【摘要】 目的探讨颠簸样三相T波诊断心尖肥厚型心肌病(AHCM)的临床价值。方法对66例肥厚型心肌病(HCM)患者的临床资料和动态心电图进行回顾性分析,将其中明确诊断为AHCM的患者12例和同期动态心电图检查中出现颠簸样三相T波的患者7例为研究对象。应用12导联动态心电分析系统观察并记录:(1)胸前导联QRS波群振幅;(2)巨大T波倒置发生的导联、形态,与RR间期的关系;(3)最大ST段下移发生的导联;(4)颠簸样三相T波的疾病分布情况,发生的导联、形态,发生时心率;(5)QTc延长程度;(6)出现病理性Q波情况。颠簸样三相T波诊断AHCM的评价方法:(1)敏感度=真阳/真阳+假阴×100%;(2)阳性预告值=真阳/真阳+假阳×100%。结果 (1)12例AHCM,占同期诊断HCM的18.18%(12/66),男女比例5:1,平均年龄54.65±17.58,合并冠心病1例(1/12)。(2)房颤发生率25%(3/12),室性心律失常发生率83.33%(10/12)。(3)左胸导联R波振幅增高12例(12/12,100%);V3～V6导联巨大深而窄T波倒置11例(11/12,91.67%),均与RR间期限呈正相关;最大ST段下移发生于V4～V6导联12例(12/12,100%)。(4)QTc延长>500 ms5例(5/12)。(5)病理性Q波1例(1/12)。(6)颠簸样三相T波7例,发生时间为夜间或心率相对慢时,其中,AHCM患者6例(6/7),冠心病、二度Ⅰ型房室阻滞1例(1/7)。(7)颠簸样三相T波诊断AHCM的敏感度50%,阳性预告值85.71%;颠簸样三相T波联合特异性巨大T波倒置和左胸导联R波振幅增高,诊断AHCM的阳性预告值为100%。结论颠簸样三相T波对AHCM具有诊断价值,对易发生恶性室性心律失常的高危患者具有预测价值。更多还原

【Abstract】 Objective To investigate the diagnostic value of bumpy three phase T wave to apical hypertrophic cardiomyopathy(AHCM) in clinic. Methods The clinical materials and ambulatory electrocardiograph(ECG) were retrospectively analyzed in patients with hypertrophic cardiomyopathy(HCM, n=66), and among them 12 cases with diagnosed AHCM and 7 with bumpy three phase T wave were chosen as objects. The analysis system of 12-lead ambulatory ECG was used for observing and recording:(1)amplitude of QRS complex in precordial lead;(2)lead and shape of giant T-wave inversion and relationship between them and RR interval;(3)lead with maximum STsegment depression;(4)disease distribution, lead, shape and heart rate at the time of occurrence of bump threephase T wave;(5)QTc prolongation degree and(6)pathological Q wave. The reviewing methods of bump threephase T wave for diagnosing AHCM including(1)sensitivity=true positive/true positive+false negative×100% and(2)positive predictive value=true positive/true positive+false positive×100%. Results(1)There were 12 AHCM cases accounted for 18.18%(12/66) of HCM diagnosed in the same period. The ratio of male to female was 5:1,and average age was(54.65±17.58). There was 1 case(1/12) was complicated by coronary heart disease.(2)The incidence rate of atrial fibrillation was 25%(3/12), and that of ventricular arrhythmia was 83.33%(10/12).(3)The amplitude of R wave in left chest lead increased in 12 cases(12/12, 100%), there were 11 cases(11/12, 91.67%)with huge, deep and narrow T wave inversion in lead V3～V6, all of which were positively correlated to RR duration,and the maximum ST-segment depression occurred in 12 cases(12/12, 100%) in lead V4～V6.(4)QTc prolongation was more than 500 ms in 5 cases(5/12).(5)Pathological Q wave was observed in 1 case(1/12).(6)There were 7 cases of bumpy three-phase T wave occurred at night or relative slow heart rate. Among them, 6 cases(6/7) had AHCM, 1 case(1/7) had coronary heart disease and 1 case(1/7) had type II atrioventricular block.(7)The sensitivity of bumpy three-phase T wave in AHCM diagnosis was 50%, and positive predictive value was 85.71%. The positive predictive value of bumpy three-phase T wave combined with specific giant T wave inversion and increased R wave amplitude in left chest lead was 100% in AHCM diagnosis. Conclusion Bumpy three phase T wave has diagnostic value to AHCM, and can predict malignant ventricular arrhythmia in high-risk patients.更多还原