QT离散度与冠状动脉病变的关系及经皮冠状动脉腔内成形术对其影响

目的　探讨QT离散度 (QTd)与冠心病患者冠状动脉 (冠脉 )病变的关系以及经皮冠状动脉腔内成形术 (PTCA)对其影响。方法　选择 2 5例冠脉病变狭窄程度≥ 80 %冠心病患者并对其病变血管实施PTCA术。 3支冠脉中 1支有病变者归入单支病变组 (A组 ,10例 ) ,2支以上有病变者归入多支病变组 (B组 ,15例 )。测定两组患者PTCA术前及术后第 1、第 7天的标准 12导联心电图及校正的QT离散度(QTcd)。结果　术前及术后第 1天B组QTcd显著大于A组 (P <0 .0 1)。术后第 7天A组与B组QTcd无显著差别 (P >0 .0 5 )。术后两组患者的QTcd均显著小于各自术前 (P <0 .0 0 1) ,B组术后第 1天QTcd仍显著大于术后第 7天 (P <0 .0 5 ) ,而A组术后第 1天QTcd与术后第 7天比较无显著差异。结论　QT离散度与冠脉病变支数呈正相关。成功地行PTCA术可明显减少冠心病患者QT离散度 ;多支病变QT离散度减少速度慢于单支病变。     

静脉溶栓与直接经皮冠状动脉腔内成形术治疗急性心肌梗死时对QT离散度影响的比较研究

急性心肌梗死 (AMI)可致 QT间期延长 ,QT离散度 (QTd)增大 〔1〕。成功的溶栓或经皮冠状动脉 (冠脉 )腔内成形术(PTCA)治疗可减小 QTd〔2 ,3〕。本研究旨在通过对比观察静脉溶栓与 PTCA治疗 AMI时对 QT离散度的影响 ,为临床选择 AMI的治疗方法提供一个心电图的观察指标。1　资料与方法1.1　病例选择 :1997— 2 0 0 0年我院心内科收治的 AMI患者 15 5例。入选标准 :持续胸痛超过 30分钟 ,含服硝酸甘油不能缓解 ;相邻 2个以上导联 ST抬高≥ 0 .2 m V ;症状发作在 12小时以内 ;无电解质、酸碱平衡紊乱 ,无束支传导阻滞 ,未服用抗…     

经皮冠状动脉腔内成形术及支架植入术对QT离散度的影响

目的 :观察冠心病患者在经皮冠状动脉内成形术 (PTCA)及支架植入术 (stenting)后QT离散度 (QTdispersion ,QTd)的变化。方法 :对 6 8例冠状动脉造影证实冠状动脉管腔狭窄≥ 75 %而成功行PTCA和stent植入术前 ,术后 (4h、2 4h、1周 )进行同步 12导联心电图检查 ,测量QTd和QTcd ,还同期测量了 6 2例仅行冠状动脉造影术的患者术前、术后 (4h、2 4h、1周 )的QTd和QTcd。结果 :(1)冠状动脉造影组 :冠状动脉造影后 (4h、2 4h、1周 )与冠状动脉造影前的QTd和QTcd比较均无明显改变 (P >0 .0 5 )。 (2 )PTCA和stent植入术组 :PTCA和stent植入术后 (4h、2 4h、1周 )与术前的QTd和QTcd比较均明显缩短(P <0 .0 5 ) ,但术后 4h、2 4h、1周之间的QTd和QTcd比较均无明显改变 (P >0 .0 5 )。亚组分析表明 :多支病变组QTd、QTcd较单支病变组明显延长 (P <0 .0 5 )。单支病变组术后 (4h、2 4h、1周 )与术前QTd、QTcd比较均明显改善 (P均 <0 .0 5 ) ,但术后 4h、2 4h、1周QTd、QTcd相互比较无明显变化 (P均 >0 .0 5 )。单支病变组术后 (4h、2 4h、1周 )与术前比较QTd、QTcd改善率为 78% ,恶化率 15 % ,无变化者 7%。多支病变组术后 (4h、2 4h、1周 )与术前比较QTd、QTcd均无明显变化 (P均 >0 .0 5 )。多支病变组术后 (4h、2     

冠状动脉成形术对急性心肌梗死QT离散度影响分析

目的 探讨冠状动脉病变程度、病变部位及经皮冠状动脉介入治疗(PCI)对急性心肌梗死(AMl)患者QT离散度(QTd)、心率校正QT离散度(correcteqd QT dispersion,QTcd)的影响.方法 对确诊的130例AMI患者于入院第5～10天行PCI治疗,其中单支血管病变68例(包括左前降支30例、右冠状动脉20例、左回旋支18例),多支血管病变62例,与100例同期冠状动脉造影结果 正常者(对照组)进行比较,对照分析术前1 d和术后1 d的标准18导联同步心电图QTd及QTcd.结果 AMI患者QTd及QTcd均较对照组延长(均P<0.05),且多支血管病变组QTd、QTcd较单支血管病变组延长(均P<0.05).冠状动脉病变部位对QTd和QTcd无明显影响(均P>0.05).PCI术后QTd和QTcd较术前缩短(均P<0.05),而单独进行冠状动脉造影(coronary angiography,CAG)对QTd、QTcd无明显影响(P>0.05).结论 AMI患者QTd、QTcd明显高于正常人,且随着血管病变范围增大而变异增大,冠状动脉病变部位对QTd、QTcd无影响.成功的PCI能显著减小AMI患者QTd以及QTcd.     

经皮腔内冠状动脉成形术对QT离散度的影响

QT离散度(QTD)增大可见于多种心脏疾病,且与其恶性室性心律失常的发生有关,溶栓治疗能明显减轻梗死后心肌复极的离散度[1].本文旨在探讨经皮腔内冠状动脉成形术(PTCA)加冠状动脉(冠脉)内支架术对冠心病患者心肌复极电生理的影响.     

直接经皮腔内冠状动脉成形术对急性心肌梗塞患者QT离散度的影响

目的 :研究直接经皮腔内冠状动脉成形术 (PTCA)对急性心肌梗死 (AMI)患者QT离散度 (QTd)的影响 ,及心梗相关动脉再通后对QTd的影响。方法 :回顾 12 5例成功接受PTCA术的急性心肌梗死患者术前及术后不同时段的心电图测量 ,对比分析10 6例不适合或因各种原因未行PTCA或溶栓患者 (对照组 )不同时间QTd的变化。结果 :PTCA再通组同对照组比较术前QTd、QTcd均明显延长 ,但两组无明显统计学意义 (P >0 0 5 )。PTCA组术后 2 4小时、3天QTd、QTcd同本组术前比较明显缩短 (P <0 0 5 ) ,同对照组比较明显缩短 (P <0 0 1)。结论 :对于AMI患者 ,成功PTCA后QTd和QTcd明显缩短     

PTCA及其术后再狭窄对QT间期离散度的影响

近年来,QT间期离散度(QTd)作为心肌复极不同步已被证实在心肌缺血、损伤、坏死时发生显著变化。大量研究表明,急性心肌梗死在溶栓成功或冠状动脉造影术(PTCA)术后     

直接经皮腔内冠状动脉成形术对急性心肌梗死QT离散度的影响

目的：观察直接经皮腔内冠状动脉成形术（PTCA）对急性心肌梗死（AMI）患者QT间期离散度（QTd)的影响。方法：采用标准12导联心电图,对直接TPCA组26例和未再灌注治疗组30例AMI患者行心电图描记,分别测量入院时、直接PT-CA后2h、24h、1周、2周的QTd值,并观察两组恶性室性心律失常事件的发生。结果：直接PTCA组与未再灌注治疗组入院时QTd无差异（P＞0.05),直接PTCA组除术后2hQTd一过性增大外,24h后明显缩小,与未再灌注治疗组比较差异显著（P＜0.01),同期直接PTCA组恶性室性心律失常发生率低（P＜0.01)。结论：AMI后直接PTCA能缩小患者QTd,并能降低急性期恶性室性心律失常事件的发生。     

Effects of Ischemia and Reperfusion on QT Dispersion During Coronary Angioplasty

The effects of ischemia and reperfusion on QT interval dispersion (QTD: QT_max-QT_min in the 12-lead ECG) were analyzed in 15 patients (12 males, 57 ± 13 years) undergoing coronary angiopiasty (PTCA). AH patients had single-vessel coronary artery disease (only one ≥ 85% stenosis in a major coronary artery) and normal left ventricular function. AH were in sinus rhythm with normal atrioventricular and intraventricular conduction on the surface ECG. No patient was on therapy that could affect the QT interval. The ECG was recorded (all 12 leads simultaneously) at 50 mm/s speed before the first balloon inflation, at the end of the first inflation during PTCA, and at 30" and 60" during reperfusion following the first inflation. In order to avoid ischemic preconditioning, only recordings of the first inflation were used. In each tracing QT_max and QT_min were evaluated. All values were rate corrected using a simple linear equation (QT linear corrected = QT + 0.154 [1-RR]). QTD increased significantly during both ischemia and reperfusion. QT_max was not changed by ischemia and was increased by reperfusion. QT_min was reduced by ischemia and increased by reperfusion. These results indicate that both ischemia and reperfusion alter ventricular repolarization, inducing a less homogeneous ventricular recovery pattern.     

Carvedilol Versus Metoprolol in Patients Undergoing Direct Percutaneous Coronary Interventions for Myocardial Infarction: Effects on QT Dynamicity

Beta-adrenergic blockers exert significant antiarrhythmic activity during ischemia and reperfusion. To further explore the beneficial effects conferred by alpha-1-adrenoceptor blockade on ventricular repolarization dynamicity in the acute phase of myocardial infarction (AMI), we compared carvedilol with metoprolol in the setting of primary percutaneous coronary intervention (PCI). In a prospective study, 100 consecutive patients undergoing primary PCI for AMI were randomized to metoprolol 200 mg/day versus carvedilol 25 mg/day. The first oral dose of study drug was administered and a 24-hour ambulatory electrocardiogram recorded upon hospital admission. Slopes of the linear QT/RR regression were determined before and after reperfusion. A total of 38 recordings of patients treated with metoprolol and 34 recordings of patients with carvedilol were eligible for analysis of QT/RR slopes. The two study groups were similar with respect to age, gender, TIMI perfusion grades, ventricular function, duration of ischemia, and site and size of infarction. Mean RR- and QT-intervals were similar to the metoprolol and carvedilol groups, before and after PCI. Likewise, there was no significant difference in QT/RR slopes between the metoprolol and carvedilol groups before PCI. In contrast, after PCI, there was a trend toward lower QT/RR slopes in the metoprolol group (from 0.18 ± 0.07 to 0.17 ± 0.08), and a significant decrease in QT/RR slopes in the carvedilol group (from 0.17 ± 0.07 to 0.14 ± 0.09). In patients undergoing successful direct PCI for AMI, treatment with carvedilol, in contrast to metoprolol, was associated with a significant decrease in QT–RR slopes, suggesting greater cardiac electrical stability.     

急诊直接冠状动脉成形术与溶栓治疗急性心肌梗死比较研究

目的 :比较直接经皮腔内冠状动脉成形术 (PTCA)与静脉溶栓治疗急性心肌梗死 (AMI)患者近期和长期的临床疗效。方法 :选择首次AMI患者 ,71例患者接受静脉溶栓治疗 ,6 2例接受直接PTCA治疗 ,比较两组临床和住院期及随访期超声心动图结果。结果 :溶栓组院内死亡率高于直接PTCA组 (P <0 .0 5 )。溶栓组血管再通率为 73.2 % ,梗塞相关血管 (IRA)达到TIMIIII级血流者为 6 4 .3% ;直接PTCA组血管再通率为 10 0 % ,均达TIMIIII级血流。AMI后 2周左室射血分数 (LVEF)溶栓组为 5 0 .4± 13.3% ,直接PTCA组为 6 3.8± 9.4 % ,两组有显著差异 (P <0 .0 5 )。溶栓成功者其AMI后 2周LVEF也明显低于直接PTCA组 (5 4 .3± 8.2vs 6 3.8± 9.4 ,P <0 .0 5 )。溶栓组中采用内科保守治疗者其AMI后 3、6个月的LVEF始终低于直接PTCA组 (P <0 .0 5 )。溶栓组因溶栓失败行补救PTCA者为 18.3% ,IRA开通率为 10 0 % ,其AMI后 2周及 3、6个月的LVEF略低于直接PTCA组 ,但无显著差异 (P <0 .0 5 )。溶栓组因IRA未能开通或存在梗死后心肌缺血症状行择期PT CA的比率明显高于直接PTCA组 (32 .4 %vs 0 % ,P <0 .0 5 )。结论 :与溶栓治疗比较 ,直接PTCA能使IRA安全有效充分开通 ,可更好地改善患者近期和长期心功能 ,降低院内死亡率。补救PT     

超声评价心肌梗塞患者经皮腔内冠状动脉成形术后左室功能变化

为观察经皮冠状动脉腔内成形术（PTCA）对心肌梗塞患者左室功能的作用，对29例首次心肌梗塞患者于发病后5．8±3．8周行PTCA，并于术前（平均4．8±4．3天）、术后早期（平均4．5±2．6天）和随访期（术后6．3±1．5月）用二维和多普勒超声测定左室功能。结果，PTCA成功25例（管腔狭窄由94．1±4．6％降至17．5±13．9％）；其术后左室容量明显减小，而整体和局部收缩功能明显改善，左室舒张功能变化不明显。本研究提示，心肌梗塞恢复期PTCA对患者具明显的临床有益作用。     

组织定征技术对急性心肌梗死经皮腔内冠状动脉成形术的定量评价

目的 :探讨背向散射积分技术 (IBS)及彩色室壁运动分析技术 (CK) ,定量评价急性心肌梗死(AMI)经皮腔内冠状动脉成形术 (PTCA)治疗疗效 ,以及急性心肌梗死后早期再灌注的临床意义。方法 :选取PTCA治疗的急性心肌梗死患者 36例 ,分为 A组 (发病至再灌注治疗时间≤ 4h)与 B组 (发病至再灌注治疗时间 >4h) ,测定其治疗后 30 d时背向散射积分标化值 (IBS% ) ,背向散射积分周期变异幅度 (CVIB) ,标化背向散射积分周期变异延迟时间 (DTCV% )及全收缩期心内膜位移速度 (VSEM)。结果 :在两组临床基本情况无明显统计学差异时 ,B组梗死区的 CVIB、 VSEM明显低于 A组 (P<0 .0 5) ,IBS%则明显高于 A组 (P<0 .0 5)。结论 :心肌缺血后 4小时内的早期再灌注治疗对于急性心肌梗死患者有较好的治疗作用 ,背向散射积分技术及彩色室壁运动分析技术能定量评价 PTCA参数 ,因而具有重要的临床实用价值     

Influence of Early Coronary Reperfusion on QT Interval Dispersion After Acute Myocardial Infarction

We studied the influence of early coronary reperfusion on QT interval dispersion in patients with acute myocardial infarction (MI). Tbere were 54 males and 18 females witb a mean age of 60 ± 10 years. Of the 51 patients with recanalization of the infarct related vessel in the recovery phase, 28 (group A) had early coronary reperfusion (5.5 ± 2.7 bours), 23 other patients (group B) were not confirmed with early coronary reperfusion. Twenty-one patients (group C) did not undergo recanalization of the infarct related vessel in the recovery phase. Corrected QT (QT_c) maximum, QT_c minimum, and QT_C dispersion calculated as tbe difference between the maximum and minimum QT_c intervals, were compared among these three groups at both acute and recovery phase. At the acute phase after MI, there were no significant differences in the QT_c maximum, QT_c minimum, QT dispersion, and QT_c dispersion among these three groups. At the recovery phase after MI, there were also no significant differences in the QTc maximum and QTc minimum. However, there were significant differences in the QT dispersion (0.035 ± 0.010 in group A, 0.049 ± 0.015 in group B, and 0.061 ± 0.031 s in group C, respectively; P = 0.0001), and QT_c dispersion (0.038 ± 0.012 in group A, 0.050 ± 0.015 in group B, and 0.063 ± 0.032 s in group C, respectively; P = 0.0003) among the three groups. Comparison of QT_c dispersion between acute and recovery phase revealed significant reduction from acute to recovery phase in group A. The number of premature ventricular contraction was lower in groups A and B than group C. In summary, early coronary reperfusion may reduce electrophysiological instability by reducing QT dispersion in the recovery phase after acute MI.     

超声评价经皮冠状动脉腔内成形术对心肌梗塞后左室重构的作用

为了评价经皮冠状动脉腔内成形术（PTCA）对心肌梗塞后左室重构的作用，将51例首次心肌梗塞患者分为两组：PTCA组（25例PTCA成功患者）和对照组（26例未行PTCA患者）。对PTCA组患者于术前（4．8±4．3天）、随访则（术后6．3±1．5月）及对照组患者予相问时间进行超声心动图检查。结果表明，PTCA组患者术后随访期左室容量减小、在室收缩功能明显改善，而左室舒张功能无显著变化。与对照组相比，PTCA组随访期左室容量较小．而收缩及舒张功能明显好于对照组。结论：心肌梗塞恢复期PT－CA能明显阻止左室重构，具临床有益作用。     

QT离散度在冠状动脉搭桥术中的意义及其应用

为阐明冠状动脉搭桥术(CABG)对QT离散度(QTd)的影响,并探讨其临床意义,我们记录并分析了我院24例冠心病患者(心绞痛2例,陈旧性心肌梗塞19例,冠心病心力衰竭3例)行CABG术前及术后不同时间的心电图,测算其QTd和心率校正的QT离散度(QTcd),同时观察其心绞痛缓解程度、心功能改善状况及左室射血分数的变化。结果显示:术前病人QTd、QTcd(91.47±27.57、96.76±25.88ms)均明显高于正常(40～50ms),而术后dl即明显减小(64.80±23.38、76.18±21.12、P<0.001),术后10d基本恢复正常(35.91±11.59、40.19±9.83),且这一结果与其它临床指标明显相关。结论:CABG能有效地改善心肌供血,缓解心绞痛,提高心功能;QTd、QTcd无论在CABG术前病情判断还是在术后疗效观察中,都是一项可靠而敏感的指标。