完全性心动过速性心肌病临床特点及预后分析  

Clinical characteristics and prognosis of pure tachycardia-induced cardiomyopathy

作　　者：钱海燕[1] 黄觊[2] 杨跃进[1] 杨艳敏[3] 张朝阳[3] 李志忠[2] 张京梅[2] 

机构地区：[1]中国医学科学院北京协和医学院国家心血管病中心阜外心血管病医院心血管疾病国家重点实验室冠心病诊治中心,北京市100037 [2]首都医科大学附属北京安贞医院心内科,北京市100029 [3]中国医学科学院北京协和医学院国家心血管病中心阜外心血管病医院急诊科心血管疾病国家重点实验室,北京市100037

出　　处：《中华实用诊断与治疗杂志》2013年第3期216-218,共3页Journal of Chinese Practical Diagnosis and Therapy

基　　金：国家自然科学基金(81000091);国家自然科学基金(81000130);北京新星计划(2008B78)

摘　　要：目的探讨完全性心动过速性心肌病(tachycardia-induced cardiomyopathy,TCM)患者的临床特点和预后。方法完全性TCM患者45例(TCM组)与扩张性心肌病(dilated cardiomyopathy,DCM)患者50例(DCM组),记录2组首诊和随访时临床资料,总结分析其特点及预后。结果 TCM组28例接受射频消融术根治心律失常,17例持续用药物控制心室率或维持窦性心律,其中1例植入自动复律除颤器;随访10～14个月时,TCM组心率、纽约心功能Ⅲ～Ⅳ级患者比例、脑钠肽前体水平及左心室舒张末期内径均明显低于治疗前及DCM组,左室射血分数明显高于治疗前及DCM组(P<0.01);随访10～14个月时TCM组发生复合终点事件3例(6.7%),DCM组发生复合终点事件16例(32.0%),差异有统计学意义(P<0.01)。结论当合并存在快速性心律失常和心力衰竭时,应注意TCM的诊断;药物控制或射频消融术可使多数TCM患者心脏结构和功能恢复正常,预后明显优于DCM。Objective To analyze the characteristics and prognosis of pure tachycardia-induced cardiomyopathy （TCM）. Methods The clinical data of 45 pure TCM patients （TCM group） and 50 dilated cardiomyopathy patients （DCM group） were recorded at the first admission and follow up survey to analyze the clinical characteristics and prognosis. Results In TCM group, 28 patients received catheter ablation, and the other 17 patients received medications to control ventricular rate or maintain the sinal rhythm, in which one patient was implanted automatic implantable cardioverter defibrillator. After the follow up survey for 10 to 14 months, the heart rate, the proportion of patients with NYHA [~ ~IV class, N- terminal pro-brain natriuretic peptide （NT-ProBNP） level and left ventrieular end-diastolic dimension were significantly lower than those before treatment in TCM group as well as after treatment in DCM group （P^0. 01）. After the follow-up survey for 10 to 14 months, composite events occurred in 3 cases （6.7%） in TCM group and 16 cases （32.0%） in DCM group, which showed a significant difference （P〈0. 01）. Conclusion TCM should be considered when tachyarrhythmia is complicated with heart failure. Catheter ablation or medication treatment can restore the heart structure and function in TCM patients, with a better prognosis than DCM patients.

关 键 词：心动过速性心肌病 扩张性心肌病 心律失常 诊断 治疗 预后 

分 类 号：R542.2[医药卫生—心血管疾病]