完全性左束支传导阻滞患者avL导联q波与器质性心脏病相关性的探讨  

Correlation between q wave in avL and organic heart disease in patients with complete left bundle branch block

作　　者：张诗梦[1] 张恒莉 崔畅 顾凯[1] 陈明龙[1] ZHANG Shimeng;ZHANG Hengli;CUI Chang;GU Kai;CHEN Minglong(Division of Cardiology,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China)

机构地区：[1]南京医科大学第一附属医院心内科,江苏南京210029

出　　处：《南京医科大学学报（自然科学版）》2020年第4期557-562,共6页Journal of Nanjing Medical University(Natural Sciences)

基　　金：国家重点研发计划(2017YFC1307803)。

摘　　要：目的:分析完全性左束支传导阻滞(complete left bundle branch block,CLBBB)患者中avL导联q波的发生率、形态特征及其与门控单电子发射型计算机断层心肌灌注显像(single-photon emission computed tomography myocardial perfusion imaging,SPECT-MPI)检查及冠状动脉造影(coronary angiography,CAG)或冠状动脉计算机断层血管造影(coronary computed tomography angiography,CCTA)所诊断的器质性心脏病(organic heart disease,OHD)的相关性。方法:回顾性分析1 882例标准12导联心电图诊断的CLBBB患者并收集其SPECT-MPI、CAG及CCTA的信息。测量心电图中avL导联QRS时限及振幅、q波时限及振幅,分析q波与器质性心脏病的相关性。结果:最终入选了157例患者,证实伴有OHD的患者122例(77.8%),其中avL导联出现q波者56例(45.9%)。avL导联q波出现预测OHD的特异性及阳性预测值分别是97.1%和98.2%。与avL导联q波缺失且伴有OHD的CLBBB患者相比,avL导联出现q波的患者SPECT-MPI所测得的左心室收缩末容积(end systolic volume,ESV)和舒张末容积(end diastolic volume,EDV)显著升高(P均<0.001),而左心室射血分数(left ventricular ejection fraction,LVEF)显著下降(P<0.001)。散点图和线性相关性分析显示CLBBB患者avL导联q波的时限、振幅和面积与SPECT-MPI所测得的左心室ESV、EDV和LVEF无线性相关性。结论:CLBBB患者avL导联出现q波与严重的左心室病变有关,但q波的时限、振幅及面积与左心室病变严重度无线性相关性。Objective:To determine the prevalence of q wave in avL,prescribe its characteristics,and evaluate the correlation between the q wave in avL and organic heart disease(OHD)verified by gated single-photon emission computed tomography myocardial perfusion imaging(SPECT-MPI)and coronary angiography(CAG)or coronary computed tomography angiography(CCTA)in the patients with complete left bundle branch block(CLBBB). Methods:A total of 1 882 CLBBB patients were initially involved in the study,and the results of SPECT-MPI,CAG and CCTA were collected. The prevalence,duration and amplitude of q wave as well as the duration and amplitude of QRS complex in avL were measured,on which the correlation between q wave and OHD were analyzed. Results:In this study,157 patients were involved finally,and 122 of which(77.8%)were confirmed with OHD by SPECT-MPI,CAG and CCTA.Septal q waves were present in 56 of the 122 OHD patients(45.9%)[OHD(+)q(+)group]. Specificity and positive predictive value of q wave in avL for OHD were 97.1% and 98.2% respectively. Comparing with the CLBBB patients in OHD(+)q(-)group,the CLBBB patients in OHD(+)q(+)group have larger end diastolic volume(EDV)(P<0.001)and end systolic volume(ESV)(P<0.001),but lower left ventricular ejection fraction(LVEF)(P<0.001). Scatter chart and correlation analysis showed no significant linear correlations between the duration,amplitude,areas of q wave and the left ventricular ESV,EDV and LVEF verified by SPECT-MPI.Conclusion:Occurrence of q wave in avL in CLBBB patients indicates serious left ventricular disease,but there is no linear correlation between the characteristics of q wave and the severity of left ventricular disease.

关 键 词：完全性左束支传导阻滞 Q波 AVL导联 器质性心脏病 

分 类 号：R541.7[医药卫生—心血管疾病]