and nighttime PR interval, significant decrease in difference of PR interval between day and night and they were more significant as cardiac function aggravates, indicating that in this time vagus nerve damage is more severe, optimizing CRT may significantly improve curative effects in these patients with NYHA class Ⅳ.