致心律失常性右室心肌病高危患者相关危险因素分析  

The risk stratification in patients with arrhythmogenic right ventricular dysplasia/cardiomyopathy.

作　　者：王培宁[1] 吴书林[1] 侯跃双[1] 何亚乐[1] 杨平珍[1] 费洪文[1] 詹贤章[1] 方咸宏[1] 薛玉梅[1] 卓伟民[1] 

机构地区：[1]广东省人民医院广东省心血管病研究所广东省医学科学院,广东广州510080

出　　处：《中国心脏起搏与心电生理杂志》2009年第1期26-29,共4页Chinese Journal of Cardiac Pacing and Electrophysiology

基　　金：广东省医学科研基金课题(项目编号:A2008054)

摘　　要：目的探讨致心律失常性右室心肌病(ARVD/C)高危患者相关危险因素。方法根据1994年ARVD/C诊断标准,纳入43例ARVD/C先证者。分组标准:有晕厥病史并记录到室性心动过速(简称室速)为高危病人;记录到室性早搏(简称室早)、室速但无晕厥病史及其他临床情况定为低危病人。收集参数包括:①心电图V1～3QRS波时限≥110 ms、V1～3导联S波升支时限≥55 ms、Epsilon波、T波倒置、(V1+V2+V3)/(V4+V5+V6)QRS波时限≥1.2、QRS波离散度≥40 ms、QT离散度≥65 ms;②信号平均心电图记录晚电位参数;③Holter记录室早或室速;④超声记录双房、双室及右室流出道、流入道内径大小。Logistic回归分析高危患者ARVD/C病人的相关危险因素。结果心室晚电位阳性、右室射血分数<0.40与高危ARVD/C显著相关。结论晚电位阳性、右心功能不全是ARVD/C的高危因素。Objective To systematically investigate risk stratification in the high-risk ARVD/C patients. Methods The study included 45 probands with ARVD/C meeting the criteria in 1994. The high-risk patients had syncope companied by ventricular tachycardia, while the remaining were the low risk patients. The items of the clinical evaluation included：（1） The value of different ECG criteria （QRS duration in V1-3 leads ≥1110 ms, S-wave upstroke duration in V1-3 leads ≥ 55 ms, Epsilon potentials and T-wave inversions in the right precordial leads, （V1 ＋ V2 ＋ V3 ）/（ V4 ＋ Vs ＋ V6 ）QRS duration 1.2, QRS dispersion/〉 dO ms, QT dispersion ≥ 65 ms. （2） signal averaged- ECG. （3） ventricular tachycardia and pre- mature ventricular complex during 24h-Hoher monitor. （4） The size of the atrium and ventricle from echocardiography. A stepwise binary logistic regression was performed to identify those with high- risk ARVD/C using a probability value of PC 0.05. Results Ventricular late potential, right ventricular ejection fraction were significantly correlated with high-risk ARVD/C patients. Conclusion Ventricular late potential, right ventricular failure are high-risk parameters for the ARVD/C patients in the study. [ Chinese Journal of Cardiac Pacing and Electrophysiology, 2009,23 （1） ：26 -29 ]

关 键 词：心血管病学 致心律失常性右室心肌病 室性心动过速 心室晚电位 右室射血分数 

分 类 号：R541.71[医药卫生—心血管疾病] R540.41[医药卫生—内科学]