高血压伴左心室肥厚与T波顶峰后宽度的关系

目的探讨高血压左心室肥厚(LVH)患者T波顶峰后宽度(TpTe间期)的改变及其临床意义。方法随机抽取2010-10-2011-06桂林医学院附属医院心内科住院的原发性高血压(EH)患者313例,根据超声心动图(UCG)测定的左心室质量指数(LVMI)分为LVH组和非LVH(NLVH)组。比较两组TpTe间期、校正TpTe间期(TpTec)、QT间期、校正QT间期(QTc)、QRS时限、LVMI、左心室舒张末期内径(LVEDD)、室间隔厚度(IVST)、左心室后壁厚度(LVPWT)的改变及其相互关系;比较不同血压水平对TpTe间期的影响;EH患者左心室不同构型TpTe间期改变的特点。结果与NLVH组比较,LVH组TpTe间期(100.0±23.3)比(85.3±14.1)ms]、TpTec(108.6±26.7)比(91.4±15.4)ms]、QTc(435.0±23.6)比(420.0±23.5)ms]、QRS时限(105.3±22.3)比(95.6±16.1)ms]均延长(均P<0.01),LVMI(142.8±29.3)比(82.5±19.0)g/m2],LVEDD(58.9±7.5)比(47.6±6.5)cm],IVST(9.7±1.0)比(8.8±1.2)cm],LVPWT(9.4±1.1)比(8.5±1.1)cm]明显增大(均P<0.01),QT间期延长,但差异无统计学意义。TpTe间期在不同左心室构型间的改变为:离心型肥厚>向心性肥厚>左心室游离壁肥厚>正常心室形态。Pearson相关分析表明,TpTe间期、TpTec与LVMI(r=0.43,0.44)、LVEDD(r=0.41,0.43)呈正相关(P<0.05)。多元线性回归分析显示,LVMI、LVEDD是TpTe间期重要的影响因素(β=0.026、0.280)。结论 TpTe间期可作为评价高血压伴左心室肥厚靶器官损害程度的心电学指标之一。

T wave peak-to-end interval in hypertensive patients with left ventricular hypertrophy

Objective To investigate the change of T wave peak-to-end interval ( TpTe interval ) and its clinical implications in hypertensive patients with left ventricular hypertrophy ( LVH ) . Methods By randomized sampling method,313inpatients with primary essential hypertension ( EH ) from cardiology department of Affiliated Hospital of Guilin Medical University between October 2010and June 2011were enrolled. Those patients were divided into LVH group ( hypertension with LVH ) and NLVH group ( hypertension without LVH ) according to left ventricular mass index ( LVMI ) determined by echocardiogram ( UCG ) . Alterations of TpTe interval,corrected TpTec ( TpTec ) interval,QT interval,corrected QT ( QTc ), QRS duration were evaluated. Left ventricle ( LV ) parameters such as LVMI,LV end-diastolic dimension ( LVEDD ), interventricular septal thickness ( IVST ) and LV posterior wall thickness ( LVPWT ) were obtained. The relationships between TpTe interval and either hypertension grades or LVH patterns were analyzed. Results TpTe interval,TpTec,QTc,and QRS duration in LVH group were significantly longer than those in NLVH group TpTe interval ( 100.0±23.3 ) vs ( 85.3±14.1 ) ms,TpTec ( 108.6±26.7 ) vs ( 91.4±15.4 ) ms,QTc ( 435.0±23.6 ) vs ( 420.0±23.5 ) ms,and QRS duration ( 105.3±22.3 ) vs ( 95.6±16.1 ) ms,all P<0.01 ] . LVMI,LVEDD,IVST and LVPWT in LVH group increased significantly compared with NLVH group LVMI ( 142.8±29.3 ) vs ( 82.5±19.0 ) g / m 2,LVEDD ( 58.9±7.5 ) vs ( 47.6± 6.5 ) cm,IVST ( 9.7±1.0 ) vs ( 8.8±1.2 ) cm,LVPWT ( 9.4±1.1 ) vs ( 8.5±1.1 ) cm,all P<0.01 ] . QT interval was prolonged in LVH patients,but there was no statistical difference between the two groups. The sequence of TpTe interval in different LV patterns was eccentric hypertrophy LVH>concentric LVH>LV free wall hypertrophy>normal LV group. Pearson correlation analysisi showed that the TpTe interval and TpTec were positively correlated with LVMI ( r=0.43,0.44 ), LVEDD ( r=0.41,0.43 ) . LVMI and LVEDD were important factors for TpTe interval ( β =0.026,0.280 ) by multiple linear regression analysis. Conclusion TpTe interval may be a newelectrocardiologic index to evaluate the damage degree of the target organs in EH patients with LVH.