急性心肌梗死患者急性期体表心电图T波峰末间期与恶性室性心律失常的关系研究

目的探讨急性心肌梗死患者体表心电图T波峰末间期(TpTe)与急性期室性心律失常的关系。方法102例接受直接PCI(pPCI)治疗的急性心肌梗死患者中,共有46例出现室性心动过速(VT)和心室纤颤(VF),作为病例组。其余56例未出现室性心律失常,作为对照组。测量并比较两组pPCI前后12导联心电图的QT、TpTe、QT离散度(QTd)及经心率校正的QT间期(QTc间期)、TpTe(TpTec)。研究室性心律失常与QTc和TpTec各时段上限值的相关性并比较不同梗死部位的QT及TpTe值。结果 pPCI治疗前两组对象的QT间期、QTd间差异无统计学意义(P>0.05),但QTc和TpTec间差异有统计学意义(P<0.05)。经pPCI治疗后第3天,两组间QT和QTd间差异仍无统计学意义,而QTc、TpTe和TpTec间差异有统计学意义(P<0.05)。pPCI治疗后1周TpTe、QTc和TpTec间差异仍有统计学意义(P<0.05)。两组pPCI治疗前后的RR间期无差异(P>0.05)。QTc间期各时段上限值与VT+VF的发生率无相关性(r=0.376,P>0.05)。TpTe及TpTec间期各时段上限值与VT+VF的发生率呈正相关(r=0.677,P<0.05;r=0.698,P<0.05)。结论在急性期出现VT和VF的急性心肌梗死患者与不出现室性心律失常的患者相比,TpTe和TpTec明显延长,但QT和QTd则无明显差异。TpTe可能预示着心肌梗死急性期恶性心律失常。

Relationship between Tpeak-Tend(TpTe)and Malignant Ventricular Arrhythmia in the Acute Phase of Myocardial Infarction

Objective To study the relationship between Tpeak-Tend(TpTe)in surface electrocardiogram and malignant ventricular arrhythmia during the acute phase of myocardial infarction.Methods Of 100 acute myocardial infarction(AMI) patients who had undergone primary percutaneous coronary interventions(pPCI),46 patients who showed ventricular tachycardia(VT)and ventricular fibrillation(VF)were assigned to the case group and the other 54 patients without ventricular arrhythmia were assigned to the control group.QT,corrected QT(QTc),TpTe,and corrected TpTe(TpTec) intervals were measured before and after pPCI and compared between the two groups.The correlations between the malignant ventricular arrhythmia and the upper limit value of QT and TpTec at each time interval were studied,and the value of QT and TpTe were compared between different infarct zone.Results QT and QTd before and after pPCI in the case group were not significantly different compared with those in control group(P>0.05),while the QTc and TpTec after heart rate correction showed significant difference(P<0.05).There were still no significant differences in QT and QTd between the two groups on the third day after pPCI,while QTc,TpTe and TpTec were significantly different(P<0.05).No significant difference was found in RR interval between the two groups before and after pPCI(P>0.05).The upper limit value at each time period during QTc interval was not significantly correlated with the incidence of VT+VF(r=0.376,P>0.05),while it was positively correlated with the incidence of VT+VF during TpTe and TpTec(r=0.677,P<0.05;r=0.698,P<0.05).Conclusion TpTe and TpTec(but not QT and QTd) extend in AMI patients with VT and VF in the acute phase.TpTe may be a predictor for malignant ventricular arrhythmia in the acute phase in AMI patients.