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.     

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.     

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     

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     

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…     

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。     

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.     

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     

QT Dispersion Does Not Predict Early Ventricular Fibrillation After Acute Myocardial Infarction

Ventricular arrhythmias may be associated with increased QT dispersion (difference between maximum and minimum QT on standard 12-lead ECG). We performed a case control study to determine if QT dispersion on the admission ECG could predict early VF after acute myocardial infarction. The cases were 24 patients with acute myocardial infarction (14 inferior, 8 anterior, and 2 lateral) with VF within 12 hours of admission. There were 24 control patients without VF matched for site of infarction and ST segment score (sum of ST segment elevation). VF occurred a median of 153 minutes (interquartile range 93–245) after onset of chest pain and 33 minutes (range 7–104) after initial ECG. QT (399 ± 37 and 394 ± 37), QT corrected (440 ± 38 and 429 ± 29), and QT dispersion (68± 20 and 66 ± 27) were similar in patients and controls. By design, ST score was similar (11 ± 9 vs 9 ± 5 mV), although a good match could not be obtained for three patients with extreme ST elevation. Patients with VF presented to the hospital earlier after the onset of chest pain (median 95 min [range 65–188] compared to 150 min [range 80–270], P= 0.05) and had a lower serum sodium (138 ± 2.4 vs 140 ± 2.5, P = 0.05) than controls. Thus, QT interval and QT dispersion, measured on the presenting ECG, did not predict early VF after myocardial infarction.     

急性心肌梗死患者溶栓前后QT离散度的变化

目的:观察急性心肌梗死(AMI)患者溶栓前后QT离散度(QTdispersion,QTd)的变化及早期再灌注对QTd的影响。方法:对61例AMI患者给予尿激酶静脉溶栓治疗,予溶栓前及溶栓2h后同步记录18导联心电图,分别测量成功组及失败组的QTd,并进行前后比较。结果:溶栓后再通41例,溶栓后未通20例。血管未通组其QTd较前减少,但无统计学意义(P>0.05),溶栓后再通组其QTd较血管未通组降低程度更大,有统计学意义(P<0.01)。结论:QTd可作为评价AMI患者溶栓后判断溶栓成功与否的一项临床早期参考指标。     

经皮冠状动脉腔内成形术对心绞痛和心肌梗塞QT离散度的影响及其临床意义

目的：探讨经皮冠状动脉内成形术（ＰＴＣＡ）对心绞痛和心肌梗塞病人ＱＴ离散度（ＱＴｄ）的影响及其意义。方法：分析８４例心绞痛和心肌梗塞患者ＰＴＣＡ术前、术后一天内所记录的心电图,测算ＱＴ间期、ＱＴ离散度、心率校正ＱＴ离散度（ＱＴｃｄ）。病例分为三组：心绞痛ＰＴＣＡ成功组、心肌梗塞ＰＴＣＡ成功组、心肌梗塞ＰＴＣＡ失败组。分别对三组ＱＴｄ、ＱＴｃｄ作术前、术后比较。结果：前二组术后ＱＴｄ、ＱＴｃｄ较术前显著减少（Ｐ＜０．０１）,失败组术前、术后ＱＴｄ及ＱＴｃｄ差异无显著性（Ｐ＞０．０５）。结论：成功的ＰＴＣＡ能显著减少心绞痛和心肌梗塞患者的ＱＴｄ,提示可能减少心律失常的发生率,从而减少心肌缺血患者的死亡率,可以改善患者的预后,术后心肌梗塞患者ＱＴｄ减少可能反映了顿抑或冬眠心肌的“苏醒“,并表明梗塞区内尚有存活心肌。     

基层医院开展急诊经皮冠状动脉支架植入术治疗急性心肌梗死的可行性研究

目的：探讨基层医院开展急诊经皮冠状动脉支架植入术（PCI）治疗急性心肌梗死（AMI）的可行性、安全性。方法：回顾分析2002年11月～2009年4月我院41例AMI患者的急诊PCI资料。结果：41例AMI患者,急诊开通梗死相关动脉（IRA）39例（即时成功率95.1%）,开通IRA者中术后死亡2例（死亡率4.9%）,总成功率90.2%。结论：在有条件的基层医院开展急诊PCI安全有效。     

急性心肌梗塞早期QT离散度分析

本文回顾分析了60例急性心肌梗塞（AMI）患者,患者在发病24 h内就诊,并描记首次心电图,分为有严重室性心律失常组和无室性心律失常组。发现两组QT离散度（QTd）和心率校正的QT离散度,（QTcd）均有显著的差异。而不同部位的急性心肌梗塞分组比较QTd和QTcd未显示明显的差异。     

Manual Measurement of QT Dispersion in Patients with Acute Myocardial Infarction and Nondiagnostic Electrocardiograms

OBJECTIVE: To determine whether manually measured QT dispersion (QTD) may be a useful diagnostic adjunct for acute myocardial infarction (AMI) in emergency department patients with chest pain (CP) and nondiagnostic initial electrocardiograms (ECGs). METHODS: This was a retrospective review of a cohort of patients admitted to the coronary triage unit (CTU) at a large urban facility over a two-year period (1997-1999). Cases included all patients with nondiagnostic initial ECGs diagnosed as having AMI by enzymatic criteria. Controls consisted of patients admitted to the CTU who received a final diagnosis of "musculoskeletal pain" at discharge. The QT intervals were measured on the ECGs obtained on presentation. The ECGs were included only if the QT interval could be measured on at least eight out of 12 leads. The QTD was calculated as the difference between the longest and shortest QT intervals in all measured leads. All measurements and calculations were done by a single individual. The QTDs were compared for cases versus controls using 50 msec as a cutoff for the presence of AMI. RESULTS: The study cohort consisted of 36 cases and 124 controls. The QTDs between the two groups were markedly different, with the mean for the cases at 85.5 msec [range: 40 to 200; +/-standard deviation (SD) = 39.6] and for the controls 47.1 msec (range: 0 to 120; +/-SD = 20.4). The unadjusted odds ratio (OR) of having a QTD greater than 50 msec in the setting of AMI and a nondiagnostic initial ECG in this cohort was 11.9 [95% confidence interval (95% CI) = 5.0 to 28.4; p < 0.0001] and was 12.5 (95% CI = 4.8 to 32.3; p < 0.0001) adjusted for age, gender, and ethnicity. CONCLUSIONS: Manually measured QTD is significantly greater in patients with AMI and nondiagnostic ECGs versus healthy controls with musculoskeletal CP. Along with other data, QTD may serve as a useful diagnostic and decision-making tool in patients with acute CP and nondiagnostic ECGs.     

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.