J波与J波综合征

J波是指心电图上QRS波与ST段之间的圆顶状或驼峰状电位变化。新近临床研究表明，在早期复极综合征、Brugada综合征和特发性心室颤动等心电图中，均存在J波形态、时限和幅度的显著改变，上述与J波密切相关的一系列临床综合征统称为J波综合征。本文详尽阐述了J波的细胞电生理和离子流机制，分析了早期复极综合征、Brugada综合征、心电图下壁导联高大J波相关的心脏性猝死的临床特点及内在机制。     

Dispersion of P wave duration and P wave vector in patients with atrial septal aneurysm.

AIMS: Atrial septal aneurysm (ASA) may be involved in the genesis of atrial arrhythmias as a consequence of disturbances in the propagation of depolarization, which may be easily assessed by P wave dispersion measurement. The aim of this study is to assess the dispersion of P wave duration and P wave vector in patients with ASA and to determine the effect of associated interatrial shunt on the magnitude of P wave dispersion. METHODS AND RESULTS: The study population consisted of 23 healthy volunteers and 88 patients with ASA base more than 15 mm and protrusion more than 7.5 mm. The size of aneurysms and atria was determined by echocardiography and P wave dispersion was measured on the surface ECG. In ASA patients, dispersion of P wave duration was significantly increased when compared with healthy controls (7.8 +/- 12.1 vs. 3.7 +/- 3.5 ms; P < 0.01). Dispersion of P wave vector was also significantly increased (8.5 +/- 10.1 degrees vs. 4.6 +/- 3.6 degrees ; P < 0.005). In healthy volunteers, the mean values of both parameters were below the cutoff points. CONCLUSION: In patients with ASA, there was a significant dispersion of P wave duration and P wave vector. Variation in P wave duration was significantly correlated with the dispersion of P wave vector and age of these patients. Dispersion of P wave vector was significantly decreased in ASA patients with interatrial shunt. P wave dispersion in ASA patients may predispose to the development of atrial arrhythmias.     

估算的脉搏波传导速度与臂踝脉搏波传导速度的分布及一致性分析

目的观察估算的脉搏波传导速度(ePWV)和臂踝脉搏波传导速度(baPWV)在开滦研究人群中的分布特征并分析二者的一致性(差异及关联)。方法选择参加baPWV检测且基线资料完整的43 235例开滦集团公司职工作为观察人群。将研究对象按有无传统心血管危险因素分为风险人群和正常人群。在两人群中分别采用多元线性回归建立baPWV与年龄、年龄的平方、平均动脉压(MAP)的回归方程,并以此分别计算两人群的ePWV。观察ePWV和baPWV在人群中的分布特征并采用配对样本t检验和线性回归分析二者的差异和关联。结果在正常人群中,ePWV与baPWV分别为11.38±0.70 m/s和12.90±1.17 m/s;在风险人群中,ePWV与baPWV分别为14.29±1.85 m/s和15.74±1.76 m/s。无论在正常人群还是风险人群中,ePWV与baPWV均随年龄的增加而增加,男性的ePWV与baPWV均高于女性。同时,baPWV略高于ePWV(P0.01),在正常人群和风险人群中,二者平均差值分别为1.80 m/s和2.17 m/s。线性回归分析结果提示,二者在总人群、正常人群和风险人群中的线性R~2分别为0.428、0.279和0.388。结论 ePWV与baPWV具有相似的年龄、性别分布特征。二者差值相对较小且具有良好的线性关联。因此,ePWV可作为baPWV的良好替代指标。     

颈-股及颈-桡脉搏波速度测定在老年急性脑梗死患者中的一致性

目的 分析老年急性脑梗死患者颈动脉-股动脉脉搏波速度(cf-PWV)及颈动脉-桡动脉脉搏波速度(cr-PWV)的一致性,探讨脉搏波速度(PWV)在脑梗死防治工作中测定部位及参考值的选取.方法 测定44例老年急性脑梗死患者双侧cf-PWV及cr-PWV,Pearson相关分析及t检验分析不同部位测量值的一致性.结果 ①双侧cr-PWV无显著差异[左侧(10.73±1.88) m/s vs 右侧(10.97±1.82) m/s,P>0.05],双侧cf-PWV无显著差异[左侧(11.80±2.50) m/s vs 右侧(11.76±2.55) m/s,P>0.05];②双侧cr-PWV均显著低于cf-PWV(P<0.05);③同侧cr-PWV和cf-PWV显著相关,相关系数分别为右侧r=0.356,左侧r=0.300(P均<0.05).结论 老年急性脑梗死患者各部位PWV均有一致性,测量cf-PWV和cr-PWV均可反映脑血管弹性改变.     

非体外循环冠状动脉旁路移植术后一过性J波伴T波高耸的观察与分析

目的 探讨非体外循环冠状动脉旁路移植术(OPCAB)后形成一过性J波伴T波高耸的相关因素及其意义.方法 回顾性分析55例行OPCAB患者的临床资料,根据心电图是否出现J波伴T波高耸,分为有一过性J波伴T波高耸组(观察组18例)与无一过性J波伴T波高耸组(对照组37例),比较两组冠状动脉病变受累情况、冠状动脉狭窄的程度、...     

L wave in echo Doppler

62-Year-old female presented with progressive dyspnea NYHA class III for six months. Echocardiography showed normal left ventricular (LV) systolic function, mild biatrial enlargement, an L wave in pulse wave Doppler at mitral inflow and in M mode echocardiography across mitral valve. Tissue Doppler imaging at medial mitral annulus showed an L′ wave in mid diastole in addition to E′ and A′ wave. An L wave in pulse wave Doppler and M mode echocardiography represents continued pulmonary vein mid diastolic flow through the left atrium in to LV across mitral valve after early rapid filling. Presence of an L′ wave in these patients associated with higher E/E′ is indicative of advance diastolic dysfunction with elevated filling pressures.     

P波最大时限及P波离散度与急性心肌梗死并发心房颤动的关系

目的探讨P波最大时限（Pmax）及P波离散度（Pd）与急性心肌梗死并发心房颤动的关系。方法急性心肌梗死患者60例中出现房颤29例，未发生房颤31例。比较两组体表12导联心电图的Pmax、Pd。结果两组Pmax、Pd差异均有统计学意义（P〈0．01）．Pmax≥110ms,Pd≥40ms及两者相结合时预测心房颤动的敏感性分别为89．7％、86．2％、75．9％，特异性分别为77．4％、83．9％、90。3％，阳性预测值分别为78．8％、83．3％、88．0％。结论急性心肌梗死患者Pmax和Pd明显增加时易发生房颤，提示Pmax和Pd是预测急性心肌梗死患者发生房颤的一种简单可靠的方法。     

急性前壁心肌梗死R波、Q波和ST段演变速度的观察

目的 通过心电图对急性心肌梗死的诊断提供更多的信息。方法 对21例急性前壁心肌梗死患者进行R波、Q波和ST段变化进行同步12导联心电图动态观察。将开始到结束的7次标测分成6个时间间隔．分别计算各个时间间隔的∑R、∑Q、和∑ST的平均值和标准差。结果∑R于胸痛发作后12h内迅速下降；∑Q逐渐增大，24h内变化最显著；EST 12h内迅速下降，48h后渐趋稳定。12例（57％）R波消失，Q波在发病后12h内形成；另9例（43％）于24h内形成。结论心肌梗死后ST段抬高、R波下降和Q波形成在快速型和慢速型心肌梗死患者中不同。     

P wave assessment: state of the art update

Diagnostic (mapping) and therapeutic (ablation, pacing) advances have provided insightinto atrial depolarization processes and new developments in P wave analysis. Information about interatrial pathwaysis important to the understanding of interatrial conduction delay. A standardized method for P wave analysis isnecessary for the development of a clinical role for management of patients with paroxysmal atrial fibrillationusing signal-averaged P wave analysis and P wave dispersion. Algorithms for predicting localization of ectopic Pwaves may facilitate catheter ablation. P wave changes due to pacing at different atrial sites may be useful forpermanent pacing for prevention of atrial fibrillation. Introduction of these developments into clinical practiceshould allow better prevention and treatment of atrial arrhythmias and could have considerable impact in view oftheir high frequency especially in the older population.     

Brugada波电交替及临床意义探讨

目的分析Brugada波的电交替现象。方法回顾性分析存在1型Brugada波且伴ST段和/或T波电交替现象的5例患者的心电图及临床特点。结果 5例患者均为男性,年龄18~50岁,入院时均存在1型Brugada波,并且分别在病因诊断确立或病情得到纠正过程中见到ST段和/或T波的电交替现象。ST段电交替可表现为抬高程度(高和低)的交替和抬高类型的(穹隆型和马鞍型)的交替,T波电交替表现为振幅(高和低)的交替和方向(双向和倒置)的交替。结论 Brugada波电交替现象可以发生于多种情况,同样具有多变性的特点。     

血压逆向梯度与重搏波的形成

本文用带二个血压传感器的导管测定了12条狗主动脉的血压波形.二传感器之间相距5厘米,分析了主动脉不同部位血压值的变化.特别是逆向血压梯度的形成,认为动脉血流的惯性及左心室的舒张是重搏波切迹前短时期内近心端血压低于远心端血压的主要原因,在动脉中存在着惯性动能与压力势能之间的相互转化.在此过程中形成了重搏波,而血压波的反射并不是形成重搏波的主要原因.并研究了多巴酚丁胺和硝酸甘油对重搏波的影响.     

A simple independent prognostic electrocardiography parameter in first acute anterior myocardial infarction; Precordial total Q wave/precordial total R wave

Background

We investigated the prognostic value of precordial total Q wave amplitude/precordial total R wave amplitude ratio (Q/R) in patients with first acute anterior MI treated with primary percutaneous coronary intervention (PPCI).

P波指数对心脏再同步治疗效果的预测价值

目的探讨心电图P波指数对慢性心力衰竭患者心脏再同步治疗(CRT)效果的预测价值。方法依据术前心电图P波指数(P波时限(PWD)、V1导联P波终末电势(Ptf或Morris指数)和P波时限/PR段值(Macruz指数,M))大小,将患者分为PWD1(<120ms)和PWD2(≥120ms)、Ptf1(≤-0.04mm·s)和Ptf2(>-0.04mm·s)、M1(≤1.6)和M2(>1.6)组,比较同一指标的两组患者间CRT术后6个月时的心功能指标改善及反应率有无差别。结果共117例患者资料纳入分析,结果显示:CRT术后6个月,各组患者心功能指标均有所改善,P波时限及P波终末电势不同的两组患者间相关指标改善程度差异有显著性(p<0.05),而P波时限/PR段值不同的两组患者间相关指标的改善程度并无明显差别(p>0.05),CRT反应率亦有类似发现。多因素分析显示LAD>40mm、PWD≥120ms及Ptf>-0.04mm·s与CRT反应率降低有关。结论术前心电图P波增宽及V1导联P波终末电势延长是CRT术后无反应的可能预测因子。     

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.     

快速心房刺激对P波时限及离散度的影响

目的分析快速心房刺激对P波时限及离散度的影响.方法在74例射频消融术及82例经食管心房调搏检查中,用180ppm的S1S1刺激心房3min,在刺激前后立刻记录12导联同步心电图,通过心电图测出刺激前后的最大P波时限、最小P波时限及P波离散度,然后进行比较.结果射频消融组最大P波时限在心房刺激后比刺激前有显著性延长（p=0.002）,最小P波时限及P波离散度无显著性差异,食管心房调搏组最大P波时限及P波离散度在心房刺激后比刺激前有显著性增加（p=0.001）,最小P波时限无显著性差异.结论快速心房刺激能引起心房传导时间延长,非均质电活动的离散程度增加.最大P波时限及P波离散度是可以用来评价心房电重构的简便而无创的指标.     

短阵房性心动过速后窦性心律的T波增高

目的探讨房性心动过速后窦性搏动T波增高的临床意义.方法分析12导联动态心电图证实的375例房性心动过速患者心动过速发生前后的心电图变化,尤其是T波的改变.结果 375例房性心动速患者中,P波改变14例,R波振幅改变5例（增高1例,降低4例）,ST段压低7例,U波改变2例,T波改变66例（17.6%）.66例T波改变的患者中,46例表现为T波低平或倒置,20例T波振幅增高,包括1例巨大直立T波.结论房性心动过速停止后,窦性心律下,多数患者表现为T波低平或倒置,T波振幅增高相对少见,巨大直立T波罕见,其临床意义尚待探讨.     

The osborn wave of hypothermeia in normothermic patients

The Osborn wave (also referred to as “the J wave,” “the J deflection,” or “the camel's hump”) is a distinctive deflection occurring at the QRS-ST junction of approximately 80% of hypothermic patients (core body temperature ≤95°F). Generally, the amplitude and duration of Osborn waves are inversely related to core temperature. We report on eight normothermic patients whose 12-lead electrocardiograms demonstrated QRS-ST junction notches similar to those seen in hypothermia. These data support the concept that the Osborn wave is not pathognomonic of hypothermia.     

An initial trial of quantitative evaluation of autoimmune pancreatitis using shear wave elastography and shear wave dispersion in transabdominal ultrasound

Background/ObjectivesWe aimed to examine therapeutic efficacy and prognosis prediction of autoimmune pancreatitis (AIP) using shear wave elastography (SWE) and shear wave dispersion (SWD) in transabdominal ultrasound (US).MethodsThe subjects were 23 patients with diffuse type 1 AIP who underwent SWE and SWD, and 34 controls with a normal pancreas. Elasticity and dispersion were defined as the pancreatic elastic modulus (PEM) and dispersion slope, respectively. PEM and dispersion slope were compared between AIP and control cases, and the short-term therapeutic effect and long-term prognosis were examined.ResultsPEM (30.9 vs. 6.6 kPa, P < 0.001) and dispersion slope (15.3 vs. 13.0 (m/sec)/kHz, P = 0.011) were significantly higher in AIP cases than in controls. Among the 17 AIP patients followed-up in two weeks after treatment, these parameters were 12.7 kPa and 10.5 (m/sec)/kHz with median decrease rate of 37.2% and 32.8%, respectively, which were significantly higher than the change in the size of pancreatic parenchyma (14.4%, P = 0.026). Fourteen of these subjects were followed up for >12 months, during which 2 had relapse; diabetes improved in 5 and worsened in 2; in 60% of cases, the pancreatic parenchyma was atrophied. The % change in PEM after two weeks was tended to be higher in non-atrophy cases.ConclusionSWE and SWD measurement in US may be useful for quantitative assessment of AIP and evaluation of short-term treatment efficacy.     

胺碘酮与缬沙坦对阵发性心房颤动患者P波离散度的影响的研究

目的 评价胺碘酮与缬沙坦对阵发性心房颤动（PAF）患者P波离散度和最大P波时限（Pmax）的影响。方法 96例阵发性心房颤动的患者被随机分成胺碘酮加缬沙坦组32例，胺碘酮组31例，缬沙坦组33例。对照组34例为正常健康人，观察药物治疗3个月前后心电图Pmax和Pdis的变化。结果 阵发性心房颤动患者Pmax、Pdis治疗前均与对照组比有显著性差异（P〈0．01），药物治疗3个月后，胺碘酮治疗能改善Pmax和Pdis，但胺碘酮加缬沙坦组改善Pmax和Pdis更显著（P〈0．05），缬沙坦组则与治疗前相比无显著性差异（P〉0．05）。结论 PAF患者的Pmax和Pdis与对照组相比有显著性差异，胺碘酮加缬沙坦治疗能显著改善PAF患者的Pmax和Pdis。