QT离散度在急性肺栓塞中的临床意义
摘要
目的探讨QT离散度在急性肺栓塞患者与正常人的差异,治疗前后的动态变化及其与肺栓塞患者住院期间短期预后的关系。
方法收集2011年5月至2012年4月我院急性肺栓塞患者42例,入院24小时内及治疗后分别行同步十二导联心电图检查,手工测量QT间期,并计算出QT离散度(QT dispersion,QTd)及心率校正的QT离散度(heart rate-corrected QT dispersion,QTcd),短期随访患者住院期间生存情况。同时期按年龄与性别匹配的健康体检者30例为正常对照组。
结果QTd及QTcd在高危组(70.2±34.0ms)(88.1±43.3ms)及非高危组(49.3±21.8ms)(59.1±26.2ms)均显著大于正常对照组(33.2±12.4ms)(36.7±14.2ms)(P<0.05)；高危组显著大于非高危组(P<0.05)。前后两次心电图间隔5.6±2.5天。治疗后生存组QTd及QTcd (41.O±16.4ms)(47.4±18.0ms)较入院时(54.0±33.Oms)(67.2±40.5ms)显著减小(P<0.05),但仍大于正常组(P<0.05),死亡组治疗前后QTd及QTcd差异不显著。ROC曲线示治疗后的QTd及QTcd分别取最佳截点值51.5ms和58.1ms时,预测死亡敏感性为63.6%及81.8%,特异性为80%及88%。单因素及多元logistic回归分析表明入院时高危、存在右室功能障碍、治疗后QTcd仍大于正常范围是住院期间死亡的主要影响因素。
结论1.急性肺栓塞患者QTd及QTcd显著高于正常人,入院时危险分层越高,QTd及QTcd越大；2.急性肺栓塞患者住院期间QTd及QTcd呈动态变化,经过治疗QTd及QTcd有所回落；3.合并右室功能障碍、入院时危险度高及治疗后QTcd大于正常范围者,住院期间短期预后不良。
Objective
To compare QT dispersion measurements in acute pulmonary embolism (PE) patients and normal subjects. To observe the alteration and the clinical significance of QT dispersion (QTd or QTcd) in acute pulmonary embolism.
Methods
A total of42patients with PE and30age and gender matched normal subjects were studied. Patients were divided into high-risk group and non-high-risk group according to the state on admission. QT interval was measured manually in12-lead conventional electrocardiogram within24hours on admission as well as after treatment. QT dispersion (QTd) and heart rate-corrected QT dispersion were also calculated. All patients had been followed up in-hospital course.
Results
QTd and QTcd were significantly higher in high-risk group and non-high-risk group than in the normal subjects, while the same in high-risk group and non-high-risk group(70.2±34.0ms,49.3±21.8ms,33.2±12.4ms, P<0.05, in QTd)(88.1±43.3ms,59.1±26.2ms,36.7±14.2ms, P<0.05, in QTcd). The twice electrocardiograms were separated for5.6±2.5days. There were no difference in early QTd or QTcd between the patients who died and the survivors. QTd and QTcd fell significantly from early to late ECG in survivors, but not in patients who die(54.0±33.0ms vs41.0±16.4ms P<0.05, in QTd)(67.2±40.5ms vs47.4±18.0ms P<0.05,in QTcd). Based on receiver-operator characteristic curves a QTd≥51.5ms or a QTcd≥58.1ms could predict death in-hospital course with sensitivities of63.6%and80%, specificities of81.8%and88%. Logistic regression showed that hight-risk group, the presence of right ventricular dysfunction (RVD) and QTcd after treatment above normal range were the main risk factors of death in-hospital course.
Conclusion
1.QTd and QTcd were higher in PE patients than in normal subjects, the server of situation on admission the higher of QTd and QTcd.2.During the process of treatment QTd and QTcd has been decreased in survivors.3. High-risk group, right ventricular dysfunction and QTcd after treatment above normal range suggested of weakness prognosis in PE.
方法收集2011年5月至2012年4月我院急性肺栓塞患者42例,入院24小时内及治疗后分别行同步十二导联心电图检查,手工测量QT间期,并计算出QT离散度(QT dispersion,QTd)及心率校正的QT离散度(heart rate-corrected QT dispersion,QTcd),短期随访患者住院期间生存情况。同时期按年龄与性别匹配的健康体检者30例为正常对照组。
结果QTd及QTcd在高危组(70.2±34.0ms)(88.1±43.3ms)及非高危组(49.3±21.8ms)(59.1±26.2ms)均显著大于正常对照组(33.2±12.4ms)(36.7±14.2ms)(P<0.05)；高危组显著大于非高危组(P<0.05)。前后两次心电图间隔5.6±2.5天。治疗后生存组QTd及QTcd (41.O±16.4ms)(47.4±18.0ms)较入院时(54.0±33.Oms)(67.2±40.5ms)显著减小(P<0.05),但仍大于正常组(P<0.05),死亡组治疗前后QTd及QTcd差异不显著。ROC曲线示治疗后的QTd及QTcd分别取最佳截点值51.5ms和58.1ms时,预测死亡敏感性为63.6%及81.8%,特异性为80%及88%。单因素及多元logistic回归分析表明入院时高危、存在右室功能障碍、治疗后QTcd仍大于正常范围是住院期间死亡的主要影响因素。
结论1.急性肺栓塞患者QTd及QTcd显著高于正常人,入院时危险分层越高,QTd及QTcd越大；2.急性肺栓塞患者住院期间QTd及QTcd呈动态变化,经过治疗QTd及QTcd有所回落；3.合并右室功能障碍、入院时危险度高及治疗后QTcd大于正常范围者,住院期间短期预后不良。
Objective
To compare QT dispersion measurements in acute pulmonary embolism (PE) patients and normal subjects. To observe the alteration and the clinical significance of QT dispersion (QTd or QTcd) in acute pulmonary embolism.
Methods
A total of42patients with PE and30age and gender matched normal subjects were studied. Patients were divided into high-risk group and non-high-risk group according to the state on admission. QT interval was measured manually in12-lead conventional electrocardiogram within24hours on admission as well as after treatment. QT dispersion (QTd) and heart rate-corrected QT dispersion were also calculated. All patients had been followed up in-hospital course.
Results
QTd and QTcd were significantly higher in high-risk group and non-high-risk group than in the normal subjects, while the same in high-risk group and non-high-risk group(70.2±34.0ms,49.3±21.8ms,33.2±12.4ms, P<0.05, in QTd)(88.1±43.3ms,59.1±26.2ms,36.7±14.2ms, P<0.05, in QTcd). The twice electrocardiograms were separated for5.6±2.5days. There were no difference in early QTd or QTcd between the patients who died and the survivors. QTd and QTcd fell significantly from early to late ECG in survivors, but not in patients who die(54.0±33.0ms vs41.0±16.4ms P<0.05, in QTd)(67.2±40.5ms vs47.4±18.0ms P<0.05,in QTcd). Based on receiver-operator characteristic curves a QTd≥51.5ms or a QTcd≥58.1ms could predict death in-hospital course with sensitivities of63.6%and80%, specificities of81.8%and88%. Logistic regression showed that hight-risk group, the presence of right ventricular dysfunction (RVD) and QTcd after treatment above normal range were the main risk factors of death in-hospital course.
Conclusion
1.QTd and QTcd were higher in PE patients than in normal subjects, the server of situation on admission the higher of QTd and QTcd.2.During the process of treatment QTd and QTcd has been decreased in survivors.3. High-risk group, right ventricular dysfunction and QTcd after treatment above normal range suggested of weakness prognosis in PE.
引文
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[12]Liset S, Sudha M, Marc L.QT Dispersion as a Noninvasive Predictor of Inducible Ventricular TachycardiaJournal of Electrocardiology,l 999,32(2) 173-7.
[13]Moreno FL, Villanueva T, Karagounis LA. Reduction in QT interval dispersion by successful thrombolytic therapy in acute myocardial infarction. TEAM-2 Study Investigators Circulation,1994,90:94-100=
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[16]Dursun D.Effect of CPAP on QT interval dispersion in obstructive sleep apnea patients without hypertension Nese Dursunoglub Sleep Medicine,2007,8: 478-83
[17]Akgiil F, Seyfeli E, Melek I, et al. Increased QT dispersion in sickle cell disease: effect of pulmonary hypertension.Acta Haematol.2007,118(1):1-6.
[18]张洪亮,王勇,罗勤等,肺动脉高压患者心率校正QT间期和QT离散度 的研究.肺血管病杂,2010,29(2):91-4.
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[20]Dalen JE, Alpert JS. Natural history of pulmonary embolism. Prog Cardiovasc Dis,1975,17:259-70.
[21]Oger E. Incidence of venous thromboembolism:a community-based study inWestern France. EPI-GETBP Study Group. Thromb Haemost 2000,83:657-60.
[22]Wood KE. Major pulmonary embolism:review of a pathophysiologic approach to the golden hour of hemodynamically significant pulmonary embolism. Chest,2002,121:877-905.
[23]Ermis N, Ermis H,Sen N,QT dispersion in patients with pulmonary embol-ism.Wien Klin Wochenschr,2010,122:691-97
[24]Adam T,Arnaud P,Stavros K,et al.Guidelines on the diagnosis and managemen- tof acute pulmonary embolism.European Heart Journal,2008,29,:2276-315
[25]Kurt R. Daniel K, Mark C, Jeffrey A. Pulmonary Embolism With 12-Lead ECG Assessment of Cardiac Stress From Massive. Chest,2001,120:474-81.
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[2]Day P, McComb J, Campbell WF, et alQT dispersion:an indication of arrhythmia risk in patients with long QT intervals Br Heart J,1990,63:342-4
[3]Higham PD, Hilton CJ, Aitcheson JD, et al. QT dispersion does reflect regional variation in ventricular recovery. Circulation,1992,86 (Suppl):392.
[4]Michael R. Franz and Markus Zabel, et al. Electrophysiological Basis of QT Dispersion Measurements, Progress in Cardiovascular Diseases,2000,42: 311-24.
[5]Bazett HC. An analysis of the time-relations of electrocardiograms. Heart. 1920,7:353-370.37.
[6]Linker NJ, Colonna P, Kekwick CA. Assessment of QT dispersion in symptomatic patients with congenital long QT syndrome. Am J Cardiol,1992, 69:634-8
[7]Higham PD, Furniss SS, Campbell RWF. QT dispersion and components of the QT interval in ischemia and infarction,Br Heart 1995,73:32-6.
[8]Yan G, Antzelevitch C. Cellular basis for the electrocardiographic J wave. Circulation,1996 93:372,
[9]Grimm W, Steder U, Menz V, et al. Clinical significance of increased QT dispersion in the 12-lead standard ECG for arrhythmia risk prediction in dilatedcardiomyopathy. Pace,1996,19:1886-9.
[10]Jamil M, Manjit S, Katherine M, Left Ventricular Hypertrophy and QT Dispersion in Hypertension Hypertension,,1996,28:791-796.
[11]Claudia C,Gil S,Katia B.Clinical determinants of increased QT dispersion in patients with diabetes mellitus International Journal of Cardiology,2001,76: 253-262
[12]Liset S, Sudha M, Marc L.QT Dispersion as a Noninvasive Predictor of Inducible Ventricular TachycardiaJournal of Electrocardiology,l 999,32(2) 173-7.
[13]Moreno FL, Villanueva T, Karagounis LA. Reduction in QT interval dispersion by successful thrombolytic therapy in acute myocardial infarction. TEAM-2 Study Investigators Circulation,1994,90:94-100=
[14]Barr C, Nass A, Freeman M, et al. Q T dispersion and sudden unexpected death in chronic hear t failure. Lancet,1994,343:327
[15]Tuncer M, Gunes Y, Guntekin U, et al.Association of increased QTc dispersion and right ventricular hypertrophy Med Sci Monit.2008,14(2):102-105.
[16]Dursun D.Effect of CPAP on QT interval dispersion in obstructive sleep apnea patients without hypertension Nese Dursunoglub Sleep Medicine,2007,8: 478-83
[17]Akgiil F, Seyfeli E, Melek I, et al. Increased QT dispersion in sickle cell disease: effect of pulmonary hypertension.Acta Haematol.2007,118(1):1-6.
[18]张洪亮,王勇,罗勤等,肺动脉高压患者心率校正QT间期和QT离散度 的研究.肺血管病杂,2010,29(2):91-4.
[19]Dalen JE. Pulmonary embolism:what have we learned since Virchow? Natural history, pathophysiology, and diagnosis. Chest,2002,122:1440-56.
[20]Dalen JE, Alpert JS. Natural history of pulmonary embolism. Prog Cardiovasc Dis,1975,17:259-70.
[21]Oger E. Incidence of venous thromboembolism:a community-based study inWestern France. EPI-GETBP Study Group. Thromb Haemost 2000,83:657-60.
[22]Wood KE. Major pulmonary embolism:review of a pathophysiologic approach to the golden hour of hemodynamically significant pulmonary embolism. Chest,2002,121:877-905.
[23]Ermis N, Ermis H,Sen N,QT dispersion in patients with pulmonary embol-ism.Wien Klin Wochenschr,2010,122:691-97
[24]Adam T,Arnaud P,Stavros K,et al.Guidelines on the diagnosis and managemen- tof acute pulmonary embolism.European Heart Journal,2008,29,:2276-315
[25]Kurt R. Daniel K, Mark C, Jeffrey A. Pulmonary Embolism With 12-Lead ECG Assessment of Cardiac Stress From Massive. Chest,2001,120:474-81.
[26]de Bruyne MC, Hoes AW, Kors JA, Hofman A, van Bemmel JH, Grobbee DE. QTc dispersion predicts cardiac mortality in the elderly. The Rotterdam study. Circulation,1998,97:467-72.
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