老年慢性心力衰竭患者心室结构-心电重构与心律失常的关系  

Ventricular structure electrical remodeling and arrhythmia in elderly patients with chronic congestive heart failure

作　　者：李刚[1] 刘运俊[2] 石磊[2] 

机构地区：[1]重庆医科大学附属第一医院老年科心血管病组,重庆400016重庆400010 [2]重庆医科大学附属第二医院内科心血管病组,重庆400010

出　　处：《心脏杂志》2007年第3期329-331,共3页Chinese Heart Journal

基　　金：重庆市卫生局科研项目[渝卫教2004(53)04-2-154]

摘　　要：目的探讨老年心肌梗死后慢性心力衰竭(CHF)患者心室结构-心电重构与心律失常的关系。方法收集老年心肌梗死后CHF患者55例[心功能(NYHA分级):II级23例,III级15例,Ⅳ级17例]及心肌梗死后心功能(NYHA)I级患者30例,采用超声心动图,标准12导联心电图及24小时动态心电图检测其心室腔大小,QT间期,校正QT间期(QTc)及心律失常。结果与心功能I级组比较,CHF组心室腔显著扩大[CHF组:左室舒张末直径(LVEDD)(57±8)mm,左室收缩末直径(LVESD)(45±8)mm;心功能I级组:LVEDD(45±5)mm,LVESD(31±5)mm,P<0.05]。两组间心室复极指标无显著差异[CHF组:QT(0.41±0.07)s,QTc(0.44±0.06)s;心功能I级组:QT(0.41±0.04)s,QTc(0.44±0.04)s]。两组间室性心律失常亦无显著差异[CHF组:室性早搏(VPB)(219±598)次/24h;心功能I级组:VPB(345±504)次/24h]。结论老年心肌梗死后CHF时,心室结构重构显著,心室腔显著扩大,但在本研究中心室结构重构未见引起显著心电重构,心室复极延长及室性心律失常未见显著增加。AIM To investigate the relation between ventricular structural electrocardiological remodeling and ventricular arrhythmia in elderly patients with chronic congestive heart failure （CHF） secondary to old myocardial infarction. METHODS Fifty-five elderly patients with CHF secondary to old myocardial infarction （23 in cardiac function class Ⅱ, 15 in class Ⅲ, 17 in class Ⅳ, NYHA ） and in 30 agematched elderly patients with cardiac function class Ⅰ （NYHA） secondary to old myocardial infarction were included in this study. Their ventricular chamber sizes, QT, QTc intervals and the ventricular arrhythmia were assessed respectively with echocardiography, standard 12-lead electrocardiography and 24- hour Hoher recordings. RESULTS The ventricular chamber sizes were significantly larger in the elderly patients with CHF than those in cardiac function class I group [ CHF group： left ventricular end diastolic diameter （LVEDD） （57 ± 8 ） ram; left ventricular end systolic diameter （LVESD） （45 ± 8 ） mm vs. cardiac function class Ⅰgroup： LVEDD （45 ± 5 ）mm; LVESD （ 31± 5 ） mm, P 〈 0.05, respectively ]. However, there was no difference in ventricular repolarization indices between the two groups [ CHF group： QT （ 0.41±0.07） s; QTc （ 0.44±0.06） s vs. cardiac function class Ⅰ group： QT （0.41 ± 0.04 ） s, QTc （0.44 ± 0.04） s, respectively ]. The ventricular arrhythmogenesis was also not found to be significantly higher in the elderly patients with CHF than those in cardiac function class Ⅰ group [ CHF group： ventricular premature beat （VPB） （219 ±598）1/24 h vs. cardiac function class Ⅰ group： VPB（345 ± 504）1/24 h ]. CONCLUSION The ventricular structural remodeling enlargement is significant in elderly patients with CHF secondary to old myocardial infarction. However, the ventricular structural re-modeling enlargement does not cause significant prolongation of the ventricular repolarization and the increase of the ventricular arrhythmo

关 键 词：心力衰竭 心律失常 QT间期 心室 

分 类 号：R541.75[医药卫生—心血管疾病]