心电图评估伴有肺动脉反流的法洛四联症患者的右心功能的临床价值

目的 探讨通过心电图评估伴有肺动脉反流(PR)的法洛四联症(TOF)患者的右心功能的临床价值。 方法 选取于笔者医院进行TOF矫治手术后合并PR的TOF患者61例作为研究对象,行标准12导联心电图与心脏磁共振(CMR)检查,测定QRS时限、碎裂QRS波群(fQRS),右心室收缩末期容积指数(RVESVi),右心室舒张末期容积指数(RVEDVi),右心室射血分数(RVEF)。对上述数据采用Pearson 分析,并进行单因素Logistic回归分析各因素对右心室扩张、功能障碍的影响。 结果 研究对象中有28例患者(45.9%)出现fQRS,45例患者(73.7%)QRS间期时限>120ms,45例患者(73.7%)出现完全性右束支传导阻滞,19例(31.1%)患者RVEF<45%,被诊断为右心功能不全。30例患者(49.1%)RVESVi>150ml,被诊断为右心室扩张。QRS间期时限与RVEF呈显著负相关(r=-0.60, P=0.000);QRS间期时限分别与RVESVi、RVEDVi呈显著正相关(r=0.63,P=0.000;r=0.55,P=0.000)。出现fQRS患者的QRS间期(156.83±25.45ms)显著高于未出现者(131.5±26.00ms),差异有统计学意义(P=0.000)。单因素Logistic回归分析显示QRS间期>120ms分别与右心室扩张、右心室功能障碍相关(HR=6.69,P=0.000;HR=10.62,P=0.000)。 结论 初步认为可以借助QRS间期辅助判断伴有PR的TOF患者右心室功能障碍,但仍需更多的研究和循证依据。

Value of the Electrocardiogram as a Predictor of Right Ventricular function in TOF Patients With Pulmonary Regurgitation

Objective To investigate the value of the electrocardiogram as a predictor of right ventricular function in TOF patients with PR. Methods Sixty-one consecutive patients diagnosed with PR after repair of TOF who met the inclusion criteria (n=122) in our hospital were recruited. The tests included electrocardiography and CMR. QRS duration, fQRS, RVESVi, RVEDVi and RVEF were analyzed. The correlation between QRS duration, fQRS and volume parameters and right ventricular function were analyzed. Independent predictor of right ventricular dilation and dysfunction in logistic regression models were analyzed. Results Twenty-eight patients(45.9%)had fQRS, 45 patients(73.7%)was found QRS duration >120ms and complete right bundle branch block, 19 patients(31.1%)was found RVEF<45%, and 30 patients(49.1%)was found RVESVi>150ml. The Pearson correlation demonstrated a significant negative correlation between QRS duration and RVEF (r=-0.60, P=0.000) and a significant positive correlation between QRS duration and RVESVi (r=0.63,P=0.000) and RVEDVi (r=0.55,P=0.000). Compared with the QRS duration in patients without fQRS(131.5±26.00 ms), patients with fQRS had a significantly higher level of QRS duration (156.83±25.45 ms). In logistic regression models, QRS duration> 120 ms was found to be the independent predictor of right ventricular dilation and dysfunction(HR=6.69,P=0.000;HR=10.62,P=0.000). Conclusion QRS duration constitutes an independent predictor of the presence of right ventricular dilation and dysfunction in TOF Patients with PR. But more studies are needed to provide more evidences.