儿童肥厚型心肌病的心电异常及处理
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摘要
肥厚型心肌病(HCM)是儿童和青少年猝死的常见原因之一,儿童期猝死事件主要归因于室性心律失常。HCM的心电活动异常与其心肌肥厚的组织学特点和遗传性病因相关,虽然心电异常缺乏特异性,但某些异常对预测心电不良事件具有一定的敏感性,或可提示潜在病因,可以为儿童HCM的病因诊断和高危患者的筛查及管理、植入式心律转复除颤器治疗指征的把握提供有价值的依据。
Hypertrophic cardiomyopathy(HCM)is a common cause of sudden deaths in children and adolescents,mostly due to ventricular arrhythmia. The abnormal ECG activity of HCM is related to the histological characteristics of myocardial hypertrophy. Although ECG lacks specificity,some changes still have certain sensitivity in HCM,or give hints to potential causes. These can provide valuable basis for the early diagnosis,as well as the monitoring and management of high-risk patients,and help estimate the time of ICD treatment.
Hypertrophic cardiomyopathy(HCM)is a common cause of sudden deaths in children and adolescents,mostly due to ventricular arrhythmia. The abnormal ECG activity of HCM is related to the histological characteristics of myocardial hypertrophy. Although ECG lacks specificity,some changes still have certain sensitivity in HCM,or give hints to potential causes. These can provide valuable basis for the early diagnosis,as well as the monitoring and management of high-risk patients,and help estimate the time of ICD treatment.
引文
[1]Moak JP,Kaski JP.Hypertrophic cardiomyopathy in children[J].Heart,2012,98(14):1044-1054.
[2]Maron BJ,Doerer JJ,Haas TS,et al.Sudden deaths in young competitive athletes:analysis of 1866 deaths in the United States,1980-2006[J].Circulation,2009,119(8):1085-1092.
[3]Shah M.Hypertrophic cardiomyopathy[J].Cardiol Young,2017,27(S1):S25-S30.
[4]桂永浩,刘芳.实用小儿心脏病学[M].北京:人民军医出版社,2009:310-316.
[5]张丽华,方理刚,程中伟,等.回顾性调查线粒体疾病患者的心脏病变[J].中华心血管病杂志,2009,37(10):892-895.
[6]石璐,王昆鹏,侯小锋.PRKAG2心脏综合征发病机制及诊疗进展[J].中华心律失常学杂志,2018,22(3):267-270.
[7]张乾忠,马沛然,陈新民,等.小儿心肌病诊治进展[J].中国实用儿科杂志,2006,21(2):81-92.
[8]Maron BJ,Mc Kenna WJ,Danielson GK,et al.American College of Cardiology/European Society of Cardiology clinical expert consensus document on hypertrophic cardiomyopathy.A report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents and the European Society of Cardiology Committee for Practice Guidelines[J].J Am Coll Cardiol,2003,42(9):1687-1713.
[9]Elliott PM,Anastasakis A,Borger MA,et al.2014 ESC Guidelines on diagnosis and management of hypertrophic cardiomyopathy:the Task Force for the Diagnosis and Management of Hypertrophic Cardiomyopathy of the European Society of Cardiology(ESC)[J].Eur Heart J,2014,35(39):2733-2779.
[10]梁栩常,袁越.实用小儿心电图学[M].3版.北京:人民卫生出版社,2018:377-378.
[11]邵虹,马志玲,刘丽文.肥厚型心肌病心电图特征分析[J].临床心电学杂志,2015,24(3):177-180.
[12]Mussinelli R,Salinaro F,Alogna A,et al.Diagnostic and prognostic value of low QRS voltages in cardiac AL amyloidosis[J].Ann Noninvasive Electrocardiol,2013,18(3):271-280.
[13]李威,刘少稳,张锋.碎裂QRS波-无创心电学的新指标[J].国际心血管病杂志,2009,36(6):355-358.
[14]Debonnaire P,Katsanos S,Joyce E,et al.QRS fragmentation and QTc duration relate to malignant ventricular tachyarrhythmias and sudden cardiac death in patients with hypertrophic cardiomyopathy[J].J Cardiovasc Electrophysiol,2015,26(5):547-555.
[15]王维,陆锡利,王继征,等.肥厚型心肌病心电图特点与预后分析[J].中国循环杂志,2015,(z1):61.
[16]Torigoe K,Tamura A,Kawano Y,et al.The number of leads with fragmented QRS is independently associated with cardiac death or hospitalization for heart failure in patients with prior myocardial infarction[J].J Cardiol,2012,59(1):36-41.
[17]Morita H,Kusano KF,Miura D,et al.Fragmented QRS as a marker of conduction abnormality and a predictor of prognosis of Brugada syndrome[J].Circulation,2008,118(17):1697-1704.
[18]Basaran Y,Tigen K,Karaahmet T,et al.Fragmented QRS complexes are associated with cardiac fibrosis and significant intraventricular systolic dyssynchrony in nonischemic dilated cardiomyopathy patients with a narrow QRS interval[J].Echocardiography,2011,28(1):62-68.
[19]Haghjoo M,Mohammadzadeh S,Taherpour M,et al.ST-segment depression as a risk factor in hypertrophic cardiomyopathy[J].Europace,2009,11(5):643-649.
[20]杨承健,叶新和,徐欣,等.心尖肥厚型心肌病超声诊断特点及随访[J].中华内科杂志,2010,49(2):119-121.
[21]Park SY,Park TH,Kim JH,et al.Relationship between giant negative T-wave and severity of apical hypertrophy in patients with apical hypertrophic cardiomyopathy[J].Echocardiography,2010,27(7):770-776.
[22]王幸,洪建凤,张春丽,等.心尖肥厚型心肌病的心电图对比观察[J].实用心电学杂志,2004,13(4):262-263.
[23]Dinshaw L,Munch J,Dickow J,et al.The T-peak-to-T-end interval:a novel ECG marker for ventricular arrhythmia and appropriate ICD therapy in patients with hypertrophic cardiomyopathy[J].Clin Res Cardiol,2018,107(2):130-137.
[24]Panikkath R,Reinier K,Uy-Evanado A,et al.Prolonged T-peak-to-tend interval on the resting ECG is associated with increased risk of sudden cardiac death[J].Circ Arrhythm Electrophysiol,2011,4(4):441-447.
[25]Bachmann TN,Skov MW,Rasmussen PV,et al.Electrocardiographic T peak-Tend interval and risk of cardiovascular morbidity and mortality:Results from the Copenhagen ECGstudy[J].Heart Rhythm,2016,13(4):915-924.
[26]Badran HM,Elnoamany MF,Soltan G,et al.Relationship of mechanical dyssynchrony to QT interval prolongation in hypertrophic cardiomyopathy[J].Eur Heart J Cardiovasc Imaging,2012,13(5):423-432.
[27]Baranowski R,Chojnowska L,Michalak E,et al.Analysis of the corrected QT before the onset of nonsustained ventricular tachycardia in patients with hypertrophic cardiomyopathy[J].Pacing Clin Electrophysiol,2003,26(1 Pt 2):387-389.
[28]Macfarlane PW,McLaughlin SC,Rodger JC.Influence of lead selection and population on automated measurement of QT dispersion[J].Circulation,1998,98(20):2160-2167.
[29]Buja G,Miorelli M,Turrini P,et al.Comparison of QT dispersion in hypertrophic cardiomyopathy between patients with and without ventricular arrhythmias and sudden death[J].Am J Cardiol,1993,72(12):973-976.
[30]Yetman AT,Hamilton RM,Benson LN,et al.Long-term outcome and prognostic determinants in children with hypertrophic cardiomyopathy[J].J Am Coll Cardiol,1998,32(7):1943-1950.
[31]Uchiyama K,Hayashi K,Fujino N,et al.Impact of QT variables on clinical outcome of genotyped hypertrophic cardiomyopathy[J].Ann Noninvasive Electrocardiol,2009,14(1):65-71.
[32]Shimizu M,Ino H,Yamaguchi M,et al.Chronologic electrocardiographic changes in patients with hypertrophic cardiomyopathy associated with cardiac troponin 1 mutation[J].Am Heart J,2002,143(2):289-293.
[33]傅立军,陈茜.婴儿型庞贝病的诊治进展[J].精准医学杂志,2018,33(4):283-285,291.
[34]傅立军,陈树宝,邱文娟,等.婴儿型糖原贮积病Ⅱ型的临床特点及其转归[J].中华医学杂志,2013,93(20):1567-1570.
[35]蔡迟.Danon病临床研究进展[J].心血管病学进展,2012,33(1):39-42.
[36]石璐,王昆鹏,侯小锋.PRKAG2心脏综合征发病机制及诊疗进展[J].中华心律失常学杂志,2018,22(3):267-270.
[37]刘洋,林立,刘启功,等.PRKAG2心脏综合征[J].中华心血管病杂志,2010,38(9):859-862.
[38]张丽华,方理刚,程中伟,等.回顾性调查线粒体疾病患者的心脏病变[J].中华心血管病杂志,2009,37(10):892-895.
[39]Young TJ,Shah AK,Lee MH,et al.Kearns-Sayre syndrome:a case report and review of cardiovascular complications[J].Pacing Clin Electrophysiol,2005,28(5):454-457.
[40]Holmgren D,Wahlander H,Eriksson BO,et al.Cardiomyopathy in children with mitochondrial disease:Clinical course and cardiological findings[J].Eur Heart J,2003,24(3):280-288.
[41]Karanikis P,Korantzopoulos P,Kountouris E,et al.KearnsSayre syndrome associated with trifascicular block and QT prolongation[J].Int J Cardiol,2005,101(1):147-150.
[42]Raaijmakers R,Noordam C,Noonan JA,et al.Are ECG abnormalities in Noonan syndrome characteristic for the syndrome?[J].Eur J Pediatr,2008,167(12):1363-1367.
[43]Guttmann OP,Rahman MS,O’Mahony C,et al.Atrial fibrillation and thromboembolism in patients with hypertrophic cardiomyopathy:systematic review[J].Heart,2014,100(6):465-472.
[44]Katritsis DG,Camm AJ.Nonsustained ventricular tachycardia:where do we stand?[J].Eur Heart J,2004,25(13):1093-1099.
[45]Di Salvo G,Pacileo G,Limongelli G,et al.Non sustained ventricular tachycardia in hypertrophic cardiomyopathy and new ultrasonic derived parameters[J].J Am Soc Echocardiogr,2010,23(6):581-590.
[46]Adabag AS,Casey SA,Kuskowski MA,et al.Spectrum and prognostic significance of arrhythmias on ambulatory Holter electrocardiogram in hypertrophic cardiomyopathy[J].J Am Coll Cardiol,2005,45(5):697-704.
[47]中华医学会心血管病学分会中国成人肥厚型心肌病诊断与治疗指南编写组,中华心血管病杂志编辑委员会.中国成人肥厚型心肌病诊断与治疗指南[J].中华心血管病杂志,2017,45(12):1015-1032.
[48]Corrado D,Calkins H,Link MS,et al.Prophylactic implantable defibrillator in patients with arrhythmogenic right ventricular cardiomyopathy/dysplasia and no prior ventricular fibrillation or sustained ventricular tachycardia[J].Circulation,2010,122(12):1144-1152.
[2]Maron BJ,Doerer JJ,Haas TS,et al.Sudden deaths in young competitive athletes:analysis of 1866 deaths in the United States,1980-2006[J].Circulation,2009,119(8):1085-1092.
[3]Shah M.Hypertrophic cardiomyopathy[J].Cardiol Young,2017,27(S1):S25-S30.
[4]桂永浩,刘芳.实用小儿心脏病学[M].北京:人民军医出版社,2009:310-316.
[5]张丽华,方理刚,程中伟,等.回顾性调查线粒体疾病患者的心脏病变[J].中华心血管病杂志,2009,37(10):892-895.
[6]石璐,王昆鹏,侯小锋.PRKAG2心脏综合征发病机制及诊疗进展[J].中华心律失常学杂志,2018,22(3):267-270.
[7]张乾忠,马沛然,陈新民,等.小儿心肌病诊治进展[J].中国实用儿科杂志,2006,21(2):81-92.
[8]Maron BJ,Mc Kenna WJ,Danielson GK,et al.American College of Cardiology/European Society of Cardiology clinical expert consensus document on hypertrophic cardiomyopathy.A report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents and the European Society of Cardiology Committee for Practice Guidelines[J].J Am Coll Cardiol,2003,42(9):1687-1713.
[9]Elliott PM,Anastasakis A,Borger MA,et al.2014 ESC Guidelines on diagnosis and management of hypertrophic cardiomyopathy:the Task Force for the Diagnosis and Management of Hypertrophic Cardiomyopathy of the European Society of Cardiology(ESC)[J].Eur Heart J,2014,35(39):2733-2779.
[10]梁栩常,袁越.实用小儿心电图学[M].3版.北京:人民卫生出版社,2018:377-378.
[11]邵虹,马志玲,刘丽文.肥厚型心肌病心电图特征分析[J].临床心电学杂志,2015,24(3):177-180.
[12]Mussinelli R,Salinaro F,Alogna A,et al.Diagnostic and prognostic value of low QRS voltages in cardiac AL amyloidosis[J].Ann Noninvasive Electrocardiol,2013,18(3):271-280.
[13]李威,刘少稳,张锋.碎裂QRS波-无创心电学的新指标[J].国际心血管病杂志,2009,36(6):355-358.
[14]Debonnaire P,Katsanos S,Joyce E,et al.QRS fragmentation and QTc duration relate to malignant ventricular tachyarrhythmias and sudden cardiac death in patients with hypertrophic cardiomyopathy[J].J Cardiovasc Electrophysiol,2015,26(5):547-555.
[15]王维,陆锡利,王继征,等.肥厚型心肌病心电图特点与预后分析[J].中国循环杂志,2015,(z1):61.
[16]Torigoe K,Tamura A,Kawano Y,et al.The number of leads with fragmented QRS is independently associated with cardiac death or hospitalization for heart failure in patients with prior myocardial infarction[J].J Cardiol,2012,59(1):36-41.
[17]Morita H,Kusano KF,Miura D,et al.Fragmented QRS as a marker of conduction abnormality and a predictor of prognosis of Brugada syndrome[J].Circulation,2008,118(17):1697-1704.
[18]Basaran Y,Tigen K,Karaahmet T,et al.Fragmented QRS complexes are associated with cardiac fibrosis and significant intraventricular systolic dyssynchrony in nonischemic dilated cardiomyopathy patients with a narrow QRS interval[J].Echocardiography,2011,28(1):62-68.
[19]Haghjoo M,Mohammadzadeh S,Taherpour M,et al.ST-segment depression as a risk factor in hypertrophic cardiomyopathy[J].Europace,2009,11(5):643-649.
[20]杨承健,叶新和,徐欣,等.心尖肥厚型心肌病超声诊断特点及随访[J].中华内科杂志,2010,49(2):119-121.
[21]Park SY,Park TH,Kim JH,et al.Relationship between giant negative T-wave and severity of apical hypertrophy in patients with apical hypertrophic cardiomyopathy[J].Echocardiography,2010,27(7):770-776.
[22]王幸,洪建凤,张春丽,等.心尖肥厚型心肌病的心电图对比观察[J].实用心电学杂志,2004,13(4):262-263.
[23]Dinshaw L,Munch J,Dickow J,et al.The T-peak-to-T-end interval:a novel ECG marker for ventricular arrhythmia and appropriate ICD therapy in patients with hypertrophic cardiomyopathy[J].Clin Res Cardiol,2018,107(2):130-137.
[24]Panikkath R,Reinier K,Uy-Evanado A,et al.Prolonged T-peak-to-tend interval on the resting ECG is associated with increased risk of sudden cardiac death[J].Circ Arrhythm Electrophysiol,2011,4(4):441-447.
[25]Bachmann TN,Skov MW,Rasmussen PV,et al.Electrocardiographic T peak-Tend interval and risk of cardiovascular morbidity and mortality:Results from the Copenhagen ECGstudy[J].Heart Rhythm,2016,13(4):915-924.
[26]Badran HM,Elnoamany MF,Soltan G,et al.Relationship of mechanical dyssynchrony to QT interval prolongation in hypertrophic cardiomyopathy[J].Eur Heart J Cardiovasc Imaging,2012,13(5):423-432.
[27]Baranowski R,Chojnowska L,Michalak E,et al.Analysis of the corrected QT before the onset of nonsustained ventricular tachycardia in patients with hypertrophic cardiomyopathy[J].Pacing Clin Electrophysiol,2003,26(1 Pt 2):387-389.
[28]Macfarlane PW,McLaughlin SC,Rodger JC.Influence of lead selection and population on automated measurement of QT dispersion[J].Circulation,1998,98(20):2160-2167.
[29]Buja G,Miorelli M,Turrini P,et al.Comparison of QT dispersion in hypertrophic cardiomyopathy between patients with and without ventricular arrhythmias and sudden death[J].Am J Cardiol,1993,72(12):973-976.
[30]Yetman AT,Hamilton RM,Benson LN,et al.Long-term outcome and prognostic determinants in children with hypertrophic cardiomyopathy[J].J Am Coll Cardiol,1998,32(7):1943-1950.
[31]Uchiyama K,Hayashi K,Fujino N,et al.Impact of QT variables on clinical outcome of genotyped hypertrophic cardiomyopathy[J].Ann Noninvasive Electrocardiol,2009,14(1):65-71.
[32]Shimizu M,Ino H,Yamaguchi M,et al.Chronologic electrocardiographic changes in patients with hypertrophic cardiomyopathy associated with cardiac troponin 1 mutation[J].Am Heart J,2002,143(2):289-293.
[33]傅立军,陈茜.婴儿型庞贝病的诊治进展[J].精准医学杂志,2018,33(4):283-285,291.
[34]傅立军,陈树宝,邱文娟,等.婴儿型糖原贮积病Ⅱ型的临床特点及其转归[J].中华医学杂志,2013,93(20):1567-1570.
[35]蔡迟.Danon病临床研究进展[J].心血管病学进展,2012,33(1):39-42.
[36]石璐,王昆鹏,侯小锋.PRKAG2心脏综合征发病机制及诊疗进展[J].中华心律失常学杂志,2018,22(3):267-270.
[37]刘洋,林立,刘启功,等.PRKAG2心脏综合征[J].中华心血管病杂志,2010,38(9):859-862.
[38]张丽华,方理刚,程中伟,等.回顾性调查线粒体疾病患者的心脏病变[J].中华心血管病杂志,2009,37(10):892-895.
[39]Young TJ,Shah AK,Lee MH,et al.Kearns-Sayre syndrome:a case report and review of cardiovascular complications[J].Pacing Clin Electrophysiol,2005,28(5):454-457.
[40]Holmgren D,Wahlander H,Eriksson BO,et al.Cardiomyopathy in children with mitochondrial disease:Clinical course and cardiological findings[J].Eur Heart J,2003,24(3):280-288.
[41]Karanikis P,Korantzopoulos P,Kountouris E,et al.KearnsSayre syndrome associated with trifascicular block and QT prolongation[J].Int J Cardiol,2005,101(1):147-150.
[42]Raaijmakers R,Noordam C,Noonan JA,et al.Are ECG abnormalities in Noonan syndrome characteristic for the syndrome?[J].Eur J Pediatr,2008,167(12):1363-1367.
[43]Guttmann OP,Rahman MS,O’Mahony C,et al.Atrial fibrillation and thromboembolism in patients with hypertrophic cardiomyopathy:systematic review[J].Heart,2014,100(6):465-472.
[44]Katritsis DG,Camm AJ.Nonsustained ventricular tachycardia:where do we stand?[J].Eur Heart J,2004,25(13):1093-1099.
[45]Di Salvo G,Pacileo G,Limongelli G,et al.Non sustained ventricular tachycardia in hypertrophic cardiomyopathy and new ultrasonic derived parameters[J].J Am Soc Echocardiogr,2010,23(6):581-590.
[46]Adabag AS,Casey SA,Kuskowski MA,et al.Spectrum and prognostic significance of arrhythmias on ambulatory Holter electrocardiogram in hypertrophic cardiomyopathy[J].J Am Coll Cardiol,2005,45(5):697-704.
[47]中华医学会心血管病学分会中国成人肥厚型心肌病诊断与治疗指南编写组,中华心血管病杂志编辑委员会.中国成人肥厚型心肌病诊断与治疗指南[J].中华心血管病杂志,2017,45(12):1015-1032.
[48]Corrado D,Calkins H,Link MS,et al.Prophylactic implantable defibrillator in patients with arrhythmogenic right ventricular cardiomyopathy/dysplasia and no prior ventricular fibrillation or sustained ventricular tachycardia[J].Circulation,2010,122(12):1144-1152.