经皮冠状动脉腔内成形术对冠心病患者心室晚电位的影响

为观察经皮冠状动脉腔内成形术（ＰＴＣＡ）对心室晚电位（ＶＬＰ）的影响，对３８例冠心病患者ＰＴＣＡ前、后的信号平均心电图（ＳＡ－ＥＣＧ）进行定性、定量分析和随访观察。时域分析发现，３例ＶＬＰ阳性中的１例ＰＴＣＡ术后ＶＬＰ消失，有５．７％（２／３５）ＶＬＰ阴性患者术后ＶＬＰ转为阳性；频谱时间标测发现，４例ＶＬＰ阳性中的２例术后ＶＬＰ消失，有１１．８％（４／３４）ＶＬＰ阴性患者术后ＶＬＰ转为阳性；全组患者中，ＰＴＣＡ前、后ＳＡ－ＥＣＧ参数的变化无显著性（Ｐ＞０．０５）。术后随访１０．９±２．５（４～１４）个月，未发生心律失常事件。提示ＰＴＣＡ可使ＶＬＰ阳性的部分患者转阴；使很少部分患者ＶＬＰ阴性转为阳性，提示再灌注可能改善冠心病患者的预后     

无症状左心功能不全高血压患者的心室晚电位

观察无症状左心功能不全高血压患者心室晚电位（ＶＬＰ），与左心功能的相关性。方法用彩色多普勒及ＫＧＣ－４００检测仪测定５０例高血压患者心室晚电位。结果ＶＬＰ阳性２８例（占５６％），心脏射血分数（ＥＦ）４５±８．７，Ａ／Ｅ１．２１±０．２２。ＶＬＰ的Ｖ４０与ＥＦ、Ａ／Ｅ的相关系数ｒ＝－０．８２，Ｐ＜０．０５。５０例高血压左室肥厚（ＬＶＨ）检出１７例（占３４％），其中２８例ＶＬＰ阳性者１４例（占５０％），２２例ＶＬＰ阴性者３例（占１３．６％）。结论ＶＬＰ与高血压左心功能不全关系密切。     

经皮冠状动脉腔内成形术对冠心病患者心室晚电位的 …

为观察经皮冠状动脉内成形术（ＰＴＣＡ）对心室晚电位（ＶＬＰ）的影响，对３８例冠心病患者ＰＴＣＡ前，后的信号平均心电图（ＳＡ－ＥＣＧ）进行定位，定量分析和随访观察，时域分析发现，３例ＶＬＰ阳性中的１例ＰＴＣＡ术后ＶＬＰ消失，有５．７％（２／３５）ＶＬＰ阴性患者后ＶＬＰ转为阳性；频谱时间标测发现，４例ＶＬＰ阳性中的２例术后ＶＬＰ消失，有１１．８％（４／３４）ＶＬＰ阴性患者术后ＶＬＰ转为阳性；全组患者中     

高血压病左室肥厚的室性心律失常与心室晚电位关系的探讨

检测３２２例有或无左室肥厚（ＬＶＨ）高血压病患者的心室晚电位（Ｌｐ）和２４小时动态心电图。结果发现：Ｌｐ阳性检出率为１８．３％，室性心律失常（ＶＡ）检出率为５３．１％。ＬＶＨ者和无ＬＶＨ者Ｌｐ阳性检出率分别为３４．９％和９．９％（Ｐ＜０．０１）；ＶＡ的检出率为８１．７％和３８．５％（Ｐ＜０．０１）。并发现ＬＶＨ又Ｌｐ阳性者ＶＡ、复杂ＶＡ及室速（ＶＴ）检出率（１００％、９７．４％、８１．９％）均高于ＬＶＨ的Ｌｐ阴性者（７１．８％，Ｐ＜０．０１，２１．１％、１．４％，Ｐ＜０．００１）和无ＬＶＨ的Ｌｐ阳性者（７６．２％，Ｐ＜０．０１，５７．１％、４７．６％，Ｐ＜０．００１）。表明Ｌｐ与高血压病的ＶＡ，尤其是复杂ＶＡ及ＶＴ具有密切关系。     

冠心病心室晚电位与左室功能的关系

目的：观察心室晚电位（ＶＬＰ）、心律失常事件（ＡＥ）与左室功能之间的关系。方法：１４５例冠心病患者均进行信号平均心电图（ＳＡ－ＥＣＧ）检测和２４小时ＨＯＬＴＥＲ监测，同期进行冠状动脉造影和左室造影及随访观察。结果：１１４５例冠心病患者（心绞痛５５例、陈旧性心肌梗死９０例），随访１４１±７１（４－３６）月，发生ＡＥ７例。２ＶＬＰ阳性组左室射血分数（ＬＶＥＦ）显著降低（Ｐ＜００５）。３发生ＡＥ组ＬＶＥＦ显著降低（Ｐ＜００５）。结论：左室功能障碍者ＶＬＰ阳性率高、容易发生ＡＥ。     

52例心肌梗塞患者心室晚电位临床分析

５２例心肌梗塞患者心室晚电位临床分析林娜（江苏省盐城市第一人民医院盐城２２４００１）心肌梗塞（心梗）患者用心室晚电位（ＶＬＰ）筛选心源性猝死风险的高危病人日益受到临床重视。为了观察心粳患者ＶＬＰ出现阳性的情况，作者对５２例心梗患者ＬＶＰ临床资料分析如...     

急性心肌梗塞伴心律失常患者心室晚电位与肌酸激酶的关系

作者报道急性心肌梗塞（ＡＭＩ）患者早期（一周内）伴有室性心律失常（ＶＡ）４４例，其心室晚电位（ＶＬＰ）阳性率２９．５％与血清肌酸激酶（ＣＫ）及同功酶（ＣＫ－ＭＢ）峰值呈正相关；与年龄，性别，心梗部位无关。室速（ＶＴ）和室颤（ＶＦ）组的ＶＬＰ阳性率明显高于室早组（Ｐ＜０．０５）。但两组的ＣＫ，ＣＫ－ＭＢ比值无统计学意义。     

心肌梗塞病人心室晚电位与电程序刺激的相关性及其预后意义

对４８例心肌梗塞（ＭＩ）病人的心室晚电位（ＶＬＰ）检测与自发和心室电程序刺激（ＥＰＳ）诱发单形性持续性室性心动过速（ＳＭＶＴ）的相关性的研究表明：（１）临床无自发持续室速者ＶＬＰ和ＥＰＳ阳性率分别为１９％和２６％；（２）ＥＰＳ诱发ＳＭＶＴ者ＶＬＰ检出率（６２．５％）高于未诱发者（９。４％）；（３）ＶＬＰ阳性者ＥＰＳ－ＳＭＶＴ诱发率（７６．９％）高于ＶＬＰ阳性者（１７．１％）（Ｐ〈０．０５）。结果显     

老年冠心病患者心室晚电位与多普勒超声左室舒张功能测定…

对４８例老年冠心病患者及２０例健康老年人作心室晚电位（ＶＬＰ）和彩色多普勒超声左心室舒张功能测定。结果显示：冠心病组ＶＬＰ阳性率比健康组显著升高（分别为３３．３％及０％，Ｐ＜０．０１），左心室舒张功能较健康组明显降低；ＶＬＰ阳性组与阴性组比较，前者左室舒张功能降低更明显；左室舒张功能参数（Ａ／Ｅ比率）与ＶＬＰ各指标（ＱＲＳ时限、Ｄ４０、Ｖ４０）之间有直线相关关系。     

单次大剂量口服妥卡尼、普罗帕酮对心室晚电位的影响

目的：通过急性药物试验，研究抗心律失常药物对心室晚电位（ＶＬＰ）的影响，为选用合适的抗心律失常药物。方法：２４例ＶＬＰ阳性的冠状动脉粥样硬化性心脏病（冠心病）患者参加了２７例次急性药物试验，单次大剂量口服妥卡尼８００ｍｇ１３例次或普罗帕酮４００ｍｇ１４例次，观察两种抗心律失常药物对ＶＬＰ的影响。结果：发现妥卡尼和普罗帕酮均不能消除ＶＬＰ，但可延长滤波后的ＱＲＳ波群时限（分别为４．３９％，Ｐ＜０．０５及１４．６７％，Ｐ＜０．０１），且普罗帕酮能选择性延长振幅信号持续时间（２４．０４％，Ｐ＜０．０１）。结论：急性药物试验安全可行，无明显毒副作用，可作为ＶＬＰ阳性患者选择合适抗心律失常药物的初步筛选试验。ＶＬＰ阳性患者，抗心律失常药物可能通过延长滤波后的ＱＲＳ波群时限及（或）振幅信号持续时间而防治恶性室性心律失常。     

心室晚电位与老年心肌梗塞关系的研究

检测４７例老年心肌梗塞患者的心室晚电位（ＶＬＰ），结果发现老年人患心肌梗塞后，在急性期或伴有左室收缩功能异常时，其ＶＬＰ阳性检出率明显升高；溶栓治疗对于降低老年急性心肌梗塞患者的ＶＬＰ阳性率有一定意义。     

3366例心脏病人心室晚电位的临床分析

目的:探讨心性猝死与心室晚电位的关系.方法:比较3366例心脏病人心室晚电位阳性与阴性患1年内死亡率及转阴后的死亡率变化.结果:3366例中心室晚电位阳性189例,占受检病人的5.6%,经治疗后121例转为阴性,转阴率为64%,随访1年,有7例(3.7%)猝死,6例发生于晚电位持续阳性,1例发生于转阴后,3177例晚电位阴性病人1年内死亡30例,死亡率为0.94%.结论:心室晚电位阳性有预测发生心脏恶性事件的价值.其有效防治十分必要.     

46例睡眠呼吸暂停综合征患者夜间室性心律失常和猝死

本文对４６例睡眠呼吸暂停综合征（ＳＡＳ）患者进行了心室晚电位（ＶＬＰ）检查，阳性３０例（６５％）；夜间室性心律失常（ＮＶＡ）１５例，３例夜间猝死。采用多元Ｌｏｇｉｓｔｉｃ回归分析，筛选出ＶＬＰ、窦缓、窦速与ＳＡＳ密切相关。与对照组相比，ＶＬＰ阳性率和ＮＶＡ发生率均有显著差异（Ｐ＜０．０１和Ｐ＜０．０５）。提示应用ＶＬＰ．对ＳＡＳ患者的ＮＶＡ和猝死预测是一项有用的新指标。     

原发性高血压左心室肥大伴室性心律失常与心室晚电位关系探讨

为探讨心室晚电位与原发性高血压左心室肥大伴室性心律失常之间的关系,检测66例合并及94例不合并左心室肥大原发性高血压患者的心室晚电位和动态心电图.结果心室晚电位阳性率13.1%,合并或不合并左心室肥大者分别为20.6%和7.6%(P<0.01);室性心律失常检出率为82.3%和38.4%(P<0.01).心室晚电位阳性的左心室肥大伴室性心律失常、复杂室性心律失常及室性心动过速检出率(100%、64.5%、28.5%)均高于心室晚电位阴性的左心室肥大者(76.9%、47.1%、15.4%,P<0.05)及无左心室肥大的心室晚电位阳性者(71.4%、28.6%、14.3%,P<0.05).提示心室晚电位对原发性高血压的室性心律失常,尤其是复杂性室性心律失常有一定预测价值.     

晚电位与冠心病

对心室晚电位（ＶＬＰ）与冠心病（ＣＡＤ）的关系进行了探讨，并观察了ＶＬＰ的动态演变。结果：ＣＡＤ及其急性心肌梗塞（ＡＭＩ）和陈旧性心肌梗塞（ＯＭＩ）患者ＶＬＰ阳性率分别为４２．０％（１１３／２６９）、５０９％（５４／１０６）和３７．１％（５３／１４３）；在ＡＭＩ合井持续性室性心动过速（ＶＴ）或室颤（ＶＦ）者则高达９１．７％（１１／１２）；发现ＶＬＰ在ＡＭＩ、ＯＭＩ和正常者均存在一定程度的演变。     

Prevalence of ventricular late potentials in patients with obstructive sleep apnea syndrome

BACKGROUND: It is known from various cardiac disorders that the presence of ventricular late potentials (VLP) in the signal-averaged electrocardiogram (ECG) is associated with an increased risk of sudden cardiac death. HYPOTHESIS: In view of the increased cardiovascular mortality of patients with obstructive sleep apnea syndrome (OSAS), we assessed the prevalence of VLP in these patients. METHODS: In all, 118 consecutive patients with polysomnographically verified OSAS were prospectively studied; 21 snorers without evidence of a sleep-related breathing disorder served as a control group. Signal-averaged ECG and 24-h Holter ECG were performed in all patients and controls, and left ventricular function was determined by radionuclide ventriculography in the OSAS group. Furthermore, patients and controls were followed for up to 45.5 months for arrhythmic events, syncopes, or sudden cardiac death. RESULTS: An abnormal signal-averaged ECG was seen in seven patients (5.9%) and in one snorer (4.8%). Patients with and without VLP did not differ with respect to age, body mass index, left ventricular ejection fraction, or ectopic activity in the 24-h Holter ECG, but the former had significantly higher mean (standard deviation) apnea/hypopnea indices [55.4 (25.2)/h vs. 37.4 (22.6)/h; p < 0.05]. Of the 118 patients, 110 could be followed for 26.7 (7.9) months. During this period, two patients had syncopes and one patient had sudden cardiac death. The seven patients with VLP remained free of events during the follow-up period, as did the 21 snorers. CONCLUSIONS: Patients with OSAS have a low prevalence of VLP in the signal-averaged ECG, not exceeding that in normal subjects. Moreover, abnormal signal-averaged ECGs do not appear to be useful as a prognostic marker.     

心率变异预测急性心肌梗死预后的价值

为探讨急性心肌梗死（ＡＭＩ）预后与心率变异（ＨＲＶ）的关系及ＨＲＶ与左室射血分数（ＬＶＥＦ）、心室晚电位（ＶＬＰ）联合应用对心律失常事件的预测价值，对８４例ＡＭＩ后两周的患者进行ＨＲＶ时域及频域分析和ＶＬＰ检测，并进行长期随访。平均随访１６．７５±７．７４（４～２９）个月（１２例失访）。结果表明：①发生严重心律失常事件的ＡＭＩ患者（１５例）的ＨＲＶ较无严重心律失常事件者（５７例）明显下降〔ＳＤ：３．８７９±０．３５５ｌｎ（ｍｓ）ｖｓ４．０７７±０．２８１ｌｎ（ｍｓ），Ｓｔ．Ｇｅｏｒｇｅｓ指数：３．６７７±０．５６９ｖｓ３．９２９±０．３５８，ＬＦ：４．３９９±１．１７９ｌｎ（ｍｓ２／Ｈｚ）ｖｓ５．０４１±０．９１２ｌｎ（ｍｓ２／Ｈｚ），Ｐ均＜０．０５〕。②ＨＲＶ对严重心律失常事件预测的敏感性为４６．７％，高于ＬＶＥＦ（３３．３％）及ＶＬＰ（２６．７％）；阳性预测值为３０．４％，与ＬＶＥＦ（３１．２％）及ＶＬＰ（３０．８％）相近。③ＨＲＶ分别与ＬＶＥＦ、ＶＬＰ合用，可明显提高阳性预测值（依次为６０％和５０％）。提示ＡＭＩ后心律失常事件的发生及心脏性猝死与ＨＲＶ有密切关系。     

Geographical variation of mortality from cardiovascular diseases. The Project 'Myocardial Infarction in mid-Sweden'

In this study, the geographical variation of the mortality rate in mid-Sweden was studied. Data on mortality from all causes and mortality from cardiovascular diseases, cerebrovascular diseases, ischaemic heart disease (IHD) and non-cardiovascular diseases for men and women 45-74 years of age living in 76 communities in mid-Sweden were obtained from the National Bureau of Statistics. After age standardization, the rates for mortality from all causes and cardiovascular mortality were substantially higher in the Westernmost communities compared with those in the East, whereas for non-cardiovascular mortality there were no systematic differences. The county with the higher rate for IHD had a 60% higher rate for men aged 45-64 years and a 53% higher rate for women aged 45-64 years than the county with the lowest rate. The corresponding excess mortality rates from stroke were 73% for men aged 45-74 and 46% for women aged 45-74 years. The cause of this variation is not known. It is not due to the confounding effect of different age distributions in the communities, differences in the registration of causes of death, or differences in case fatality rate.     

陈旧性心肌梗塞患者心室晚电位与临床关系探讨

本文对50例陈旧性心肌梗塞（OMI）患者利用动态心电图（DCG）分析系统进行了心室晚电位（VLP）检测，并以90例正常人作对照。结果发现：①OMI患者VLP阳性率为22％（11／50例）；②OMI患者在VLP检测时有非持续性室速者VLP阳性率为75．0％（3／4例），而无非持续性室速者VLP阳性率为17．4％（8／46例），二者相比，差异十分显著（P＜0．01）；③VLP阳性与梗塞部位、室性早搏情况、心功能不全、室壁瘤形成等无明显相关。     

Assessment of autonomic function in patients with acute myocardial infarction or diabetes mellitus by heart rate variability, ventricular late potential and QT dispersion.

To compare the efficacy and sensitivity of heart rate variability (HRV), QT dispersion (QTd) and ventricular late potential (VLP) examination in judging autonomic function. Thirty three patients with acute myocardial infarction (AMI) and 33 patients with diabetes mellitus (DM), all of whom were diagnosed with autonomic neuropathy determined by a standard test of cardiovascular autonomic function, were examined by HRV (timing domain methods), QTd and VLP. Thirty three normal individuals served as controls. The mean SD of the normal R-R interval (SDNN) in both the AMI and DM groups was significantly less than that in the control group (p< 0.01); and of course, the QTd of these groups was significantly greater than that of the controls (p< 0.01). The VLP positive rate of the AMI and DM groups were much higher than that of the control group (p< 0.001). SDNN was shown to be significantly negatively correlated to QTd (r= -0.45); and significantly negatively correlated to VLP (r= -0.47); QTd was shown to be positively, though not significantly, correlated to VLP (r=0.48). QTd could be looked as sieving index; HRV could be looked as routine examination of cardiovascular autonomic function, especially SDNN; the combination of HRV and VLP could improve the accuracy of diagnosis.