心电图与主动脉瓣反流瓣膜置换术后预后的相关性  

Correlation between electrocardiogram and long-term prognosis after aortic valve replacement in patient with aortic regurgitation

作　　者：靳慧君 卞晓明[2] 王泽峰[1] 江雪[1] 刘吉义[1] 刘璐[1] 赵维龙[1] 石昕 张树龙[1] Jin Huijun;Bian Xiaoming;Wang Zefeng;Jiang Xue;Liu Jiyi;Liu Lu;Zhao Weilong;Shi Xin;Zhang Shulong(Heart Center,Zhongshan Hospital,Dalian University,Dalian 116001,China;Department of Cardiology,First Affiliated Hospital of Dalian Medical University,Dalian 116011,China)

机构地区：[1]大连大学附属中山医院心脏中心,116001 [2]大连医科大学附属第一医院心内科,116011

出　　处：《中华心律失常学杂志》2019年第6期511-517,共7页Chinese Journal of Cardiac Arrhythmias

基　　金：国家自然科学基金(81370307)。

摘　　要：目的评价主动脉瓣置换术(AVR)术前心电图指标对于预测主动脉瓣反流(AR)患者术后左心室结构、功能恢复及临床预后的价值。方法回顾性分析2005年1月至2015年1月在大连医科大学附属第一医院首次接受AVR患者50例临床资料,根据术前及术后早期左心室舒张末期内径(LVEDD)的变化将其分为两组:左心室重构组(术后早期LVEDD较术前减少≥10%);左心室非重构组(术后早期LVEDD较术前减少<10%)。比较两组患者AVR术前心电图等指标,并使用log-rank检验影响术后早期左心室重构的因素,采用Kaplan-Meier法绘制生存曲线。结果40例(82%)AR患者AVR术后早期较术前LVEDD降低≥10%。左心室重构组较非重构组心电图各参数比较,右胸前导联S波振幅变化最为显著(P<0.001)。AVR术前S2≤2.9 mV对于预测术后晚期左心室射血分数(LVEF)>45%的敏感度90.0%,特异性90.0%,因心力衰竭(心衰)再住院及全因死亡率均较S2>2.9 mV组高(P<0.001)。结论单纯慢性AR患者AVR术前V2导联S波振幅与术后早期左心室重构及晚期预后有一定关联。The aim of this study was to determine whether cardiac remodeling and clinical outcomes after aortic valve replacement(AVR)could be predicted by simple preoperative electrocardiographic analysis.Methods In a single-center,from January 2005 to January 2015,we retrospectively analyzed the clinical data of 50 patients with pure chronic aortic regurgitation(AR)who had underwent AVR.Based on the presence or absence of early left ventricular(LV)diastolic remodeling,the patients were divided into 2 groups.Early diastolic remodeling was defined as an early postoperative LV diastolic dimension reduction of 10%or more,while non-remodeling group was early postoperative LV diastolic dimension decreased less than 10%.Results Forty patients(82%)had positive early LV remodeling after AVR.The amplitude of S wave in the right thoracic lead decreased significantly in the left ventricular remodeling group(P<0.001).The amplitude of S wave≤2.9 mV was the predictor of late postoperative when left ventricular ejection fraction(LVEF)was>45%(sensitivity 90%and specificity 90%)applied ultrasound measurement at(1.7±1.1)years.Patients with an amplitude of S wave>2.9 mV had higher heart failure prehospitalization and all-cause mortality(P<0.001)during mean 601 days follow-up.Conclusion S wave amplitude of V2 lead before AVR in patients with chronic AR is associated with early left ventricular remodeling and advanced prognosis.

关 键 词：心电描记术 主动脉瓣反流 主动脉瓣置换术 S波振幅 

分 类 号：R54[医药卫生—心血管疾病]