T波电交替的重复检测及其对致心律失常型右室心肌病患者室性心律失常事件的预测价值  

The predictive value of twice microvolt T-wave alternans tests for ventricular arrhythmias in patients with arrhythmogenic right ventricular cardiomyopathy

作　　者：薛社亮[1] 徐波[1] 李文华[1] 蔡高军[1] 宋艳斌[1] 俞磊[1] 李峰[1] 肖建强[1] XUE She-liang;XU Bo;LI Wen-hua;CAI Gao-jun;SONG Yan-bin;YU Lei;LI Feng;XIAO Jian-qiang(Department of Cardiology,Wujin Hospital Affiliated with Jiangsu University,The Wujin Clinical college of Xuzhou Medical University,Changzhou 213017,Jiangsu,China)

机构地区：[1]江苏大学附属武进医院,徐州医科大学武进临床学院心血管内科,江苏常州213017

出　　处：《中国心脏起搏与心电生理杂志》2022年第5期422-426,共5页Chinese Journal of Cardiac Pacing and Electrophysiology

基　　金：常州市武进区科技支撑(社会发展)项目(WS201802);江苏大学2018年度临床医学科技发展基金项目(JLY20180082)。

摘　　要：目的 探讨时域法微伏级T波电交替(MTWA)重复检测对致心律失常型右室心肌病(ARVC)患者室性心律失常事件发生的预测价值。方法 2007年1月至2008年11月间顺序入组20例ARVC患者[男性18例,年龄(38.7±8.0)岁],及正常对照组60人,所有患者签署知情同意书,行活动平板法MTWA检测,并随访观察。在随访4~5年后复查MTWA一次。阳性事件定义为有症状的持续性室性心动过速(简称室速)、埋藏式心律转复除颤器(ICD)恰当治疗及心脏性猝死的发生。结果 20例ARVC患者入组时胸前各导联MTWA检测均高于正常对照组,操作者特征曲线(ROC)表明,以11.5μV作为MaxValt(V~V导联中的MTWA最大值)的截断值时,其区别ARVC与正常对照组的诊断价值最大。20例ARVC患者随访(64.7±4.6)个月,11例发生阳性事件(其中11例发生持续性室速,1例因室速发生晕厥,1例植入ICD者因室速行放电治疗,3例因室速发作新植入ICD)。以MaxValt 11.5μV为截断值,20名患者中原有MTWA阳性16例,MTWA阴性4例。KM曲线表明,阳性患者的累积生存率显著降低。复测MTWA阳性13例,MTWA阴性7例。其中,第一次MTWA阴性者,复测MTWA均仍为阴性,且此4人均无室性心律失常事件发生。结论 MTWA阳性患者发生室性心律失常事件的风险增高,而持续阴性则预示着发生室性心律失常事件风险较低。Objective To investigate the predictive value of twice microvolt T-wave alternans(MTWA) tests for ventricular arrhythmias in patients with arrhythmogenic right ventricular cardiomyopathy(ARVC). Methods From January 2007 to November 2008, 20 ARVC patients and 60 healthy controls were enrolled. All patients signed informed consent and underwent MTWA test by treadmill method. MTWA was reexamined after 4-5 years of follow-up. A positive event was defined as the first occurrence of sudden cardiac death(SCD), documented sustained ventricular tachycardia(VT), ventricular fibrillation(VF), or the administration of appropriate implantable cardioverter defibrillator(ICD) therapy. Results There were significant differences between ARVC patients and healthy people in alternation voltage of lead V-Vand MaxAlt(the maximal MTWA voltage of each people). The receiver operating characteristic(ROC) curve showed that a MaxValt of 11.5μV was the optimal cutoff value to identify ARVC patients from normal controls. Twenty patients with ARVC were followed up for(64.7±4.6) months, and 11 patients had positive events. Sixteen patients were MTWA positive and 4 patients were MTWA negative. Kaplan-Meier curve showed that the cumulative survival rate of positive patients was significantly reduced. In the second MTWA test, 11 patients were positive and 7 patients were negative. 4 patients who were negative in the first test remained negative in the second, and no ventricular arrhythmias occurred in these four patients.Conclusion The occurring of ventricular arrhythmias is higher in patients with ARVC with positive MTWA,while the occurring of ventricular arrhythmias is lower in patients with persistent negative MTWA.

关 键 词：心血管病学 时域法 微伏级T波电交替 致心律失常型右室心肌病 室性心动过速 预测 

分 类 号：R541.7[医药卫生—心血管疾病] R542.2[医药卫生—内科学] R540.41[医药卫生—临床医学]