陈旧性心肌梗死患者的微伏级T波电交替
摘要
目的研究陈旧性心肌梗死(简称心梗)患者的微伏级T波电交替(MTWA),旨在探讨MTWA的临床意义。
方法平板运动试验过程中利用渐量修正技术监测陈旧性心梗患者83例(Ⅰ组,依试验过程中有无室性心律失常发生分为Ⅰa、Ⅰb组),健康人群90例(Ⅱ组)的MTWA,分析各组之间MTWA的差异及MTWA与心梗部位的相关性。
结果①各导联组间MTWA除aVR导联三组间无差异外,余导联均有差异;②Ⅰa组与Ⅱ组除aVL导联外余各导联MTWA值无差异(P＞0.017);Ⅰa组与Ⅰb组Ⅱ、Ⅲ、aVF导联MTWA值有差异(P＜0.017),余各导联MTWA值无差异(P＞0.017);Ⅱ组与Ⅰb组各导联MTWA值有差异(P＜0.017)。③Ⅰb组不同部位心梗的相关导联MTWA值有差异。
结论运动平板试验中利用渐量修正技术监测MTWA可作为陈旧性心肌梗死患者发生恶性室性心律失常危险分层的指标。
Objective To investigate clinical importance of the microvolt T wave alternans(MTWA)in post myocardial infarction(post-MI)patients
Methods MTWA test with MMA(Modified moving average analysis)was performed in post-MI patients(n=83),comprised group Ia,there is no ventricular arrhythmia during exercise treadmill test and group Ib,ventricular arrhythmia detected during the test.90 healthy individuals were taken as control(groupⅡ).Difference of MTWA in each group and the relationship between the MTWA value and the infarcted region were analysed.
Results(1)Value difference of each leads reached statistical significancy in three groups except aVL.(2)Except avL,there was no statistical difference in group Ia andⅡon the MTWA value(P＞0.017),but it reached statistical significance between Ia and Ib group inⅡ,Ⅲ,avF leads(P＜0.017).The difference betweenⅡgroup and Ib group in all leads got statistical significance(P＜0.017);(3)In Ib group,different infarction walls showed different MTWA values on correlated ECG.
Conclusion MTWA measurement through exercise treadmill test is a promising approach for risk stratification for malignant ventricular arrhythmia in relatively low-risk post-MI patients.
方法平板运动试验过程中利用渐量修正技术监测陈旧性心梗患者83例(Ⅰ组,依试验过程中有无室性心律失常发生分为Ⅰa、Ⅰb组),健康人群90例(Ⅱ组)的MTWA,分析各组之间MTWA的差异及MTWA与心梗部位的相关性。
结果①各导联组间MTWA除aVR导联三组间无差异外,余导联均有差异;②Ⅰa组与Ⅱ组除aVL导联外余各导联MTWA值无差异(P＞0.017);Ⅰa组与Ⅰb组Ⅱ、Ⅲ、aVF导联MTWA值有差异(P＜0.017),余各导联MTWA值无差异(P＞0.017);Ⅱ组与Ⅰb组各导联MTWA值有差异(P＜0.017)。③Ⅰb组不同部位心梗的相关导联MTWA值有差异。
结论运动平板试验中利用渐量修正技术监测MTWA可作为陈旧性心肌梗死患者发生恶性室性心律失常危险分层的指标。
Objective To investigate clinical importance of the microvolt T wave alternans(MTWA)in post myocardial infarction(post-MI)patients
Methods MTWA test with MMA(Modified moving average analysis)was performed in post-MI patients(n=83),comprised group Ia,there is no ventricular arrhythmia during exercise treadmill test and group Ib,ventricular arrhythmia detected during the test.90 healthy individuals were taken as control(groupⅡ).Difference of MTWA in each group and the relationship between the MTWA value and the infarcted region were analysed.
Results(1)Value difference of each leads reached statistical significancy in three groups except aVL.(2)Except avL,there was no statistical difference in group Ia andⅡon the MTWA value(P＞0.017),but it reached statistical significance between Ia and Ib group inⅡ,Ⅲ,avF leads(P＜0.017).The difference betweenⅡgroup and Ib group in all leads got statistical significance(P＜0.017);(3)In Ib group,different infarction walls showed different MTWA values on correlated ECG.
Conclusion MTWA measurement through exercise treadmill test is a promising approach for risk stratification for malignant ventricular arrhythmia in relatively low-risk post-MI patients.
引文
1.Mark Estesl NS,Homoud MK,Link MS,et al.Assessment of risk for sudden cardiac death[J].Curr Probl Carbiol,2002,27(6):246-266
2.“中国心脏起搏与心电生理杂志”编辑部,中国生物医学工程学会心搏与电生理分会心脏碎死的防治建议[J].中国心脏起搏与心电生理杂志,2002,16(6):401-414
3.Rosenbaum DS,Jackson LE,Smith JM,et al.Electrical altemans andvulnerability to ventricular arrhythmias[J].N Engl J Med,1994,330(3):235
4.Adachi K,Ohnishi Y,Shima T,et al.Determination of microvolt-level T-wave alternans in patients with dilated cardiomyopathy[J].J Am Coll Cardiol,1999,34(2):374
5.Ikeda T,Takami M,Kondo N,et al.Combined assessment of T-wave altemans and late potentials used to predict arrhythmic events after my2ocardial infarction[J].J Am Coil Cardiol,2002,35(6):722
6.Ikeda T,Saito H,Tanno K,et al.T-wave altemans as a predictor for sudden cardiac death after myocardial infarction[J].Am J Cardiol,2002,89:79-82
7.Shimizu W,Antzelevitch C.Cellular and ionic basis for T-wave altemans under long-QT conditions[J].Circulation,1999,99:1499-1507
8.Pastore JM,Girouard SD,Laurita KP,et al.Mechanism linking T-wave alternans to the genesis of cardiac fibrillation[J].Circulation,1999,99:1385-1394
9.Kitamura H,Ohnishi Y,Okajima K,et al.Onset heart rate of microveolt-level T-wave altemans provides clinical and prognostic value in nonischemic dilated cardiomyopathy[J].J Am Coll Cardiol,2002,39:295-300
10.Nearing BD,Verder RL.Progressive increases in complexity of T-wave oscillations herald ischemia-induced ventricular fibrillation[J]Cir Res,2000,91:727-732
11.Nearing BD,Verder RL:Modified moving average analysis of T-wave altemans to predict ventricular fibrillation with high accuracy[J].J Appl Physiol 2002,92:541
12.Nearing B D,Verrier R L,System and method for quantifying altemation in an electrocardiogram signal[J].Journal of Cardiovascular Electrophysiology,2001,19(1):445
13.Verrier RL,Nearing BD,Larovere MT,et al.Ambulatory electrocardiogram-based tracking of T-wave altemans in postmyocardial infarction patient to assess risk of cardic arrest or arrhythmic death[J].J Cardiovasc Electrophsiol,2003,14:705-711
14.张兆国,张海澄,郭继鸿.T波电交替现象:一项强有力的评估心脏病患者预后的无创指标[J].中国心脏起搏与心电生理杂志,2005,19(6);497
15.Tapanainen JM,Still AM,Airaksinen KM,et al.Prognostic significance of risk stratifiers of mortality,including T wave altemans,after acute myocardial infarction:Results of a prospective follow-up study[J].J Cardiovasc Electrophysiol,2001,12:645
16.Yan GX,Antzelevitch C.Cellular basis of the normal T wave and the electrocardiographic manifestations of the Long-QT syndrome [J]..Circulation,1998,98:1928-1936
17.Pastore JM,Rosenbaum DS.Role of structural barriers in the mechanism of Altemans-induced reentry[J].Circ Res,2000,87:1147-1163.
18.Kovach JA,Nearing BD,Verrier RL.Angerlike behavioral state potentiates myocardial ischemia-induced T-wave altemans in canines[J].J Am Coil Cardiol,2001,37:1791-1725
19.Postore JM,Girouard SD,Laurita KR,et al.Mechanism linking T-wave altemans to the genesis of cardiac fibrillation[J].Criculation,1999,99:1385-1394
20.Nearing BD,Hutter JJ,Verrier RL,et al.Potent antifibrillatory effect of combined blockade of calcium channels and 5-HT2 receptors with nexopamil during myocardial ischemia and reperfusion in canines:comparison to diltiazem[J].J Cardiovasc pharmacol,1996,27:777-787
21.Qian YW,Clusin WT,Lin SF,et al.Spatial heterogeneity of calcium transient altemans during the early phase of myocardial ischemia in the blood-perfused rabbit heart[J].Circulation,2001,105:2082-2087
22. Zipes DP, Wellens HH.Sudden cardiac death[J]. Circulation,1998,98:2334
1.Smith,Clancy E,Valeri R,et al.Electrical altemans and cardiac Electrical instability[J]..Circulation,1988,77(3):110-121
2.Rosenbaum DS,Jackson LE,Smith JM,et al.Electrical altemans and vulnerability to ventricular arrhythmias.N Engl J Med,1994,330(3):235-241
3.Adachi K,Ohnishi Y,Shima T,et al.Determination of microvolt-levelT-wave altemans in patients with dilated cardiomyopathy.J Am CollCardiol,1999,34(2):374-380
4.Ikeda T,Takami M,Kondo N,et al.Combined assessment of T-wave alternans and late potentials used to predict arrhythmic events after my2ocardial infarction.J Am Coll Cardiol,2002,35(6):722-735
5.Chwartz PJ,Moss AJ,Vincent GM,et al,Diagnostic criteria for the long QT Syndrome:an update[J].,Circulation,1993,88(6);782-784.
6.Adachi K,Ohnishi Y,Shima T,et al.Determination of microvolt level T-wave altemans in patientswith dilated cardiomyopathy[J].J Am Coll Cardiol,1999,34(2):374-380.
7.Nabil EI-Sherif,Hioia Turitto.心脏猝死的危险分级在预防应用埋藏式心脏复律除颤器时代的必要性[J].,中国心脏起搏与心电生理杂志,1999,13(1):8-10
8.董朝晖,T波电交替对复杂性室性心律失常的预测价值[J].心电图学杂志,2004,23(4);23,15
9.Verrier RL,Nearing BD.Modified moving average analysis of T-wave altemansto p redict ventricular fibrillation with high accuracy[J].J App 1Physiol,2002,92:541-549
10.Schwartz PJ,Mallinani A.Electrical altemation of the T-ware.Clinical and experimental evidence of its.Relationship with the sympathetic nervous system and with long Q-T syndrome.Am heart J,1975;89:45-48
11.阿力木江,巨型倒置T波伴心电全交替[J].,心电学杂志,2003,22(2):109
12.CostwntiniO,Drwber C,Roseubaum DS.Can sudden cardial death be p redicted from the T2wave of the ECG[ J ]. PACE, 2000,23: 1407
13. B loomfieldDM, Cohen RJ. Repolarisation alternans. In:MalikM, ed. Risk of arrhythmia and sudden death [M ]. London: BMJ Books, 2001. 2562265
14. W illem JK,David SK,B nice DN, et al. Effects of acute mental stress and exercise on T2wave alternans in patientswith imp lantable cardioverter defibrillators and controls[ J ]. Circulation, 2004,109:126
15. ArmoundasAA,OsakaM,Mela T, et al. T2wave alternans and dispersion of the QT interval as risk stratification markets in patients suscep tible to sustained ventricular arrhythmias[ J ]. Am J Cardiol, 1998, 82: 1127
16. Verrier RL,Nearing BD,LarovereMT, et al. Ambulatory electrocardiogram based tracking of T2wave alternans in postmyocardial infarction patients to assess risk of cardiac arrest or arrhythmic death[ J ]. J Cardiovasc Electrophysiol,2003,14:705-711
17. Hohnloser SH ,Klingenheben T ,Bloomfield D, et al. Usefulness of microvolt T-wave alternans for prediction of ventricular tachyarrhythmic events in patients with dilated cardiomyopathy :results from a prospective observational study[J ]. J Am Coll Cardiol ,2003 ,41 (12): 20-22
18. Kuroda N ,Ohnishi Y,Yoshida A, et al. Clinical significance of T2wave alternans in hypertrophic cardiomyopathy[J ]. Circ J ,2002 ,66(5) :457-462
19. Kon Y, Watanabe J ,Koseki Y, et al .Microvolt T2wave alternans in human hypertrophy : electrical instability and abnormal myocardial arrangement [J ]. J Cardiovasc Electrophysiol ,2001 ,12(7) :759-763
20. Bardy GH ,Lee KL ,Mark DB , et al. Amiodarone or an implantable cardioverter2defibrillator for congestive heart failure [J ]. N Engl J Med,2005 ,352 (3) :225-237
21. Cruz FE,Maia IG, FagundesML, et al. Electrical behavior of T2wave polarity alternans in patientswith congenital longQT syndrome[ J ]. J Am Coll Cardiol,2000, 36: 167
22. Burattini L, ZarebaW, Rashba EJ, et al. ECG features of microvolt T2wave al2 ternans in coronary artery disease and longQT syndrome patients[ J ]. Electrocardiol, 1998,31 (supp 1): 114
2.“中国心脏起搏与心电生理杂志”编辑部,中国生物医学工程学会心搏与电生理分会心脏碎死的防治建议[J].中国心脏起搏与心电生理杂志,2002,16(6):401-414
3.Rosenbaum DS,Jackson LE,Smith JM,et al.Electrical altemans andvulnerability to ventricular arrhythmias[J].N Engl J Med,1994,330(3):235
4.Adachi K,Ohnishi Y,Shima T,et al.Determination of microvolt-level T-wave alternans in patients with dilated cardiomyopathy[J].J Am Coll Cardiol,1999,34(2):374
5.Ikeda T,Takami M,Kondo N,et al.Combined assessment of T-wave altemans and late potentials used to predict arrhythmic events after my2ocardial infarction[J].J Am Coil Cardiol,2002,35(6):722
6.Ikeda T,Saito H,Tanno K,et al.T-wave altemans as a predictor for sudden cardiac death after myocardial infarction[J].Am J Cardiol,2002,89:79-82
7.Shimizu W,Antzelevitch C.Cellular and ionic basis for T-wave altemans under long-QT conditions[J].Circulation,1999,99:1499-1507
8.Pastore JM,Girouard SD,Laurita KP,et al.Mechanism linking T-wave alternans to the genesis of cardiac fibrillation[J].Circulation,1999,99:1385-1394
9.Kitamura H,Ohnishi Y,Okajima K,et al.Onset heart rate of microveolt-level T-wave altemans provides clinical and prognostic value in nonischemic dilated cardiomyopathy[J].J Am Coll Cardiol,2002,39:295-300
10.Nearing BD,Verder RL.Progressive increases in complexity of T-wave oscillations herald ischemia-induced ventricular fibrillation[J]Cir Res,2000,91:727-732
11.Nearing BD,Verder RL:Modified moving average analysis of T-wave altemans to predict ventricular fibrillation with high accuracy[J].J Appl Physiol 2002,92:541
12.Nearing B D,Verrier R L,System and method for quantifying altemation in an electrocardiogram signal[J].Journal of Cardiovascular Electrophysiology,2001,19(1):445
13.Verrier RL,Nearing BD,Larovere MT,et al.Ambulatory electrocardiogram-based tracking of T-wave altemans in postmyocardial infarction patient to assess risk of cardic arrest or arrhythmic death[J].J Cardiovasc Electrophsiol,2003,14:705-711
14.张兆国,张海澄,郭继鸿.T波电交替现象:一项强有力的评估心脏病患者预后的无创指标[J].中国心脏起搏与心电生理杂志,2005,19(6);497
15.Tapanainen JM,Still AM,Airaksinen KM,et al.Prognostic significance of risk stratifiers of mortality,including T wave altemans,after acute myocardial infarction:Results of a prospective follow-up study[J].J Cardiovasc Electrophysiol,2001,12:645
16.Yan GX,Antzelevitch C.Cellular basis of the normal T wave and the electrocardiographic manifestations of the Long-QT syndrome [J]..Circulation,1998,98:1928-1936
17.Pastore JM,Rosenbaum DS.Role of structural barriers in the mechanism of Altemans-induced reentry[J].Circ Res,2000,87:1147-1163.
18.Kovach JA,Nearing BD,Verrier RL.Angerlike behavioral state potentiates myocardial ischemia-induced T-wave altemans in canines[J].J Am Coil Cardiol,2001,37:1791-1725
19.Postore JM,Girouard SD,Laurita KR,et al.Mechanism linking T-wave altemans to the genesis of cardiac fibrillation[J].Criculation,1999,99:1385-1394
20.Nearing BD,Hutter JJ,Verrier RL,et al.Potent antifibrillatory effect of combined blockade of calcium channels and 5-HT2 receptors with nexopamil during myocardial ischemia and reperfusion in canines:comparison to diltiazem[J].J Cardiovasc pharmacol,1996,27:777-787
21.Qian YW,Clusin WT,Lin SF,et al.Spatial heterogeneity of calcium transient altemans during the early phase of myocardial ischemia in the blood-perfused rabbit heart[J].Circulation,2001,105:2082-2087
22. Zipes DP, Wellens HH.Sudden cardiac death[J]. Circulation,1998,98:2334
1.Smith,Clancy E,Valeri R,et al.Electrical altemans and cardiac Electrical instability[J]..Circulation,1988,77(3):110-121
2.Rosenbaum DS,Jackson LE,Smith JM,et al.Electrical altemans and vulnerability to ventricular arrhythmias.N Engl J Med,1994,330(3):235-241
3.Adachi K,Ohnishi Y,Shima T,et al.Determination of microvolt-levelT-wave altemans in patients with dilated cardiomyopathy.J Am CollCardiol,1999,34(2):374-380
4.Ikeda T,Takami M,Kondo N,et al.Combined assessment of T-wave alternans and late potentials used to predict arrhythmic events after my2ocardial infarction.J Am Coll Cardiol,2002,35(6):722-735
5.Chwartz PJ,Moss AJ,Vincent GM,et al,Diagnostic criteria for the long QT Syndrome:an update[J].,Circulation,1993,88(6);782-784.
6.Adachi K,Ohnishi Y,Shima T,et al.Determination of microvolt level T-wave altemans in patientswith dilated cardiomyopathy[J].J Am Coll Cardiol,1999,34(2):374-380.
7.Nabil EI-Sherif,Hioia Turitto.心脏猝死的危险分级在预防应用埋藏式心脏复律除颤器时代的必要性[J].,中国心脏起搏与心电生理杂志,1999,13(1):8-10
8.董朝晖,T波电交替对复杂性室性心律失常的预测价值[J].心电图学杂志,2004,23(4);23,15
9.Verrier RL,Nearing BD.Modified moving average analysis of T-wave altemansto p redict ventricular fibrillation with high accuracy[J].J App 1Physiol,2002,92:541-549
10.Schwartz PJ,Mallinani A.Electrical altemation of the T-ware.Clinical and experimental evidence of its.Relationship with the sympathetic nervous system and with long Q-T syndrome.Am heart J,1975;89:45-48
11.阿力木江,巨型倒置T波伴心电全交替[J].,心电学杂志,2003,22(2):109
12.CostwntiniO,Drwber C,Roseubaum DS.Can sudden cardial death be p redicted from the T2wave of the ECG[ J ]. PACE, 2000,23: 1407
13. B loomfieldDM, Cohen RJ. Repolarisation alternans. In:MalikM, ed. Risk of arrhythmia and sudden death [M ]. London: BMJ Books, 2001. 2562265
14. W illem JK,David SK,B nice DN, et al. Effects of acute mental stress and exercise on T2wave alternans in patientswith imp lantable cardioverter defibrillators and controls[ J ]. Circulation, 2004,109:126
15. ArmoundasAA,OsakaM,Mela T, et al. T2wave alternans and dispersion of the QT interval as risk stratification markets in patients suscep tible to sustained ventricular arrhythmias[ J ]. Am J Cardiol, 1998, 82: 1127
16. Verrier RL,Nearing BD,LarovereMT, et al. Ambulatory electrocardiogram based tracking of T2wave alternans in postmyocardial infarction patients to assess risk of cardiac arrest or arrhythmic death[ J ]. J Cardiovasc Electrophysiol,2003,14:705-711
17. Hohnloser SH ,Klingenheben T ,Bloomfield D, et al. Usefulness of microvolt T-wave alternans for prediction of ventricular tachyarrhythmic events in patients with dilated cardiomyopathy :results from a prospective observational study[J ]. J Am Coll Cardiol ,2003 ,41 (12): 20-22
18. Kuroda N ,Ohnishi Y,Yoshida A, et al. Clinical significance of T2wave alternans in hypertrophic cardiomyopathy[J ]. Circ J ,2002 ,66(5) :457-462
19. Kon Y, Watanabe J ,Koseki Y, et al .Microvolt T2wave alternans in human hypertrophy : electrical instability and abnormal myocardial arrangement [J ]. J Cardiovasc Electrophysiol ,2001 ,12(7) :759-763
20. Bardy GH ,Lee KL ,Mark DB , et al. Amiodarone or an implantable cardioverter2defibrillator for congestive heart failure [J ]. N Engl J Med,2005 ,352 (3) :225-237
21. Cruz FE,Maia IG, FagundesML, et al. Electrical behavior of T2wave polarity alternans in patientswith congenital longQT syndrome[ J ]. J Am Coll Cardiol,2000, 36: 167
22. Burattini L, ZarebaW, Rashba EJ, et al. ECG features of microvolt T2wave al2 ternans in coronary artery disease and longQT syndrome patients[ J ]. Electrocardiol, 1998,31 (supp 1): 114