静息心电图巨大倒置T波的临床价值

目的 探讨静息心电图巨大倒置T波的临床应用价值。方法 分析93例一过性和103例持续性巨大倒置T波患者的病因构成、形态、Q-T间期及左心室肥大诸参数。结果 一过性巨大倒置T波者主要见于冠心病，尤其是急性冠状动脉综合征和心脏外急症，其形态对称或Q-TC间期未延长者冠心病分别占78.3％和82．0％。持续性巨大倒置T波主要见于各类器质性心脏病，其形态对称且无左心室肥大者冠心病占86．7％。结论 对称性倒置或一过性巨大倒置T波对冠心病尤其是急性冠状动脉综合征有预测价值。持续性巨大倒置T波可能是实质性心肌病变的重要预测因素，其形态对称且无左心室肥大时对冠心病尤其是并发实质性心肌病变有预测价值。     

19例巨大倒置T波的临床意义

目的　通过对 19例巨大倒置T波 (GITW)临床及随访资料的分析 ,探讨GITW的临床意义。　方法　将 19例患者 ,根据病因分为两组 ,即心源性组 12例 ,非心源性组 7例 ,测量T波深度 ,QT间期及ST段压低程度 ,并进行组间比较 ,部分患者出院后进行了随访。　结果　心源性组与非心源组相比 ,T波深度较大 ,但无显著差异 ;QT间期则有非常显著性差异 (P <0 0 1) ;住院死亡 5例 ,占 2 6 %。　结论　GITW不仅见于心源性因素 ,也可见于非心源性因素 ,并对非心源性患者预后产生严重影响。     

老年人持续性心前导联巨T倒置11例报告

本文报道１组老年人（８０．８±６．１岁）心前导联巨Ｔ倒置达数年之久，其特点认为酶学检查不增高，持续性心前导联Ｔ波非对称性倒置≥１．０ｍＶ，静滴硝酸甘油不改善，心绞痛发作时Ｔ波变浅。此组１１例均为冠心病，其中８例同时有高血压病，５例有心室肥厚。对于此类病人应慎下急性心内膜下心梗的诊断，慎用抗凝甚至溶栓治疗。     

巨大负性T波患者冠心病的预测影响因素

目的：探讨心电图巨大负性T波在冠心病诊断中的预测价值。方法：回顾性分析1998年1月至2001年12月64例心电图示巨大负性T波并在我院行冠状动脉造影检查的患者，对其心电图、超声心动图和临床资料进行统计分析。结果：心电图示无左心室肥厚或表现为对称性巨大负性T波则支持冠心病的诊断。巨大负性T波患者心电图缺乏左心室肥厚较对称性T波倒置对冠心病更有预测价值。结论：心电图巨大负性T波患者不伴左心室肥厚或对称性T波倒置是预测冠心病的重要因素。     

高血压伴左心室肥厚与T波顶峰后宽度的关系

目的探讨高血压左心室肥厚(LVH)患者T波顶峰后宽度(TpTe间期)的改变及其临床意义。方法随机抽取2010-10-2011-06桂林医学院附属医院心内科住院的原发性高血压(EH)患者313例,根据超声心动图(UCG)测定的左心室质量指数(LVMI)分为LVH组和非LVH(NLVH)组。比较两组TpTe间期、校正TpTe间期(TpTec)、QT间期、校正QT间期(QTc)、QRS时限、LVMI、左心室舒张末期内径(LVEDD)、室间隔厚度(IVST)、左心室后壁厚度(LVPWT)的改变及其相互关系;比较不同血压水平对TpTe间期的影响;EH患者左心室不同构型TpTe间期改变的特点。结果与NLVH组比较,LVH组TpTe间期[(100.0±23.3)比(85.3±14.1)ms]、TpTec[(108.6±26.7)比(91.4±15.4)ms]、QTc[(435.0±23.6)比(420.0±23.5)ms]、QRS时限[(105.3±22.3)比(95.6±16.1)ms]均延长(均P<0.01),LVMI[(142.8±29.3)比(82.5±19.0)g/m2],LVEDD[(58.9±7.5)比(47.6±6.5)cm],IVST[(9.7±1.0)比(8.8±1.2)cm],LVPWT[(9.4±1.1)比(8.5±1.1)cm]明显增大(均P<0.01),QT间期延长,但差异无统计学意义。TpTe间期在不同左心室构型间的改变为:离心型肥厚>向心性肥厚>左心室游离壁肥厚>正常心室形态。Pearson相关分析表明,TpTe间期、TpTec与LVMI(r=0.43,0.44)、LVEDD(r=0.41,0.43)呈正相关(P<0.05)。多元线性回归分析显示,LVMI、LVEDD是TpTe间期重要的影响因素(β=0.026、0.280)。结论 TpTe间期可作为评价高血压伴左心室肥厚靶器官损害程度的心电学指标之一。     

Giant R wave, convex ST-segment elevation, and negative T wave during exercise treadmill test

The giant R wave syndrome is characterized by giant R wave accompanied by widening of the QRS complex, marked ST segment elevation, QRS axis deviation, and the formation of monophasic QRS-ST complex with obliteration of S wave in leads facing the ischemic zone. This report describes a 65-year-old-man with variant angina who had a transient giant R wave syndrome during an exercise treadmill test. Initially, at peak exercise, there was a convex ST segment elevation ending in a negative T wave in the same (inferior) leads which showed giant R waves. Later, in the recovery period and coinciding with an amelioration of myocardial ischemia, there was a less marked increase of R wave amplitude associated with concave ST segment elevation and positive T wave in the inferolateral leads. Subsequently, a ST segment depression in the inferolateral leads preceded the ECG normalization. The patient had also a concave ST segment elevation and positive T wave in inferolateral leads during a spontaneous episode of variant angina at rest. An emergency coronary arteriography showed a dominant right coronary artery with an 80% and a 75% diameter stenosis of the middle and distal segment, respectively; the other arteries and left ventriculogram were normal. The underlying mechanisms of the different shapes of ST segment elevation and T waveform in the setting of acute transmural myocardial ischemia are discussed.     

Microvolt T wave alternans in human cardiac hypertrophy: electrical instability and abnormal myocardial arrangement

INTRODUCTION: Although T wave alternans (TWA) is a promising risk marker for myocardial electrical instability, it remains unclear how the presence of TWA is related to myocardial damage. METHODS AND RESULTS: TWA was measured in 28 patients with hypertrophic cardiomyopathy (HCM), 29 patients with hypertensive left ventricular hypertrophy (HLVH), and 15 normal volunteers using a CH2000 system. The amplitude of TWA (Valt) was measured at the lead with the maximum amplitude. Cardiac biopsy was performed in 12 HCM patients, who were divided into two groups (severe and mild) based on histologic findings of myocardial disarray and fibrosis. TWA was positive (Valt > 1.9 microV) in 61% of HCM and 31% of HLVH, despite a nearly identical left ventricular mass index (176 +/- 65 g/m2 vs 175 +/- 39 g/m2). Valt at heart rate = 110 beats/min was significantly greater in HCM with severe disarray and fibrosis than in HCM with mild disarray and in HLVH. CONCLUSION: In HCM patients, a positive TWA test probably is related to abnormal myocardial arrangement (disarray) and/or fibrosis, and it may reflect electrical instability of the myocardium.     

不同原因电张调整性T波的导联分布特征

目的探讨不同原因电张调整性T波改变的心电学特征。方法对30例右心室心尖部临时或永久性起搏后、10例左室下后间隔特发性室性心动过速后及8例后间隔间歇性或持续性预激综合征射频消融术后电张调整性T波的分布特征进行分析。结果①电张调整性T波的导联分布特点为:右心室心尖部起搏组分布最广,除下壁导联(Ⅱ、Ⅲ、aVF)外,胸导联(Vl￣V4100.0%,Vl￣V676.7%)亦广泛存在,其最大倒置T波的深度(0.85±0.26mV)较特发性室性心动过速组(0.42±0.18mV)、预激综合征组(0.40±0.19mV)均深,差异有非常显著性意义(P均<0.01),最深倒置的常分布在V3、V4导联。②特发性室性心动过速组分布也较广,除下壁导联外,左胸导联(V4￣V6为100.0%)亦存在,其最深倒置的常分布在V4、V5导联。③预激综合征组分布较窄,常局限于下壁导联。结论不同原因电张调整性T波的导联分布也不同,了解这些特征有助于与心肌缺血、急性肺栓塞等所致的T波改变相鉴别。     

Diurnal change of giant negative T wave in patients with hypertrophic cardiomyopathy

To examine the diurnal change of negative T wave (deeper than 10 mm in precordial leads) in apical hypertrophic cardiomyopathy and the mechanism of giant negative T wave, 24-h ambulatory electrocardiographic monitoring was performed in 8 patients with apical hypertrophic cardiomyopathy, and effect of atropine on electrocardiogram was studied. The mean depth of negative T wave at 1, 2, and 3 P.M. was 9.3 +/- 3.0 mm, and that at 1, 2, and 3 A.M. was 12.6 +/- 4.8 mm. The mean R-R interval at 1, 2, and 3 P.M. was 792 +/- 113 ms and that at 1, 2, and 3 A.M. was 1055 +/- 94 ms. In seven patients (88%), negative T wave was deeper during the night than during the daytime. There was a positive correlation between R-R interval and depth of negative T wave in 6 patients (75%). Despite significant shortening of R-R interval (879 +/- 116 to 804 +/- 110 ms, p less than 0.05), atropine did not significantly change the depth of negative T wave (14 +/- 5 to 14 +/- 5 mm). In conclusion, negative T wave is not fixed, but is variable, diurnally, probably due to the change of sympathetic tone.     

应用心电图记分法评价心肌梗死T波早期倒置的意义

对接受静脉溶栓治疗、临床评价再通的56例急性心肌梗死（MI）患者应用心电图记分法估计溶栓治疗前后MI的面积，并计算MI面积挽救程度；按有无T波早期倒置分为两组，进行统计学分析，发现有显著差异（P＜0．05）。提示存在T波早期倒置现象的患者，冠状动脉开通更充分、心肌能获得更充分再灌注，可作为估计预后及是否进一步干预治疗的证据。     

早期T波倒置对判断梗死相关动脉开通的临床价值

目的 探讨急性心肌梗死（ａｃｕｔｅ ｍｙｏｃａｒｄｉａｌ ｉｎｆａｒｃｔｉｏｎ,ＡＭＩ）早期Ｔ波倒置对判断梗死相关动脉开通的临床价值。方法 对发病≤６ｈ的６１例（男性４６例、女性１５例,年龄３９～８０岁）ＡＭＩ患者以动态心电图持续２４ｈ监测Ｔ波变化,并与冠状动脉造影结果作对照。结果 再灌注治疗患者,再灌注后Ｔ波正向振幅显著降低同时呈现Ｔ波倒置并逐渐加深,其中溶栓治疗成功的２４例于发病的２～３０（８     

急性前壁心肌梗死早期 T波倒置程度的 临床意义

目的　探讨心肌梗死早期心电图中最大倒置T波(maximalnegativeTwave;NTmax)的临床意义。方法　以初发急性前壁心肌梗死(AMI)10h以内来院就诊的80例患者作为对象。根据NTmax深度分为三组(1)深倒置T波(DNT)组NTmax≥10mm;(2)中度倒置T波(INT)组4mm≥NTmax＜10mm;(3)浅倒置T波(SNT)组NTmax＜4mm。根据铊201心肌同位素显像和锝99心室腔同位素造影分别求出心肌灌注指数和左室射血分数(LVEF),将肌酸激酶最高值(CKmax)、心肌灌注指数和LVEF作为判断心肌梗死严重程度的指标,分析了NTmax与心肌梗死面积、左室功能状况的关系。结果　NTmax出现在发病后4～102(47.2±21.4)h,NTmax与CKmax呈逆相关(r=0.416,P＜0.005),与左室射血分数(r=0.564,P＜0.003)呈正相关。DNT组与其他二组比较,V     

高血压患者心电图SD波在诊断左心室肥厚中的价值

目的测试一种新的心电图诊断标准,提高诊断原发性高血压病合并左心室肥厚的准确性。方法以美国超声心动图学会对左心室质量测量作为标准,选取高血压病(HBP)合并左心室肥厚(LVH)患者129例,同期根据年龄、性别匹配高血压左心室正常组(109名)。同步记录12导联心电图,选取所有心电图导联中最深S波(S_D)为研究对象,与采用目前公认的LVH心电图标准Cornell和Sokolow-Lyon进行比较,计算心电图相关指标判断HBP合并LVH的ROC曲线及其曲线下面积(AUC),获得鉴别的最佳临界值。结果心电图S_D预测HBP合并LVH的敏感度、特异度及AUC分别为86. 05%、81. 65%、0. 892;心电图S_D+Sv4显示最高的敏感度为88. 37%。等效性检验显示单导联S_D的AUC较Cornell、Sokolow-Lyon及S_D+Sv4标准Z值均具有统计学差异(P0. 05)。心电图S_D诊断男性HBP合并LVH的AUC及敏感度、特异度分别为0. 901、90. 29%、75. 34%,等效性检验均优于Cornell、Sokolow-Lyon及S_D+Sv4标准(P 0. 05)。结论心电图S_D诊断HBP合并LVH,提高了其诊断的敏感性,优于Cornell和Sokolow-Lyon标准,值得临床推广。     

Deep negative T waves associated with reversible left ventricular dysfunction in acute adrenal crisis

We report two cases of reversible left ventricular dysfunction associated with deep negative T waves during acute adrenal crisis due to isolated deficiency of adrenocorticotrophic hormone. There were no symptoms suggestive of heart disease in either case and left ventricular wall motion abnormalities, present mainly around the left ventricular apex, returned to normal in 1–2 weeks. Deep negative T waves normalized 4 weeks after corticosteroid administration. Acute adrenal crisis should be considered when deep negative T waves are associated with left ventricular dysfunction without cardiac symptoms.     

正常人右胸导联心电图T波形态的性别差异

目的探讨正常人右胸导联心电图男女T波形态差异规律及临床意义。方法测量240名正常人右胸导联心电图,比较男女T波形态及变化规律。结果Vl→V3R→V6R直立T波出现率逐渐减少,倒置T波出现率逐渐增多。女性以倒置T波为主,男性以直立T波多见,差异有显著意义(P<0.01)。V1→V6R的T波变化规律:可均倒置,女性多于男性(P<0.01);也可由直立→双相→平坦→倒置,男性多于女性(P<0.01),但未见由倒置→直立。结论正常人右胸导联心电图T波形态男女差异显著,应引起临床注意。     

T wave normalization during dobutamine stress testing in patients with non-Q wave myocardial infarction. A marker of myocardial ischaemia?

Conflicting results in a heterogenous patient population havebeen described on the functional significance of stress-inducedT wave normalization in the ECG. The aim of this study was toevaluate the relationship between T wave normalization duringdobutamine stress testing and stress-induced ischaemia evaluatedby echocardiography and myocardial perfusion scintigraphy inpatients with previous non-Q wave myocardial infarction. Among520 patients who underwent dobutamine stress testing in conjunctionwith simultaneous echocardiography and 201 thallium or sestamibiSPECT for evaluation of suspected myocardial ischaemia, 36 wereselected according to the following criteria: previous non-Qwave myocardial infarction, normal QRS, negative T waves intwo or more ECG leads and no significant ST segment depressionor elevation at rest or during stress. Diagnosis of ischaemiarelied upon the occurrence of reversible perfusion defects byscintigraphy and stress-induced wall motion abnormalities byechocardiography. During the test, T wave normalization (definedas a resting negative T wave becoming upright in one or moreECG leads during stress) occurred in 20 patients (group 1),while in 16 patients the T waves remained negative (group 2).The prevalence of ischaemia was higher in group I than in group2 both by scintigraphy (85% vs 38%, p=0.004) and by echocardiography(70% vs 32%, p=0·02). The sensitivity, specificity andaccuracy of T wave normalization in the detection of ischaemiawere 74%, 77% and 75% by SPECT and 74%, 65% and 69% by echocardiographyrespectively. CONCLUSION: In patients with non-Q wave myocardial infarction and suspectedmyocardial ischaemia, T wave normalization without concomitantECG changes during dobutamine stress testing is associated witha higher prevalence of ischaemia compared to patients with persistentT wave inversion. This ECG finding should not be disregardedas a marker of ischaemia in that particular patient population.     

16例持续全导联ST段下移与T波倒置患者长期随访分析

目的　进一步了解持续全导联ST段下移与T波倒置的临床意义和预后。方法　选取因不典型胸痛伴有持续全导联ST段下移与T波倒置患者 16例 ,随访观察 5～ 15年 ,常规观察心电图、超声心动图、心脏X线片、临床症状、心功能状态。结果　最后诊断肥厚型心肌病 9例 ( 5 6 3 % )、扩张型心肌病 2例 ( 12 5 % )、缩窄性心包炎 1例 ( 6 3 % )、糖尿病 2例 ( 12 5 % )、原因不明T波深倒者 2例( 12 5 % )。结论　左室肥厚是引起ST段下移与T波倒置的主要原因 ;糖尿病是又一原因。患者预后与T波倒置深度无关 ,主要取决于基础疾病的发展、恶性状态及伴发心律失常情况。     

The relationship between serial postinfarction T wave changes and infarct size and ventricular function as determined by cardiac magnetic resonance imaging

Background

The value of sequential T wave changes on the electrocardiogram (ECG) has less well been described than ST-segment changes in the follow-up of patients with myocardial infarction (MI). We investigated whether the amplitude of T wave positivity correlates with infarct size (IS) and left ventricular ejection fraction (LVEF) measured using cardiac magnetic resonance imaging 3 months after reperfusion therapy.

Materials and Methods

Fifty-five patients with a first acute MI referred for primary percutaneous coronary intervention were included. Electrocardiograms were analyzed within 4 hours after reperfusion and at 3 months, measuring T wave ampitudes in 2 contiguous infarct-related leads, summed up as one value called T wave amplitude. Cardiac magnetic resonance imaging was performed at 3 months of follow-up. Correlations between T wave amplitude, IS, and LVEF were tested with Pearson r correlation coefficient test. Subanalyses were performed using a 2-sample t test.

Results

A good correlation was found between LVEF and IS (r = −0.7, P < .0001). Most of the patients had inferior MI location (69%). In this group, there were significant positive correlations between the amount of T wave positivity and both IS (r = −0.40, P = .012) and LVEF (r = 0.33, P = .043). Results were similar in patients with and without an increase in T wave amplitude during follow-up.

Conclusions

In this study of patients with reperfused MI, patients with inferior locations demonstrated a statistically significant relationship between the amount of positivity of T wave amplitude and both IS and LVEF measured at 3 months. Furthermore, these results were independent of whether the T wave positivity was persistent or evolutionary between the immediate postreperfusion and 3-month ECG recordings.