西拉普利与氨氯地平对原发性高血压患者QT间期离散度与室性心律失常影响的比较研究

将2012年5月~2014年3月我院收治的140例原发性高血压合并室性心律失常的患者纳入研究,随机分为接受西拉普利联合常规降压治疗的观察组和接受氨氯地平联合常规降压治疗的对照组,检测两组患者的QT间期和心律失常情况。结果观察组患者的QT间期、校正QT间期、QT间期离散度低于对照组,室性心律失常分级优于对照组。西拉普利治疗有助于降低QT间期离散度、改善室性心律失常,是治疗原发性高血压合并室性心律失常的理想方法。     

美托洛尔对高血压性心脏病QT间期离散度及室性心律失常的影响

观察美托洛尔对高血压性心脏病QT间期离散度及室性心律失常的影响。选取收治的高血压性心脏病患者60例,随机分为对照组和观察组各30例,对照组给予氢氯噻嗪、卡托普利等治疗,观察组在对照组基础上加用美托洛尔治疗。随访12个月,观察两组随访期间QTd、室性心律失常发生率及室间隔厚度改变情况。两组血压均得到有效控制,治疗前后血压比较无显著性差异(P0.05);两组治疗前QTd及室间隔厚度比较无显著性差异(P0.05);治疗后,观察组QTd及室间隔厚度逐渐降低或减少,与治疗前及对照组各时间点比较差异显著(P0.05);对照组各时间点QTd及室间隔厚度比较无显著性差异(P0.05);两组治疗前室性心律失常发生率比较无显著性差异(P0.05);对照组治疗前后室性心律失常发生率比较均无显著性差异(P0.05);治疗6个月后,观察组室性心律失常发生率与治疗前比较均明显降低,差异显著(P0.05)。美托洛尔可有效改善高血压性心脏病患者的心室功能,延缓心肌增厚,降低QT间期离散度及室性心律失常发生率,改善患者预后。     

维持性血液透析患者QT间期离散度与室性心律失常的关系及其影响因素

目的 检测60例尿毒症行维持性血液透析(MHD)患者透析前后QT间期离散度(QTd)的变化,初步探讨MHD患者QTd与室性心律失常的关系及其影响因素.方法 选择南方医科大学第三附属医院血液净化中心60例MHD患者分别于透析前及透析后记录12导联同步心电图,计算QTd值,并进行临床及相关实验室检查,进行统计学分析.结果 存在室性心律失常的MHD患透析前QTd高于无室性心律失常患者(50.84±13.56比39.57±14.72,P＜0.01);透析后QTd较透析前明显增大(59.73±20.11比44.23 ±13.26,P＜0.01);回归分析表明,透析后QTd的增幅与K +浓度的变化及HCO3-的变化幅度呈正相关 (分别为r=0.67,P＜0.01;r=0.79,P＜0.01).结论 MHD患者QTd与室性心律失常的发生有关;透析后QTd进一步增大;QTd增大的机制与K +浓度的快速变化及酸中毒的快速纠正有关.     

卡托普利对高血压左室肥厚QT离散度及室性心律失常的影响

大量流行病学研究证明,左室肥厚(LVH)是高血压病主要并发症之一,是增加心血管并发症的发生与死亡率的独立危险因素[1].其猝死率高,猝死以室性心律失常(VA)为主.通过对589例高血压LVH患者,口服卡托普利1、3、6个月,对超声心动图、同步12导心电图及Holter的测定,了解卡托普利对高血压LVH、QT离散度(QTd)及VA的影响.     

高血压病左室肥厚与QT离散度及室性心律失常的关系

QT离散度反映心肌复极的非同步性,而心室复极不均一程度又与室性心律失常的发生有关。本文通过对高血压病有无左室肥厚者QT离散度及警告性定性心律失常发生率的比较分析,对高血压左室肥厚的危险性进行探讨。1监床资料1．1病例选择选择符合WHO高血压诊断标准,确诊的原发性高血压病,病程2～14年的患者196例,其中94例有左室肥厚者作为观察组,102例天左室肥厚者作为对照组。观察组男64例,女30例;平均年龄60．3岁,平均病程5．15年;对照组男69例,女33例;平均年龄59．7岁,平均病程4．91年。所有病例均无冠心病、心绞痛、心肌梗死、…     

卡维地洛对扩张型心肌病QT间期离散度及室性心律失常变化的影响

目的 :探讨卡维地洛治疗对扩张型心肌病 (DCM )患者心电图QT间期离散度 (QTd)及室性心律失常的影响。方法 :80例DCM患者分为基础治疗组 (A组 ,40例 )及基础治疗加卡维地洛治疗组 (B组 ,40例 ) ,B组在基础治疗上加服卡维地洛 10mg ,2次 /d ,疗程 9个月。治疗前后应用 2 4h动态心电图和多普勒超声心动图 ,观测QTd、QTcd、HR、室性心律失常 (VA )如室性早搏 (PVC)、非持续性室性心动过速 (NSVT) )的发生情况、左心室射血分数(LVEF)。结果 :B组QTd、QTcd及室性心律失常 (VA )发生率均较A组显著降低 (P均 <0 0 1) ,左室射血分数(LVEF)较A组明显提高 (P <0 0 1) ,而HR、血压无明显变化 (P >0 0 5 )。提示B组疗效优于A组。结论 :DCM患者长期应用卡维地洛可显著降低QTd、QTcd及VA的发生率 ,改善心功能 ,改善预后     

急性心肌梗死患者QT离散度与室性心律失常的关系

目的探讨急性心肌梗死(AMI)患者QT间期离散度(QTd)与室性心律失常的关系。方法测量42例AMI患者心电图的QTd,对有室性心律失常组与无室性心律失常组进行比较。结果AMI有室性心律失常组的QTd高于无室性心律失常组的QTd。结论AMI患者发生室性心律失常与QTd增大有关。     

高龄急性心肌梗死室性心律失常与QT间期离散度的关系

目的　探讨 70岁以上的老年急性心肌梗死 (AMI)患者室性心律失常与QTcd的关系。方法　回顾性单盲法分析 10 0例 70岁以上老年急性心肌梗死 (AMI)发病 2 4h内首次心电图未校正的QT离散度(QTd)、心率校正QT离散度 (QTcd)。结果　 5 5例QTcd大于 6 0ms患者室性心律失常发生率明显高于QTcd小于 6 0ms的患者。结论　老年急性心肌梗死QTcd增高是导致室性心律失常的原因之一 ,早期测定QTcd是防止心律失常导致猝死的重要检测内容     

QT离散度对急性心肌梗死早期室性心律失常的预测

为了评估ＱＴ离散度对急性心肌梗死早期完整无缺人常发生的预测价值。方法：用回性单盲法分析３８例ＡＭＩ发病２４ｈ内首次心电图的未校正的ＱＴ离散度、心率校正ＱＴ离散度。结果：二种方法所测量物ＱＴ离散度在心律失常与无心律失常组间差异分别均具显著性。     

QT离散度与室性心律失常及猝死的关系

目的：探讨观测ＱＴ离散度与发生室性心律失常及猝死的关系。方法：回顾性、单盲法分析４２例急性心肌梗死（ＡＭＩ）患者１周内ＱＴ离散度（ＱＴｄ）,心率校正ＱＴ离散度（ＱＴｃｄ）,观察分析ＱＴｄ,ＱＴｃｄ与室性心律失常（ＶＡ）和心脏性猝死（ＳＣＤ）之间的关系。结果：合并ＶＡ（２３例）的ＱＴｄ,ＱＴｃｄ均明显延长于无ＶＡ（ＮＶＡ１９例）者;ＶＡ的发生率随着ＱＴ的延长（ＱＴｄ以６０ｍｓ,１００ｍｓ为分组界限）     

咪达普利和氨氯地平对高血压病左室肥厚患者QT离散度及室性心律失常影响的研究

目的 探讨咪达普利对高血压病左室肥厚(LVH)患者左室质量指数(LVMI)、心率较正的QT间期离散度(QTcd)及室性心律失常(VA)的影响。方法 高血压病LVH患者共170例,随机分为氨氯地平组(n=86),咪达普利组(n=84)。两组分别于治疗前、治疗1 a后用彩色多普勒Penn法测定LVMI,分析体表标准12导联心电图QTcd并用Halter记录VA发生的情况。结果 氨氯地平组治疗前、后LVMI变化无显著差异(P>0.05);咪达普利组治疗前、后LVMI分别为153±18g/m2和140±16g/m2,P<0.01。氨氯地平组治疗前后QTcd变化无显著差异(P>0.05);咪达普利组治疗前后QTcd无显著性差异(P>0.05)。治疗后两组间QTcd存在显著性差异(P<0.05)。氨氯地平组及咪达普利组治疗后前QTcd分别为74±12 ms和65±9ms,P<0.05。治疗前氨氯地平组与咪达普利组间QTcd无显著性差异,治疗后两者间QTcd存在显著性差异(P<0.05)。氨氯地平组及咪达普利组治疗前VA恶性程度无显著性差异(P>0.05),治疗后两组间VA恶性程度比较有显著性差异(P<0.05)。LVH患者LVMI与QTcd间有显著相关性(r=0.33,P<0.01)。结论 咪达普利治疗可显著降低LVMI和QTcd,从而降低VA的恶性程度。     

QT dispersion in children with ventricular arrhythmia and a structurally normal heart

In adults, increased QT dispersion has been shown to predict arrhythmic risk as well as risk of sudden death in several clinical settings. It is not known whether or not QT dispersion is increased in children with idiopathic ventricular arrhythmia. We studied three groups of children: (1) 20 patients with idiopathic VT (aged 3-18 years; mean 11.2 years); (2) 30 patients with benign PVCs (aged 1-20 years; mean 10.5 years); and (3) 30 control subjects (aged 4-17 years; mean 12 years). Standard ECGs were reviewed and the dispersion of both QT and JT intervals was compared. No patient had structural heart disease or long QT syndrome. The QT and QTc dispersion (QT delta, QTc delta) among the three groups did not differ: QTc delta of the VT group was 70 ms +/- 30 ms, QTc delta of PVC patients was 60 ms +/- 30 ms, and the QTc delta of the control group was 65 ms +/- 30 ms. The JTc delta among the three groups did not differ as well: JTc delta of the VT group was 70 ms +/- 30 ms, the JTc delta of the PVC group was 60 msec +/- 25 msec, and the JTc delta of the control group was 70 ms +/- 30 ms. We conclude that QT and JT dispersion are not significantly altered in children with idiopathic VT or benign PVCs when compared to control subjects. QT dispersion is not a reliable marker for arrhythmic risk in children with idiopathic ventricular arrhythmias and structurally normal hearts.     

肝硬变患者QT间期延长及QT间期离散度的临床意义

目的探讨肝硬变患者QT间期及QT间期离散度 (QTd)的变化与临床意义。方法测量 13 8例病毒性肝炎肝硬变患者的同步 12导联心电图 ,分析QT间期及QTd ,并与其他消化系疾病的 5 0例住院患者进行对照。结果肝硬变患者中QT间期延长发生率非常显著高于对照组 (P <0 .0 1) ,QTd也显著高于对照组 (P <0 .0 5 ) ;肝硬变患者Child PughA、B、C3级中QT间期延长发生率逐步升高 ,QTd增加也逐渐明显 (均为P <0 .0 5 ) ;肝硬变患者中死亡者的QT间期非常显著长于存活者 ,QTd也非常显著增加 (均为P <0 .0 1)。结论肝硬变患者QT间期延长发生率高 ,QTd增加明显 ,且与肝硬变严重程度相平行。提示QT间期延长及QTd可以作为肝硬变严重程度的指标之一。     

早期康复治疗对无合并症急性心肌梗死患者QT间期离散度的影响

目的 :探讨早期康复治疗对无合并症急性心肌梗死 (AMI )患者QT间期离散度 (QTd)的影响。方法 :113例研究对象前瞻性随机分为早期康复治疗组 (5 4例 )及对照组 (5 9例 )。两组主要基线资料具可比性。早期康复组采用期康复治疗方案 ,对照组采用传统方案。所有研究对象分别在入院当时 (平均 9.3h± 1.9h)、第 1周末、第 2周末、第 3周末记录标准 12导联心电图。QT间期的测量从QRS波起点至T波终点 ,同一导联测量 3个心动周期 ,取其平均值。不同导联最大QT值减去最小为QTd值。结果 :早期康复组入院当时、第 1周末、第 2周末、第 3周末QTd(分别为 6 4± 14ms,4 6± 15ms ,4 3± 12ms,39± 13ms )与对照组 (分别为 6 7± 12ms,4 8± 16ms ,4 1± 13ms,4 0± 15ms)比较统计学上无显著性差异 (P >0 .0 5 )。结论 :无合并症AMI患者实行早期康复治疗不影响QTd值 ,因而不影响心肌电稳定性 ,提示该组患者早期康复治疗安全可行     

Impact of electrocardiogram recording format on QT interval measurement and QT dispersion assessment

The aim of this study was to determine the effect of recording conditions on the operator dependent measures of QT dispersion in patients with known and/or suspected repolarization abnormalities. Among several methods for risk stratification, QT dispersion has been suggested as a simple estimate of repolarization abnormalities. In a cohort of high and low risk patients, different components of the repolarization process were assessed in the 12-lead ECG using three different paper speeds and amplifier gains. To assess measurement error and reproducibility, a straight line was repeatedly measured. The operator error was 0.675 +/- 0.02 mm and the repeatability of the measurement error was 31 +/- 6%. The QT interval was most frequently measurable in V2-V5. Depending on the lead selected for analysis, the incidence of visible U waves was greatest in the precordial leads with high amplifier gain and low paper speed, strongly affecting QT interval measurement. The timing of the onset of the QRS complex (QRS onset dispersion) or offset of the T wave was strongly dependent on the paper speed. Paper speed, but not amplifier gain, had a significant shortening effect on the measurement of the maximum QT interval. As QT interval measurement in each ECG lead incorporates QRS onset and T wave offset (depending on the number of visible U waves), the dispersion of each of these parameters significantly affected QT dispersion. Thus, QT dispersion appears to reflect merely the presence of more complex repolarization patterns in patients at risk of arrhythmias.     

QT interval dispersion in ventricular beats: a noninvasive marker of susceptibility to sustained ventricular arrhythmias

Increased QT dispersion (QTd) calculated from sinus beats has been shown to identify patients prone to sustained VT. However, predictive accuracy of this parameter is limited. Electrophysiological properties of the myocardium may be altered by a premature ventricular beats, which is a well-established trigger for sustained VT. Therefore, the author hypothesised that QTd in spontaneous or paced ventricular beats may improve identification of patients with inducible sustained VT. In 28 consecutive patients (men, mean age 61 +/- 13 years) who underwent programmed ventricular stimulation, the values of QTd calculated in sinus and ventricular beats were compared between inducible and noninducible patients. The mean QTd values obtained using three different methods differed significantly, QTd in paced ventricular beats being the highest, QTd in spontaneous ventricular beats was intermediate, and QTd in sinus beats was the lowest (83.9 +/- 30 vs 63.0 +/- 29 ms vs 53.9 +/- 27 ms, P < 0.0001 and P < 0.004, respectively). In 13 (46%) patients sustained VT was induced. QTd values were significantly higher in inducible than noninducible patients (QTd sinus beats: 67.5 +/- 31 vs 42.1 +/- 11 ms, P = 0.02; QTd spontaneous ventricular beats: 79.3 +/- 35 vs 46.7 +/- 13 ms, P = 0.008, and QTd-paced ventricular beats: 104.8 +/- 32 vs 65.9 +/- 9 ms, P = 0.0009). The receiver operator characteristic curves showed that at a sensitivity level of 100%, the highest specificity for identification of inducible patients had QTd measured in paced ventricular beats (87%) followed by QTd in spontaneous ventricular beats (45%), and QTd in sinus beats (40%). In conclusion, (1) QTd in ventricular beats is greater than in sinus beats, and (2) QTd calculated from paced ventricular beats identifies patients with inducible sustained VT better than QTd measured during sinus rhythm.     

儿童血管迷走性晕厥QT间期离散度及P波离散度研究

目的　探讨儿童血管迷走性晕厥 (VVS)QT间期离散度 (QTd)及P波离散度 (Pd)的变化。方法　不明原因晕厥(UPS)患儿 5 5例 (研究组 ) ,均进行基础直立倾斜试验 (BHUTT)或 (和 )舌下含服硝酸甘油倾斜试验 (SNTTT)。匹配健康儿童 5 5例为对照 (对照组 )。于BHUTT前一天描记 12导联同步体表心电图 (12ECG)。选择波形清晰的 12ECG 3个心动周期 ,测量心率 (HR)、QTd 与Pd。结果　与对照组比较 ,研究组HR减慢 (P <0 0 1) ,QTmax、QTmin、QTd 延长 (P <0 0 1) ,QTcmax、QTcd增大 (P <0 0 1或P <0 0 5 ) ;Pcmax、Pcmin缩短 (P <0 0 1) ,Pd 及Pcd稍延长 (P >0 0 5 )。QTd、QTcd及Pd、Pcd在VVS患儿男女性别之间无差异(P >0 0 5 ) ,HUTT阳性组与阴性组之间亦未见差异 (P >0 0 5 )。结论　QTd 及Pd 在VVS患儿男女性别及HUTT阳性组与阴性组间未见差异。VVS患儿QTd 及QTcd增大 ,Pd 及Pcd延长不明显 ,临床上要警惕VVS患儿发生室性心律失常。     

Excessive increase in QT interval and dispersion of repolarization predict recurrent ventricular tachyarrhythmia after amiodarone

Although chronic amiodarone has been proven to be effective to suppress ventricular tachycardia (VT) and ventricular fibrillation (VF), how we predict the recurrence of VT/VF after chronic amiodarone remains unknown. This study evaluated the predictive value of the QT interval, spatial, and transmural dispersions of repolarization (SDR and TDR) for further arrhythmic events after chronic amiodarone. Eighty-seven leads body surface ECGs were recorded before (pre) and one month after (post) chronic oral amiodarone in 50 patients with sustained monomorphic VT associated with organic heart disease. The Q-Tend (QTe), the Q-Tpeak (QTp), and the interval between Tpeak and Tend (Tp-e) as an index of TDR were measured automatically from 87-lead ECG, corrected Bazett's method (QTce, QTcp, Tcp-e), and averaged among all 87 leads. As an index of SDR, the maximum (max) minus minimum (min) QTce (max-min QTce) and standard deviation of QTce (SD-QTce) was obtained among 87 leads. All patients were prospectively followed (15 +/- 10 months) after starting amiodarone, and 20 patients had arrhythmic events. The univariate analysis revealed that post max QTce, post SD-QTce, post max-min QTce, and post mean Tcp-e from 87-lead but not from 12-lead ECG were the significant predictors for further arrhythmic events. ROC analysis indicated the post max-min QTce > or = 106 ms as the best predictor of events (hazard ratio = 10.4, 95%, CI 2.7 to 40.5, P = 0.0008). Excessive QT prolongation associated with increased spatial and transmural dispersions of repolarization predict the recurrence of VT/VF after amiodarone treatment.