原发性扩张型心肌病心电图分析

原发性扩张型心肌病临床上并不少见,我院自1974年1月～1994年12月收住院的原发性心肌病,资料完整的55例,现就心电图变化进行分析。1 资料和结果1.1 一般资料:本组55例患者中,男41例(74.5％),女14例(25.5％),年龄19～78岁,平均53.02±14.88岁。 55例患者均有心电图、超声心动图、X线胸片、胸透及心功能判定。     

原发性扩张型心肌病病例心电图分析

原发性扩张型心肌病近年报道较多，国内对其临床表现、诊断及治疗亦有不少论述，但对本病的心电图分析报道尚少。现将近年来确诊的７２例原发性扩张型心肌病患者的心电图改变作一分析，报告如下。１资料和结果１．１临床资料本组７２例均为住院患者，全部病例均经过详细询...     

扩张型心肌病的心电图改变

目的观察扩张型心肌病病例的心电图改变。方法26例经心脏超声检查诊断为扩张型心肌病的病例列入观察。分析结果显示所有病例心电图均有异常改变,其中以一度房室阻滞最为常见(35%),其次是ST段下移(31%)和心房颤动(26%)。对心电图各波段测定,显示QRS时限延长明显(115±34.5ms),与心脏超声检查测定的左室大小呈线性正相关。结论提示对于心电图出现QRS时限延长,或一度房室阻滞或ST段下移或心房颤动者,有必要进行心脏超声检查。     

扩张型心肌病心电图特征探讨

为探讨扩张型心肌病心电图特征,对13例扩张型心肌病(Ⅰ组)与16例左心室内径>50mm的风湿性心脏(Ⅱ组)及20例后壁 间隔>24mm的原发性高血压(Ⅲ组)患者12导联心电图比较。发现3组存在左心室高电压者差异无显著意义。Ⅰ组肢体导联R_Ⅰ、R_Ⅱ、R_Ⅲ电压最低,S_V_1、S_V_2最深,R_V_6/R_Ⅰ、R_V_6/R_Ⅰ、R_V_6/R_Ⅲ最高,与另两组相比,仅R_V_6/R_Ⅱ差异有显著意义。R_V_6/R_V_5>1者Ⅰ组与Ⅱ、Ⅲ组差异有显著意义。R_V_6与肢体导联最高R波之比(R_V_6/R_(max))Ⅰ组最高(P<0.05、P<0.001对Ⅱ组及Ⅲ组)。R_V_6/R_(max)>2.5者Ⅰ组占61.5％,Ⅱ和Ⅲ组分别为12.5％和0％(P<0.01、P<0.00l对Ⅰ组)。提示:R_V_6/R_V_5>1及R_V_6/R_(max)增高可能为扩张型心肌病的心电图特征,R_V_6/R_(max)>2.5有一定临床应用价值。     

扩张型心肌病的心电图分析

目的 探讨心电图对扩张型心肌病的诊断价值.方法 选择102例扩张型心肌病患者常规12导联同步心电图,分析心律失常、传导阻滞、ST-T改变、异常Q波、肢导联低电压、胸前导联R波递增不良及左胸导联高电压等指标.结果 心律失常的发生率为46.08%,以室性早搏和心房颤动最常见;传导阻滞发生率为42.16%,以一度房室阻滞和完全性左束支阻滞常见;ST-T改变发生率高达94.12%;异常Q波发生率为21.57%;肢导联低电压的发生率为13.73%;胸前导联R波递增不良的发生率为67.65%.RV5+SV1≥3.5 mV或RV6≥3.5 mV的发生率为36.27%;RV6/RV5>1的发生率为61.76%;连续三个心搏的R波和S波电压之和为QRS总电压V6>V5的发生率为36.27%;RV6/Rmax≥3的发生率为31.37%.结论 扩张型心肌病常出现多种异常心电图表现,常规12导联心电图对扩张型心肌病的诊断有一定的实用价值.     

扩张型心肌病的起搏心电图2例

脉冲发生器、电极导线和心脏组织组成 1个起搏系统 ,保证心脏有效起搏。任何一部分发生故障 ,都可导致起搏失效。现有 2例扩张型心肌病病人 ,在安置ＶＶＩ型永久性起搏器后的不同时期内均发生了无效起搏 ,报告如下。例 1　男 ,71岁。临床诊断 :扩张型心肌病。于 1995年 12月 8日植入永久性ＶＶＩ型起搏器 ,电极在右心室心尖部安装。术后 5ｄ ,患者诉右上腹有跳动感。查 :心率 60次 ｍｉｎ ,律不齐。查ＥＣＧ示 :Ｒ -Ｒ长 0 .82ｓ间歇后见起搏脉冲信号规则出现 ,多数后继以宽大畸形的ＱＲＳ波 ,频率为 72次 ｍｉｎ ,部分未继以ＱＲＳ波 ,即起…     

扩张型心肌病合并左心室血栓的研究进展

<正>左心室血栓形成是扩张型心肌病的严重并发症之一,栓子脱落可引发卒中或体循环栓塞而产生不良后果。左心室血栓的诊断、危险因素识别、预防和治疗在临床诊疗中尤为重要。本文对扩张型心肌病合并左心室血栓形成的研究现状和最新进展做一综述。扩张型心肌病是一类表现为心腔扩大、心脏收缩力下降、心力衰竭、心律失常和血栓栓塞的异质性心肌病。左心室血栓形成是扩张型心肌病的常见严重并发症,血栓脱落可导致脑、肾和肢体动脉栓塞,增加致残和死亡风险。现对扩张型心肌病合并左心室血栓形成的发生机制、危险因素、预防和治疗进展做一综述。     

Partial left ventriculectomy improves left ventricular end systolic elastance in patients with idiopathic dilated cardiomyopathy

OBJECTIVE: To assess the effect of partial left ventriculectomy (PLV) on estimate of left ventricular end systolic elastance (Ees), arterial elastance, and ventriculoarterial coupling. PATIENTS: 11 patients with idiopathic dilated cardiomyopathy before and two weeks after PLV, and 11 controls. INTERVENTIONS: Single plane left ventricular angiography with simultaneous measurements of femoral artery pressure was performed during right heart pacing before and after load reduction. RESULTS: PLV increased mean (SD) Ees from 0.52 (0.27) to 1.47 (0.62) mm Hg/ml (p = 0.0004). The increase in Ees remained significant after correction for the change in left ventricular mass (p = 0.004) and end diastolic volume (p = 0.048). As PLV had no effect on arterial elastance, ventriculoarterial coupling improved from 3.25 (2.17) to 1.01 (0.93) (p = 0.017), thereby maximising left ventricular stroke work. CONCLUSION: It appears that PLV improves both Ees and ventriculoarterial coupling, thus increasing left ventricular work efficiency.     

Semiquantitative histomorphometric analysis of myocardium following partial left ventriculectomy: 1-year follow-up

BACKGROUND: Although partial left ventriculectomy (PLV) may have beneficial clinical effects in patients with dilated cardiomyopathy (DCM), there are no reports on effects of PLV on myocardial histology. The objective of this study was to assess histological properties of the LV myocardium 1 year following PLV as compared to histology at the time of the operation. METHODS: The study group consisted of 15 consecutive PLV survivors, predominantly male (13/15), aged 45+/-12 years. Surgical specimens and endomyocardial biopsies, taken 12 months postoperatively, were processed routinely and stained with Masson-trichrome. The following morphometric parameters were assessed semiquantitavely: (1) degree of hypertrophy and attenuation; (2) nuclear evidence of hypertrophy; (3) myofibrillar volume fraction; (4) degree of degenerative vacuolar changes; and (5) fibrosis volume fraction. RESULTS: Both New York Heart Association (NYHA) functional class and ejection fraction (EF) improved 12 months following surgery as compared to preoperative values (2.40+/-0.69 vs. 3.33+/-0.49, p<0.001, and 33.21+/-12.05% vs. 20.21+/-9.07%, p<0.001, respectively). Morphometric analysis demonstrated postoperative decrease in the degree of attenuation as compared to preoperative values (1.40+/-0.51 vs. 2.47+/-0.64, p<0.01), as well as a decrease in fibrosis volume fraction (2.07+/-0.80 vs. 2.67+/-0.49, p<0.001) and nuclear hypertrophy (1.27+/-0.46 vs. 1.67+/-0.62, p<0.05). On the other hand, postoperative increase in myofibrillar volume fraction (1.87+/-0.61 vs. 1.40+/-0.61, p<0.01) was noted. CONCLUSION: One year postoperatively, PLV has favourable effects on myocardial morphology that parallels improvement in the patient's functional status and LV systolic function.     

生长激素治疗扩张性心肌病前后心电图及激素水平变化

目的进一步探讨重组人生长激素(r-GH)治疗扩张性心肌病(DCM)心力衰竭前后的心电图、超声心动图(UCG)改变以及r-GH和胰岛素生长因子(IGF-1)、肿瘤坏死因子(TNF)水平的变化,探讨其相互之间的关系。方法住院确诊DCM者46例,在常规治疗心力衰竭的基础上分为常规治疗心力衰竭组(A组)与r-GH治疗组(B组),用r-GH4u皮下注射三个月后,测定治疗前后的P-R间期、心率、ST段、QRS波群间期及血清GH、IGF-1、TNF水平、左室舒张末径(LVEDd)、左室收缩末径(LVESd)心胸比例。结果①心电图在A组与B组的ST段、心率及P-R间期在组内比较有显著性差异(P<0.05)。②TNF在正常组与心力衰竭组,A组与B组内及组间比较都有显著性差异(P<0.05)。③r-GH、IGF-1在A组与B组内及组间比较无显著性差异。④心胸比例、LVEDd、LVESd在治疗前后的组内与组间比较有显著差异性(P<0.05)。结论小剂量的(r-GH)治疗DCM能够使心功能改善,短期内治疗效果良好。     

Results of partial left ventriculectomy for dilated cardiomyopathy: hemodynamic, clinical and echocardiographic observations

OBJECTIVES

The study was done to prospectively measure the echocardiographic, hemodynamic and clinical outcomes after partial left ventriculectomy (PLV).

BACKGROUND

Although PLV can improve symptoms of advanced heart failure, immediate postoperative echocardiographic findings remain abnormal.

METHODS

Fifty-nine patients with cardiomyopathy and advanced heart failure underwent PLV and concomitant mitral valve surgery between May 1996 and December 1997. Thirty-nine percent were on inotropic therapy. All were New York Heart Association (NYHA) functional class III or IV. Mechanical circulatory support (LVAD) and transplant were provided for rescue therapy when hemodynamic compromise occurred. Patients were followed for a mean of 405 ± 168 days, and clinical, echocardiographic and hemodynamic measures were obtained preoperatively, immediately postoperatively, and at 3 and 12 months prospectively.

RESULTS

Comparing preoperative and 12-month postoperative values in event-free survivors, we found: NYHA functional class improved from 3.6 to 2.1, p < 0.0001; peak oxygen consumption increased from 10.8 to 16.0 ml/kg/min, p < 0.0001; LV ejection fraction increased from 13 ± 6.0% to 24 ± 6.9%, p < 0.0001; LV end diastolic diameter decreased from 8.2 ± 1.03 to 6.2 ± 0.64 cm, p < 0.0001, and volume was reduced from 167 ± 60 to 105 ± 38 ml/m², P = 0.02. Central hemodynamics did not normalize after surgery.

CONCLUSIONS

Partial left ventriculectomy can provide structural remodeling of the heart that may result in temporary improvement in clinical compensation. However, perioperative failures and the return of heart failure limit the propriety of this procedure.     

扩张性心肌病与缺血性心肌病的心电图鉴别诊断

目的:比较扩张性心肌病(DCM)与缺血性心肌病(IHD)在ECG上的特征,为临床的鉴别诊断提供依据。方法:已确诊的DCM及IHD患者各20名,超声心动图显示左室内径增大,心功能Ⅱ～Ⅳ级,行体表心电图检查,测量Rv6.Rv5,Rv5+Sv1,RⅠ,RⅡ,RⅢ,RⅠ+Ⅲ,RV6/Rmax及异常Q波的分布情况。结果:两组的Rv2,Rv5+Sv1,R1+SⅡ差别无显著意义(P>0.05),但DCM组Rv6较IHD组显著增加(P<0.05),RⅠ、Ⅱ、Ⅲ降低(P<0.05);Rv6/Rmax也比IHD组明显增多(P<0.05),Rv6/Rmax>3.0的DCM组占67％,而IHD组竟无1例。IHD的异常Q波更常见(60％),而DCM的则仅为25％。结论:ECG的RVv6/Rmax>3.0对左心室扩大的DCM和IHD有较重要的鉴别诊断意义。     

ECG characteristics of dilated cardiomyopathy

To elucidate the electrocardiographic (ECG) characteristics of dilated cardiomyopathy (DCM), the authors analyzed the 12-lead ECGs and echocardiograms in 45 patients with DCM, 54 patients with left ventricular (LV) dilatation secondary to valvular heart disease (VHD), 101 hypertensive patients with LV hypertrophy, and 63 normal control subjects. In addition, serial ECG and echocardiographic changes in DCM during a mean follow-up period of 1.6 years were evaluated. Sokolow's criterion (S wave in lead V₁ [SV₁] + R wave in lead V₅ or V₆ [RV₅ or RV₆] > 35 mm) was met comparably in patients with DCM (69%), VHD (61%), and hypertension (74%) (P = NS). Notably, RV₆ in DCM was the highest among the four groups and correlated with the degree of LV dilatation. In contrast, the R waves in leads I, II, and III (RI, RII, RIII) in DCM were the lowest and were not affected by the degree of LV dilatation, although RII and RIII in VHD and RI in hypertension correlated with the degree of LV dilatation and hypertrophy, respectively. As a result, all voltage ratios of RV6/RI, RII, RIII in DCM were not only the highest, but also increased linearly as the LV dilated progressively during the follow-up period. In particular, RV₆ over the maximum R wave in leads I, II, and III (RV₆/Rmax) in DCM correlated with the degree of LV dilatation and inversely correlated with ejection fraction. Subjects with DCM had a significantly higher RV₆/Rmax than did patients with VHD, hypertension, and normal subjects (3.4 vs 1.7, 1.4, 1.2, respectively; P < .001), and this ratio of ≥3 was seen in 67% of the DCM patients versus 4% of the VHD patients, 1% of the hypertensive patients, and 0% of the normal subjects. Thus, DCM commonly shows the ECG signs of LV hypertrophy, but characteristically has the high voltage ratios of RV6/RI, RII, RIII.     

The electrocardiogram in the diagnosis and management of patients with dilated cardiomyopathy

The term dilated cardiomyopathy (DCM) defines a heterogeneous group of cardiac disorders, which are characterized by left ventricular or biventricular dilatation and systolic dysfunction in the absence of abnormal loading conditions or coronary artery disease sufficient to cause global systolic impairment. In approximately one third of cases, DCM is familial with a genetic pathogenesis and various patterns of inheritance. Although the electrocardiogram (ECG) has been considered traditionally non‐specific in DCM, the recently acquired knowledge of the genotype–phenotype correlations provides novel opportunities to identify patterns and abnormalities that may point toward specific DCM subtypes. A learned ECG interpretation in combination with an appropriate use of other ECG‐based techniques including ambulatory ECG monitoring, exercise tolerance test and imaging modalities, such as echocardiography and cardiovascular magnetic resonance, may allow the early identification of specific genetic or acquired forms of DCM. Furthermore, ECG abnormalities may reflect the severity of the disease and provide a useful tool in risk stratification and management. In the present review, we discuss the current role of the ECG in the diagnosis and management of DCM. We describe various clinical settings where the appropriate use and interpretation of the ECG can provide invaluable clues, contributing to the important role of this basic tool as cardiovascular medicine evolves.     

扩张型心肌病的治疗进展

扩张型心肌病(DCM)的基本治疗包括抗心力衰竭、心律失常及预防血栓栓塞等并发症。β-受体阻滞剂、血管紧张素转换酶抑制剂与血管紧张素受体拮抗剂及醛固酮受体拮抗剂可降低DCM心力衰竭的死亡率。胺碘酮对室性心律失常的治疗是安全有效的,埋藏式心脏复律除颤器(ICD)则可减少猝死,但ICD是否可在DCM的一级预防中应用尚存争议。心脏再同步治疗为部分心力衰竭患者提供了新的治疗方法。外科治疗主要适用于难以治疗的、晚期的DCM心力衰竭患者。他汀类药物及已酮可可碱、免疫球蛋白的使用可短期改善DCM患者的心功能。