急性心肌梗塞病人QT离散度与心室晚电位的临床观察

QT间期离散度(QTD)是指体表12导联心电图不同导联之间最长QT问期和最短QT的差异程度,急性心肌梗塞的早期即可发生变化。我们观察了急性心肌梗塞病人的QTD与正常人作对照分析,并与心室晚电位(VLP)检查结果作对照如下: 1 对象 AMI组45例,均为住院病人,其中男30例,女15例,符合WHO标准,年龄50～70岁,平均62.4岁,选择入院时心电图符合:①可测量QT间期的导     

美托洛尔对心肌梗死后心室晚电位和QT离散度的影响

目的探讨美托洛尔对心肌梗死（AMI）患者心室晚电位和QT离散度（QTcd）的影响。方法将80例AMI患者随机分为时照组扣治疗组。对照组予以消心痛、肠溶阿司匹林等药物，治疗组在常规治疗的基础上，服用美托洛尔50mg，2次／d，治疗6个月后测定心室晚电位（VLP）和QTcd及室性心律失常发生率，比较两组之间的差异。结果治疗组和对照组VLP分别占13．7％和38．7％，两组比较差异有统计学意义（x^2=20．05，P〈0．01）；治疗组和对照组QTcd分别为（34±11）ms和（71±24）ms，两组比较差异有统计学意义（t=4．248，P〈0．05）。治疗组室性心律失常或心因性猝死的发生率明显减少（P〈0．05，x^2=8．717）。结论美托洛尔能明显减少心肌梗死患者心室晚电位阳性率，降低QT离散度，预防心肌梗死患者恶性心律失常及猝死的发生。     

难治性癫痫患者发作间期心室晚电位及QT离散度对照观察

癫痫患者发生死亡的危险性是正常人的 2 4倍 ,在所有死亡的患者中有 10 %～ 15 %的患者为不明原因的猝死 ,尤其见于难治性癫痫患者[1] 。晚近一些研究认为恶性心律失常是癫痫患者发生猝死的主要原因[2 ] ,心室晚电位 (ＶＬＰ)和ＱＴ离散度 (ＱＴｃｄ)是目前预测室性心律失常的重要指标。我们检测 36例难治性癫痫患者发作间期ＶＬＰ和ＱＴｃｄ ,并探讨其临床意义。1　材料与方法1 1　一般资料　对象选择 2 0 0 0年 8月～ 2 0 0 1年 2月在我院就诊的难治性癫痫患者 36例 ,男 2 1例 ,女 15例 ,年龄 16～ 49(31 4± 10 5 )岁 ,病程 3～ 2 7(15 …     

心室晚电位及Q-T离散度在预测急性心肌梗死预后的作用

急性心肌梗死 (ＡＭＩ)患者预后心电学无创指标的监测越来越受到人们的关注。现观察心室晚电位 (ＶＬＰ)、Ｑ Ｔ间期离散度 (Ｑ Ｔｄ)两项在预测ＡＭＩ发生室性心律失常事件的价值。1　对象与方法1.1　病例选择　 1998年 1月至 1999年 1月住院的患者 ,经病史、心电图及酶学证实为ＡＭＩ共 40例 ;并除外药物、电解质等影响及非窦性心律、房室阻滞 ;其中男 2 4例 ,女 16例 ,平均年龄( 5 4.9± 10 .8)岁 ;平均随诊 ( 9.5± 1.3 )个月 ,期间猝死 2例 ,室颤 (ＶＦ) 2例 ,持续室性心动过速 (ＳＵＶＴ) 5例。正常对照组 40例 ,男 2 1例 ,女 19例 ,…     

QT离散度及心室晚电位对心肌梗塞急性期室性心律失常的预测价值

目的：研究QT离菜度（QTd)及心室晚电位（VLP）对心肌梗塞急性期室性心律失常的预测价值。方法：计算48例急性心肌梗塞患QTd,其中34例行VLP检测。结果：12例严重室性心律失常组QTd,校正的QT离散度（QTcd)明显延长,VLP阳性率明显高于无室性心律失常组（P＜0．01）,结论：QTd和VLP检测对心肌梗塞急性期发生室性心律失常有较高预测价值。     

老年室性心律失常患者QTd与心室晚电位的关系

目的 :探讨 QT离散度 (QTd)和心室晚电位之间的关系 ,以及它们对预测定性心律失常发生的意义。方法 :分别检测 34例老年室性心律失常患者 ,30例正常老年人的 QTd和心室晚电位 (VL P)。结果 :正常组和心律失常组患者的QTd值分别为 (76 .94± 2 2 .19) ms和 (38.88± 11.46 ) ms,具有显著性差异。VL P阳性人数分别为 6例和 2 0例 ,有显著性差异 ,而 VL P阳性者和阴性者 QTd值分别为 (6 2 .72± 30 .6 7) ms和 (43.86± 17.39) ms,经检验 ,t<3.143,P<0 .0 0 5。结论 :VL P和 QTd结合起来对预测老年室性心律失常 ,乃至猝死的发生均有意义     

250例心脏病心室晚电位临床分析

心室晚电位(VLP)代表心室肌某部延迟的电活动。信号平均心电图Signal—averaged electrocar—diogram,SAECG)可检测到这种低振幅、高频率的电活动。随着心血管疾病发病率和死亡率的增加,心源性猝死已成为常见的一种死亡病症,也是世界上未能解决的一个难题,冠心病占多数,80％是由于恶性快速心律失常室性心动过速或室颤。如能用无创性方法预测此类患者可能发生的心律失常意外,从而采取防治措施,将是一件极有意义的临床工作。上述信号平均心电图正是近年来发展的一项无创性新技术。 1 研究对象 250例心脏病患者,其中冠心病92例,急性心肌梗死62例,风心病33例,心肌病24例,不明原因的心律失常39例。     

心室晚电位的临床意义

一、概述1961年Durrer等在研究缺血实验人心肌兴个过程时,发现心内膜下梗塞区相应心外膜区有延迟电位的存在,认为它是该区兴奋延迟所致.1978年Berbari,Fontaine等用高增益放大和计算机叠加个均技术从体表记录到心室晚电位(VLP).之后国外不少学者及国内一些学者对此作了许多研究,使心律失常的研究有了推动性的进展.     

心室晚电位临床应用现状与进展

<正> 心室晚电位(Ventricular Late Potential, VLP)这一概念由Durrer和Fontain分别于1961年和1977年提出,即指在心室刚刚结束除极后出现的电活动,表现为低振幅、高频率的多形性尖波。我国于1986年起逐渐普遍地开展此项检查技术。业已证实,VLP与心室内折返之间有肯定的关系。当VLP延长,形成室性心动过速(室速),在心外膜等时标测上显示出8字形折返环,折返环共同通道的连续除极表现为连续的碎裂电位。VLP已成为心血管领     

血液透析患者左心室的结构及功能与Q-T离散度的关系

【目的】探讨血液透析患者左心室的结构、功能与QT离散度（QTd）的关系。【方法】对血液透析3个月以上患者30例及30例健康体检者（对照组）,分别采用心脏彩超测量其左心室的结构、功能,心电图测量Q-Td、计算校正的QT离散度（Q-Tcd）并比较两组各项指标的差异。【结果】血液透析组的左心室舒末内径（LVEDd）,室间隔舒张期厚度（IVST）,左室后壁舒张期厚度（PwTH）,左室心肌质量指数（LVMI）,Q-Td、Q-Tcd均大于对照组;射血分数（EF）及E／A值均小于对照组,且两组相比差异有显著性（P〈0．05）。血液透析组的LVEDd、IVST、PWTH、LVMI与Q-Tcd显著正相关。血液透析组的EF与QTcd显著负相关。两组的E／A与Q-Tcd无显著相关。【结论】血液透析患者Q-Td异常与左心室结构、功能的改变有关,左心室肥厚是导致QT-d异常的一个重要因素,测量QTcd可间接反映血液透析患者的左心室状况。     

Magnetocardiographic QT Interval Dispersion in Postmyocardial Infarction Patients with Sustained Ventricular Tachycardia: Validation of Automated QT Measurements

T dispersion is a measure of heterogeneity in ventricular repolarization. Increased ECG QT dispersion is associated with life-threatening ventricular arrhythmias. We studied if magnetocardiographic (MCG) measures of QT dispersion can separate postmyocardial infarction patients with and without susceptibility to sustained VT. Manual dispersion measurements were compared to a newly adapted automatic QT interval analysis method. Ten patients with a history of sustained VT (VT group) and eight patients without ventricular arrhythmias (Controls) were studied after a remote myocardial infarction. Single-channel MCGs were recorded from 42 locations over the frontal chest area and the signals were averaged. QT dispersion was defined as maximum — minimum or standard deviation of measured QT intervals. VT group showed significantly more QT and JT dispersion than Controls. QT_apex dispersions were 127 ± 26 versus 83 ± 21 ms (P = 0.004) and QT_end dispersions 130 ± 37 versus 82 ± 37 ms (P = 0.013), respectively. Automatic method gave comparable values. Their relative differences were 9% for QT_apex and 27% for QT_end dispersion on average. In conclusion, increased MCG QT interval dispersion seems to be associated with a susceptibility to VT in postmyocardial infarction patients. MCG mapping with automated QT interval analysis may provide a user independent method to detect nonhomogeneity in ventricular repolarization.     

冠心病伴室性心律失常与左室射血分数及QT离散度的关系

目的:探讨冠心病(CHD)伴室性心律失常与左室射血分数(LVEF)及QT离散度(QTd)的关系。方法:测量和分析56例CHD伴室性心律失常患者(CHD组)和53例正常人(对照组)的LVEF值及心电图最大QT间期(QTmax),最小QT间期(QTmin)。结果:CHD组的LVEF值和QTd分别为:(40.36±6.85)ms和(65.98±16.86)ms;对照组的LVEF值和QTd分别为:(59.68±4.16)ms和(33.05±13.23)ms。CHD组与对照组之间比较差异具有显著性,P<0.01。结论:CHD伴室性心律失常与LVEF及QTd密切相关,LVEF和QTd可作为预测CHD伴室性心律失常的可靠指标。     

QT Dispersion Does Not Predict Early Ventricular Fibrillation After Acute Myocardial Infarction

Ventricular arrhythmias may be associated with increased QT dispersion (difference between maximum and minimum QT on standard 12-lead ECG). We performed a case control study to determine if QT dispersion on the admission ECG could predict early VF after acute myocardial infarction. The cases were 24 patients with acute myocardial infarction (14 inferior, 8 anterior, and 2 lateral) with VF within 12 hours of admission. There were 24 control patients without VF matched for site of infarction and ST segment score (sum of ST segment elevation). VF occurred a median of 153 minutes (interquartile range 93–245) after onset of chest pain and 33 minutes (range 7–104) after initial ECG. QT (399 ± 37 and 394 ± 37), QT corrected (440 ± 38 and 429 ± 29), and QT dispersion (68± 20 and 66 ± 27) were similar in patients and controls. By design, ST score was similar (11 ± 9 vs 9 ± 5 mV), although a good match could not be obtained for three patients with extreme ST elevation. Patients with VF presented to the hospital earlier after the onset of chest pain (median 95 min [range 65–188] compared to 150 min [range 80–270], P= 0.05) and had a lower serum sodium (138 ± 2.4 vs 140 ± 2.5, P = 0.05) than controls. Thus, QT interval and QT dispersion, measured on the presenting ECG, did not predict early VF after myocardial infarction.     

Amiodarone Induced Torsades de Pointes with Excessive QT Dispersion Following Quinidine Induced Polymorphic Ventricular Tachycardia

We report a case of amiodarone induced torsades de pointes (TdP) associated with increase QT dispersion in a patient with a history of quinidine induced TdP. An increase in QT dispersion of > 100% was noted on the 12 lead surface ECG postamiodarone therapy. In summary, amiodarone has a potential to induce TdP in patients with a previous history of quinidine induced TdP. QT dispersion could be a potential marker of TdP in these patients.     

高血压左室肥厚超声心动图检查与心电图QT离散度测定的对比研究

对６８例高血压病患者进行二维超声及多普勒心脏检查，同时进行体表心电图ＱＴ离散度（ＱＴｄ）测定，旨在探讨左室肥厚和功能损伤与ＱＴｄ之间的关系。结果显示左室壁最大厚度与总厚度积分与ＱＴｄ呈正相关，ＱＴｄ与左室内径缩短分数之间无相关关系。６５％的患者存在１项或多项多普勒左室舒张功能异常指标，ＱＴｄ与左室舒张功能异常程度密切相关。提示高血压左室肥厚和功能损伤时表现有ＱＴｄ增大，说明高血压左室肥厚超声心动图特征与心电图ＱＴｄ增大产生的基质是一致的     

Catecholaminergic Polymorphic Ventricular Tachycardia with QT Prolongation

The QT interval in patients with catecholaminergic polymorphic ventricular tachycardia (CPVT) is typically normal. However, CPVT patients are sometimes misdiagnosed as concealed long QT syndrome (LQTS), because patients with LQTS also manifest with syncope or sudden death following periods of exertion or extreme emotion. We report a CPVT patient with a pathogenic RyR2 mutation associated with a marked QT prolongation, which normalized after flecainide therapy.     

Recurrent Ventricular Fibrillation Associated with Normal QT Intervals

Two patients after being treated for epilepsy for 20 years werefound to have recurrent syncope due to ventricular fibrillation.Neither had structural heart disease. The first patient hadnormal QT and QTc values at all times, and the second had anormal QT interval and an intermittently abnormal U wave. Inboth patients, attacks were suppressed totally by propranolol.These cases, and some similar patients reported previously suggestthat there may be a forme fruste of the long QT syndrome.     

时间频谱标测229例心肌梗塞患者心室晚电位

时间频谱标测（ＳＴＭ）心室晚电位（ＶＬＰ）在提高ＶＬＰ阳性病人的准确性上有较大的优势。本文经２２９例心肌梗塞患者的大样本临床验证，并与时域分析进行对照。其结果时域分析ＶＬＰ阳性６６例，ＳＴＭＶＬＰ阳性３７例。在ＶＬＰ阳性病例中发生室性心律失常的分别是时域分析３４例（３４／６６）占５１．５２％，ＳＴＭ３０例（３０／３７）占８１．０８％，Ｐ＜０．０１。对３８例合并室内传导阻滞者且ＶＬＰ阳性并发室性心律失常者，时域分析７例（７／１４）占５０％，ＳＴＭＩ２例（１２／１６）占７５％，Ｐ＜０．０２，利用心电图Ｗａｇｎｅｒ积分判定心肌梗塞面积，时域分析与ＳＴＭ在大面积心梗（≥１０分）组，分别是１０例（１０／６６）占１５．１５％、与１３例（１３／１７）占３５．１３％，Ｐ＜０．０２，有显著性差异。作者认为ＳＴＭ更为合理，它可使ＶＬＰ检测的准确性提高。