Tp-e间期,Tp-e/QT与ICD一级预防患者发生恶性室性心律失常的关系  

Correlation of Tp-e interval and Tp-e/Q-T ratio with malignant ventricular arrhythmia in patients with implantable cardioverter-defibrillator for primary prevention

作　　者：朱庭延 滕树恩 陈燕玉[1] 刘深荣 孟素荣[1] 彭健[1] 

机构地区：[1]南方医科大学南方医院心内科,广东广州510515

出　　处：《南方医科大学学报》2016年第3期401-404,共4页Journal of Southern Medical University

基　　金：广东省科技计划项目(2013B021800140);广州市科技计划项目(201300000146)

摘　　要：目的探讨心电图T波峰末间期（Tp-e）及T波峰末间期与QT间期的比值（Tp-e/QT）与ICD一级预防患者发生恶性室性心律失常的关系。方法分析我院2011年3月~2014年2月因严重慢性心功能不全（左室射血分数≤35%,纽约心功能分级为Ⅱ/Ⅲ级,且既往从未发生过室速或室颤等恶性心律失常）接受ICD（植入式心脏复律除颤器）一级预防的患者68例,对所有的患者随访18~38个月（平均26个月）。在随访过程中,患者根据是否发生终点事件分为高危组及低危组;本研究以SCD或室颤、室速作为终点事件。术前对所有的患者进行12导联心电图、心脏彩超、24 h动态心电图等检查,并分析Tpeak-Tend间期及（TpeakTend）/QT。结果随访过程中,因ICD识别持续性室速或室颤而引发恰当放电的患者共11例,由ICD发现非持续性室速而不需治疗的患者共7例,故高危组患者共18例。从未发生室速或室颤者共50例为低危组。高危组患者的（Tp-e）105±15 ms明显高于低危组90±17 ms（P=0.003）;（Tpeak-Tend）/QT比值在高危组与低危早组相比有明显的统计学差异（0.27±0.04 vs 0.22±0.05,P=0.002）.Tp Te/QT≥0.255预测ICD一级预防患者发生恶性室性心律失常风险的敏感性和特异性分别为72.2%和65.9%;Tp Te≥103 ms预测ICD一级预防患者发生恶性室性心律失常风险的敏感性和特异性分别为66.7%和67.9%。结论 Tp-e间期、Tp-e/QT比值与ICD一级预防患者发生恶性室性心律失常的关系密切,Tpeak-Tend间期及Tp-e/QT比值越大,ICD一级预防患者发生恶性室性心律失常如室速、室颤的可能性越大。Objective To investigate whether Tpeak- Tend interval（Tp- e） and Tp- e/QT ratio are associated with malignant ventricular arrhythmia in patients with implantable cardioverter-defibrillator（ICD） for primary prevention. Methods A cohort of 68 consecutive patients with chronic heart failure undergoing standard ICD for primary prevention indications（NYHA function class II- III, left ventricular ejection fraction ≤35%, systolic cardiomyopathy without prior malignant ventricular arrhythmia） were enrolled in this study. The patients were followed up for 18- 48 months and were divided into high- risk group and low- risk group according to the occurrence of the endpoint events of sudden cardiac death（SCD）, ventricular tachycardia（VT）, or ventricular fibrillation（VF）. Electrocardiographic and echocardiographic characteristics, Tp- e, and Tp- e/QT ratio were analyzed in all cases before ICD implantation. Results During the follow- up, ICD shock for sustained ventricular tachycardia or ventricular fibrillation occurred in 11 patients; nonsustained ventricular tachycardia（NSVT） that did not require therapy was detected by ICD in 7 patients（high-risk group, 18 cases）. ICD did not detect ventricular tachycardia or ventricular fibrillation in 50 patients（low-rsk group）. Compared with the low-rsik group, the high-risk group had an increased Tp-e /QT ratio（0.27±0.04 vs 0.22±0.05 P0.01） and an increased Tp-e（105±15 vs 90±17 ms P0.01）. ROC analysis revealed that a Tp-e/QT ratio ≥0.255 had a sensitivity of 72.2% and a specificity of 65.9%, and a Tp-e ≥103 ms had a sensitivity of 66.7% and a specificity of 67.9% for predicting VT and VF in these patients. Conclusion Increased Tp- e and Tp- e/QT ratio are associated with increased risks of ventricular arrhythmias in patients with ICD for primary prevention.

关 键 词：室性心律失常 T波峰-末间期 QT间期 植入式心脏复律除颤器 猝死 

分 类 号：R541.7[医药卫生—心血管疾病]