累及左心室的致心律失常性右室心肌病临床表型分析  

Clinical phenotype analysis of arrhythmogenic right ventricular cardiomyopathy with left venericular involvement

作　　者：马延仃 弓向荣 MA Yanding;GONG Xiangrong(Department of Cardiology,First Affiliated Hospital of Zhengzhou University,Zhengzhou,450000,China)

机构地区：[1]郑州大学第一附属医院心内科

出　　处：《临床心血管病杂志》2019年第11期1041-1046,共6页Journal of Clinical Cardiology

摘　　要：目的:分析累及左心室的致心律失常性右室心肌病(ARVC)患者的临床特点、心电图及超声心动图指标,探索左心室与ARVC间的关系,以加深对左心室受累临床表型的认识。方法:回顾性搜集郑州大学第一附属医院心内科2011-01-2019-05临床确诊为ARVC的患者,入选超声心动图提示心室结构和(或)功能异常的患者39例,根据超声心动图分为右室孤立病变组21例和左室受累组18例,比较两组的一般临床资料、心电图及超声心动图指标。结果:入选患者中,18例(46.2%)左心室受累。左室受累组发病年龄、确诊年龄均明显小于右室局部病变组。在发病至确诊时长、性别比例、发病诱因、合并症、猝死家族史、症状、临床心力衰竭等一般临床资料和心电图指标(QRS波低电压、Epsilon波、T波倒置)方面,两组差异均无统计学意义。与右室孤立病变组相比,左室受累组左室舒张末期内径(LVEDD)、左室舒张末期容积(LVEDV)、左室收缩末期容积(LVESV)更大,左室射血分数(LVEF)更低,肺动脉收缩压更低。两组RVEDD、右室功能、二尖瓣和三尖瓣反流差异均无统计学意义。结论:左心室受累可能是ARVC的独立临床表型,可发生在疾病的任何阶段,而不是疾病进展至晚期的临床表现。Objective:To analyze the clinical characteristics,electrocardiogram(ECG) and echocardiogram(UCG) of arrhythmogenic right ventricular cardiomyopathy(ARVC) with left ventricle(LV) involvement,and explore the relationship between LV and ARVC.Method:Thirty-nine ARVC patients with abnormal ventricular structure and/or function in UCG from First Affiliated Hospital of Zhengzhou University during January 2011 to May 2019 were retrospectively included.They were divided into two groups according to UCG:the right ventricular(RV) only abnormality group(n=21) and LV involvement group(n=18).The general information,data of ECG and UCG were collected and compared.Result:Eighteen patients(46.2%) were LV involvement.The onset age and diagnosis age of LV involvement group were both younger than that of RV only abnormality group.There was no significant difference between two groups in general information(duration from onset to diagnosis,sex ratio,inducing factors,complications,family history of sudden cardiac death,symptoms,clinical heart failure) and data of ECG(low voltage of QRS wave,Epsilon wave,T wave inversion).Compared with RV only abnormality group,it was larger of LVEDD,LVEDV and LVESV,LVEF was lower,pulmonary artery systolic pressure was lower in LV involvement group.There was no significant difference in RVEDD,RV function,mitral and tricuspid regurgitation between two groups.Conclusion:LV involvement may be an independent clinical phenotype of ARVC rather than the clinical manifestation of which progressing to advanced stage.It may occur at any stage of ARVC.

关 键 词：心电图 超声心动图 临床特点 右室心肌病 左心室 

分 类 号：R542.2[医药卫生—心血管疾病]