心衰患者QT离散度的变化与室性心律失常及心率变异性的相互关系

目的 探究心衰患者QT离散度的变化与室性心律失常及心率变异性的相互关系.方法 选取我院2019年1月-12月收治的100例心衰患者视为观察组,另纳入同期收治的50例体检健康者视为对照组.检测全部受检者的QT离散度、室性心律失常及心率变异性,分析QT离散度的变化与室性心律失常、心率变异性的相关性.结果 心衰死亡组QT离散度大于心衰存活组和对照组,心衰存活组QT离散度大于对照组,差异均有统计学意义(P<0.05).严重心律失常组QT离散度大于轻度心律失常组和无心律失常组,轻度心律失常组QT离散度大于无心律失常组,差异有统计学意义(P<0.05).严重心律失常心衰组心率变异性小于无心律失常心衰组和对照组,无心律失常心衰组心率变异性小于对照组,差异有统计学意义(P<0.05).行Pearson相关性分析发现,心衰患者QT离散程度与室性心律失常程度呈正相关(P<0.01),与心率变异性程度呈负相关(P<0.01).结论 心衰患者QT离散度的增加,心率变异性的减少,对心衰患者的室性心律失常有重要的监测意义.     

QT离散度与冠心病猝死

目的 :探讨 QTd对猝死的预测价值。方法 :分析 2 3例发生猝死的冠心病患者和 34例住院冠心病患者的 QT离散度及心率校正 QT离散度。结果 :猝死组 QTd明显高于对照组 ,P<0 .0 5。结论 :QT离散度增大有预测猝死的价值     

QT离散度对老年严重心力衰竭病人无预后价值

目的:探讨QT离散度(QTd)对老年严重心衰(CHF)病人的预后价值。方法:362例老年严重心衰患者入院时记录基础静态12导联同步心电图,计算QT离散度,平均随访(7.2±4.8)个月。结果:随访期间142例(39.2%)病人死亡,QT离散度为(76.3±28.6)ms,存活者220例,QT离散度为(74.8±30.2)ms。两组间比较无明显差异(P>0.05);生存分析显示QT离散度对总死亡率(RR 1.00,95%CI 1.00~1.00),心源性死亡率(RR 1.00,95%CI 1.00~1.01)及心律失常性死亡率(RR 1.00,95%CI 1.00~1.01)均无预后价值(P>0.05).结论:QT离散度(QTd)对老年严重心衰病人的总死亡率,心源性死亡率及心律失常性死亡率均无预后价值。     

高血压病患者左室肥厚逆转后QT离散度改善

目前认为,肥厚性心肌病、充血性心衰、扩张型心肌病、冠心病及心肌梗塞后的QT离散度增加可诱发严重室性心律失常或猝死。业已发现高血压并左室肥厚(LVH)时QT离散度亦增加。本文评价LVH逆转后QT离散度的变化。采用回顾性分析高血压病68例,其中男性42例,女性26例,平均年龄5...     

冠状动脉慢血流患者运动负荷试验QT离散度变化

目的探讨运动负荷试验对冠状动脉慢血流(CSF)患者QT离散度的影响。方法选取因胸痛行冠状动脉造影术、冠状动脉无明显狭窄(管腔直径狭窄40%)且发现CSF的患者81例为慢血流组,选取冠状动脉造影正常且心电图运动负荷试验阴性者80例为对照组。计算每例运动前后的最大校正QT间期(QTcmax)、最小校正QT间期(QTcmin)及校正QT离散度(QTcd)。结果静息时慢血流组QTcmax较对照组明显延长(P0.05),两组QTcmin无明显差异,慢血流组QTcd较对照组明显增大(P0.05);运动后慢血流组QTcmax和QTcmin均较对照组明显延长(P0.05),且QTcd较对照组明显增大(P0.05)。慢血流组只有9名运动负荷试验阳性,占11.11%。慢血流组运动后QTcd较静息时明显减小(46.41±12.21 ms比62.81±17.18 ms,P0.05),对照组运动前后QTcd无明显变化。结论 CSF患者QTcd较正常增大,运动会使其明显减小。     

老年高血压伴左室肥厚的QT离散度与心律失常相关性的临床观察

目的　观察老年高血压伴左室肥厚病人的 QT离散度与心律失常的关系。方法　选择 32例老年健康人和 90例老年高血压病人进行体表心电图、超声心动图和动态心电图检查 ,作 QT离散度测定。结果　 (1 )高血压伴左室肥厚组的 QT离散度明显大于健康对照组及高血压非左室肥厚组。 (2 )高血压伴心律失常组的 QT离散度明显大于健康对照组及高血压非心律失常组。 (3)高血压伴左室肥厚组其心律失常发生率明显高于健康对照组。结论　高血压伴左室肥厚病人的 QT离散度明显增高 ,其心律失常发生率也显著增高     

胺碘酮治疗慢性心衰合并心律失常对患者心功能的影响及安全性分析

目的探讨胺碘酮治疗慢性心衰合并心律失常对患者心功能的影响,并对安全性进行分析。方法以我院收治的82例慢性心衰合并心律失常患者为研究对象,随机分为观察组(41例,给予胺碘酮+常规治疗)和对照组(41例,给予常规治疗),治疗4周后,观察两组患者治疗前后血压、心率、心电图QT离散度(QTc)变化情况,根据患者心功能及心律改善情况评价疗效,并比较两组用药安全性。结果观察组心功能及心律总有效率显著高于对照组(80.49%vs 65.85%;87.81%vs 75.61%),血压、心率及QTc改善情况明显优于对照组,差异均具有统计学意义(P0.05);观察组不良反应发生情况与对照组比较差异无统计学意义(P0.05)。结论胺碘酮治疗慢性心衰合并心律失常疗效显著,能明显改善患者心功能及心律,且安全性较高,值得临床医师参考。     

QT离散度在急性心肌梗死中的临床应用价值

目的探究QT离散度在急性心肌梗死中的应用价值。方法选取2013年6月—2015年6月期间于本院进行治疗的急性心肌梗死50例患者作为研究对象,将其作为观察组,随机选取健康体检者50例为对照组,对比两组QT离散度,并研究观察组室速、室颤、心脏骤停与其他心律失常、无心律失常QT离散度的比较,此外还针对观察组静脉溶检与未溶栓QT离散度进行对比,针对QT离散度不小于100ms与QT离散度小于100ms死亡率对比进行分析。结果观察组入院后QT离散度与对照组相比,组间对比存在显著性差异,P0.05;静脉溶栓与未溶栓QT离散度存在显著性差异,P0.05;QT离散度小于100ms死亡率低于QT离散度大于等于100ms的死亡率,组间对比存在显著性差异,具备统计学意义,P0.05。结论在急性心肌梗死中,测量QT离散度,可有效预测急性心肌梗死猝死,同时,还能为预测室速、室颤、心脏骤停以及其他心律失常症状提供重要的参考。     

96例重症肺炎患儿QT离散度与心功能改变的关系探讨

目的重症肺炎患儿心电图检查QT离散度与患儿心功能指标变化的关系。方法选取本院96例确诊重症肺炎患儿,根据是否合并心衰,分为心衰组39例、肺炎组57例,同龄正常儿童50例作为健康组,分别测定三组儿童的心功能、心肌酶谱指标及心电图QT离散度并进行分析比较。结果心衰组患儿的QT离散度测定值显著大于肺炎组、健康组,且差异具有统计学意义(P0.05);心衰组患儿的CK-MB、ɑ-HBDH测定值显著的大于肺炎组、健康组,且差异具有统计学意义(P0.05);心衰组患儿心功能指标LVEF、FS、CI、PFVA测定值显著小于肺炎组、健康组,且差异具有统计学意义(P0.05);三组婴幼儿的PFVME测定值差异无统计学意义(P0.05);心衰组患儿心功能指标的QT值与LVEF、FS、CI、测定值均呈显著的负相关关系(P0.05);与PFVME、PFVA的相关系不明显(P0.05)。结论重症肺炎患儿心电图检查QT离散度测定,对于判断患儿心功能受损具有一定的价值,有利于患儿的诊治。     

老年充血性心力衰竭QT离散度与室性心律失常

观察了46例老年充血性心力衰竭患者QT离散度的变化及其与室性心动过速(PVT)和心室颤动(VF)发生之间的关系。结果表明,心衰患者的QT离散度和校正QT离散度显著增加,伴有PVT或VF发作的患者增加更为明显。QT离散度可以作为老年充血性心力衰竭患者发生恶性心律失常的预测指标之一。     

充血性心力衰竭QT离散度变化及美托洛尔对其影响

目的 :测定充血性心力衰竭 （CHF）患者的 QT离散度 （QTd）及美托洛尔对 QTd的影响。方法 :110例 CHF患者和 5 0例健康人同时作 QTd测量 ,CHF患者中 38例进行美托洛尔治疗 ,与未使用美托洛尔的 78例作比较。结果 :CHF患者的 QTd明显高于健康人 （P<0 .0 1） ;QTd与心功能受损的程度呈正相关 ;CHF伴室性心律失常者QTd大于不伴室性心律失常者 （P<0 .0 5 ） ;予美托洛尔治疗后 CHF患者 QTd明显缩短 （P<0 .0 5 ）。结论 :CHF患者 QTd明显增大。美托洛尔可使 QTd缩小 ,对防治严重心律失常和猝死有重要意义     

QT及JT离散度对心性猝死预测价值的探讨

测定３２例心性猝死和３０例非猝死性心性死亡病人入院后的首次心电图ＱＴ离散度（ＱＴｄ）和ＪＴ离散度（ＪＴｄ），产以３０例存活病人作对照，结果显示：（１）心性猝死组ＱＴｄ，ＪＴｄ较存活组和非猝死性心性死亡组显著增大（前者Ｐ均〈０．０１，后者Ｐ均〈０．０５，而非猝死性心性死亡组与存活组ＱＴｄ，ＪＴｄ比较差异均无统计学意义。（２）在心性猝死病人中，死亡直接原因为快速室性心律失常组（２３例）的ＱＴｄ，ＪＴｄ     

美托洛尔对充血性心力衰竭患者QT离散度的影响及临床意义

目的探讨美托洛尔对充血性心力衰竭（CHF）患者QT离散度的影响及临床意义。方法将56例CHF患者随机分为治疗组（28例）和对照组（28例）,对照组采用常规治疗,治疗组在常规治疗的基础上加用美托洛尔,并作治疗前后的QTd测量及比较。结果QTd与心功能受损的程度呈正相关;CHF伴室性心律失常者QTd大于不伴室性心律失常者（P〈0.05）;给予美托洛尔治疗后CHF患者QTd明显缩短（P〈0.05）。结论CHF患者QTd明显增大。美托洛尔可使QTd缩小,对防治室性心律失常和猝死有重要意义。     

老年冠心病患者QT离散度变化及其临床意义

目的探讨老年冠心病患者ＱＴ离散度（ＱＴｄ）和心率校正的ＱＴ离散度（ＱＴｃｄ）与致命性室性心律失常（ＦＶＡ）及心衰（ＨＦ）之间的关系。方法测定了８４例老年冠心病患者的ＱＴｄ及ＱＴｃｄ，其中心原性猝死（ＣＳＤ）９例，ＦＶＡ２３例，非ＦＶＡ６１例。有ＨＦ４７例，无ＨＦ３７例。结果ＣＳＤ组ＱＴｄ、ＱＴｃｄ显著大于ＦＶＡ及非ＦＶＡ组（Ｐ＜０．０５；Ｐ＜０．０１），ＦＶＡ组ＱＴｄ、ＱＴｃｄ大于非ＦＶＡ组（Ｐ＜０．０１），ＨＦ组ＱＴｄ、ＱＴｃｄ显著长于无ＨＦ组（Ｐ＜０．０１）。本文ＱＴｄ和ＱＴｃｄ呈显著正相关（ｒ＝０．９７２０，Ｐ＜０．０１）。结论作者认为ＱＴｄ和（或）ＱＴｃｄ可作为评估老年冠心病患者发生ＦＶＡ和（或）ＨＦ预后的重要参考指标。     

充血性心力衰竭QT间期离散度及卡维地洛尔的影响

目的　观察充血性心力衰竭 (CHF)患者 QT间期离散度 (QTd)变化及 β-受体阻滞剂卡维地洛尔对其影响。方法　 5 3例 CHF患者和 30例健康人作 QTd测定 ,所有 CHF患者在常规治疗基础上随机分为卡维地洛尔组 (2 6例 )和治疗对照组 (2 7例 )。结果　 CHF患者 QTd明显大于健康人 (P<0 .0 1) ;卡维地洛尔组能显著降低 CHF患者QTd(P<0 .0 5 ) ,而治疗对照组治疗前后 QTd无显著变化 (P>0 .0 5 )。结论　 CHF患者 QTd明显增加 ;β-受体阻滞剂对 CHF患者 QTd有改善作用     

The effects of chronic carvedilol therapy on QT dispersion in patients with congestive heart failure.

BACKGROUND: Carvedilol therapy reduces mortality from sudden cardiac death and progressive pump failure in congestive heart failure (CHF). However, the effect(s) of carvedilol on ventricular repolarization characteristics is unclear. AIM: The aim of the study was to investigate the effects of chronic carvedilol therapy on ventricular repolarization characteristics as assessed by QT dispersion (QTd) in patients with CHF. METHOD: Nineteen patients (age 53+/-12 years; 16 male, three female) with CHF (eight ischemic, 11 non-ischemic dilated cardiomyopathy) were prospectively included in the study. Carvedilol was administered in addition to standard therapy for CHF at a dose of 3.125 mg bid and uptitrated biweekly to the maximum tolerated dose. From standard 12-lead electrocardiograms the maximum and minimum QT intervals (QTmax, QTmin), QTd, corrected QT intervals (QTcmax, QTcmin) and corrected QTd (QTcd) values were calculated at baseline, after the 2nd and the 16th month of carvedilol therapy. RESULTS: A significant reduction was noted in the QTd and QTcd values with carvedilol therapy after the 16th month (QTd: 81+/-22 ms vs. 40+/-4.3 ms P<0.001; QTcd: 91+/-25 ms vs. 51+/-7 ms P<0.001), but not after the 2nd month (P>0.05). The resting heart rate was also significantly reduced after a 16-month course of carvedilol therapy (78+/-13 bpm vs. 66+/-15 bpm, P<0.05). Carvedilol therapy did not alter QTmax and QTcmax intervals (P>0.05), however, QT min and QTcmin significantly increased with carvedilol at the 16th month (P<0.001 and P<0.01, respectively). CONCLUSION: Long-term carvedilol therapy was associated with a reduction in QTd, an effect that might contribute to the favorable effects of carvedilol in reducing sudden cardiac death in CHF.     

老年缺血性心脏病患者跨室壁复极离散度心电学检测及临床意义

目的探讨老年缺血性心脏病患者跨室壁复极离散度的心电学检测及临床意义。方法选择老年缺血性心脏病患者159例为实验组,健康体检者143例为对照组;2组均行12导联心电图检查,测定T波峰末间期(Tp-e)、QTc、QTd、Tp-e/QTc;行24h动态心电图,实验组根据室性心律失常发生情况分为无室性心律失常组58例,室性期前收缩组76例,室性心动过速组25例;随访6~48个月,根据实验组死亡情况分为死亡组35例、存活组103例及猝死组21例,观察Tp-e、QTd、Tp-e/QTc与室性心律失常、心源性猝死的关系。结果与对照组比较,实验组和猝死组Tp-e、QTc、QTd、Tp-e/QTc明显升高(P<0.05,P<0.01);猝死组Tp-e、QTc、QTd、Tp-e/QTc较存活组和死亡组明显升高(P<0.05);与无室性心律失常组比较,室性期前收缩组和室性心动过速组Tp-e、QTc、QTd、Tp-e/QTc明显升高;与室性期前收缩组比较,室性心动过速组Tp-e、QTc、QTd、Tp-e/QTc明显升高;Tp-e、QTd、Tp-e/QTc与室性心律失常、心源性猝死相关(P<0.05,P<0.01)。结论 Tp-e、QTc、QTd、Tp-e/QTc能够反映老年缺血性心脏病跨室壁复极离散度的变化,其值增大可能是老年缺血性心脏病发生心源性猝死的危险指标。     

Effects of aerobic exercise training on indices of ventricular repolarization in patients with chronic heart failure.

BACKGROUND: Patients with chronic heart failure (CHF) have a markedly increased incidence of malignant ventricular arrhythmias. QT dispersion (QTd), defined as the difference between maximal and minimal QT intervals, reflects the regional inhomogeneity of ventricular repolarization dispersion and may mark the presence of malignant ventricular arrhythmias. PURPOSE: To determine the effects of exercise training on QTd in patients with CHF. PATIENTS: Fifteen patients with CHF and ejection fractions < 40% (mean, 28+/-9%) who were on a stable medical regimen. DESIGN AND INTERVENTION: Standardized 12-lead surface ECGs were obtained at the beginning and end of the exercise training program, and QT and JT intervals were measured manually and corrected for heart rate by using Bazett's formula. QTd, heart rate-corrected QTd (QTc-d), JT dispersion (JTd), and heart rate-corrected JTd (JTc-d) were measured in at least eight ECG leads in each patient. RESULTS: Following the cardiac rehabilitation and exercise training programs, patients with CHF had only slight improvements in exercise capacity (results were not significant). However, these patients had marked improvements in QTd (71+/-11 to 59+/-17 ms; p < 0.02), QTc-d (82+/-28 to 63+/-17 ms; p < 0.01), JTd (76+/-19 to 57+/-18 ms; p < 0.002), and JTc-d (84+/-23 to 61+/-18 ms; p < 0.001) following the exercise training programs. CONCLUSION: These data indicate that aerobic exercise training significantly reduces the indices of ventricular repolarization dispersion in patients with CHF. Further studies are needed to evaluate how effectively this reduction in ventricular repolarization dispersion decreases the risk of malignant ventricular arrhythmias and sudden death in patients with CHF.     

扩张型心肌病临床与预后的关系探讨

目的 :探讨扩张型心肌病(DCM )发生心脏性猝死 (SCD)的高危因素 ,研究DCM临床与预后的关系。方法 :对 60例DCM临床资料进行分析 ,以超声心动图 (UCG)、心电图 (ECG)、动态心电图 (DCG、Holter)及X线胸片观察心脏各参数变化 ,并做心电图QT离散度 (QTd)测定。结果 :有病毒性心肌炎病史与无病毒性心肌炎病史病人 ,重度心力衰竭、严重室性心律失常的发生率分别为 66.7%和 2 3 .3 % ,经比较有统计学意义 (P <0 .0 5 ) ;5例SCD均有病毒性心肌炎史 ,临死前都发生多次严重室性心律失常、晕厥 ;QTd对预测SCD高危因素有意义。结论 :有病毒性心肌炎史、心力衰竭、严重室性心律失常、头晕或晕厥及QTd增加 ,可作为预测发生SCD的高危因素。     

Prognostic value of plasma brain natriuretic peptide combined with left ventricular dimensions in predicting sudden death of patients with chronic heart failure

BACKGROUND: We evaluated a combined assessment of brain natriuretic peptide (BNP) with left ventricular dimensions as a prognostic marker for sudden death in patients with chronic heart failure (CHF). Ventricular dimensions and BNP are separately recognized as prognostic markers for sudden death in patients with CHF. METHODS AND RESULTS: CHF patients at Stage C and B were registered for a prospective study. From the database, we analyzed 417 patients with coronary arterial disease (CAD) or primary/secondary dilated cardiomyopathy (DCM). Main effects of BNP, left ventricular ejection fraction (EF), LV diastolic dimension (LVDD), and interaction of BNP with the EF and LVDD were tested with Cox's proportional hazard model. BNP in sudden death patients was significantly higher than that in event-free patients. Although multivariate analysis revealed that BNP by itself was not an independent risk factor for sudden death after adjustments, it was revealed that BNP entered the model via interaction with EF as a risk factor associating with sudden death. On the other hand, BNP was an independent risk factor associating with heart failure events (death and hospitalization), and BNP did not enter the model via an interaction with EF. CONCLUSION: BNP by itself was an independent risk factor for the heart failure events, but not for sudden death in CHF patients of the present study. However, BNP should be important in predicting sudden death when measured with EF.