急性ST段抬高心肌梗死直接PCI干预时间对QT离散度的影响

付文军; 包明威

doi:10.13201/j.issn.1009-5918.2017.07.013

急性ST段抬高心肌梗死直接PCI干预时间对QT离散度的影响

付文军,
包明威^,

- 武汉大学人民医院心血管内科(武汉, 430060)

详细信息

通讯作者: 包明威, E-mail:1160910716@qq.com

中图分类号: R542.2

收稿日期: 2017-06-01

Influence of primary PCI time on QT dispersion in patients with acute ST-segment elevation myocardial infarction

FU Wenjun,
BAO Mingwei^,

- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan 430060, China

More Information

Corresponding author: BAO Mingwei, E-mail: 1160910716@qq.com

Received Date: 01 June 2017

摘要

摘要: 目的:探讨急性ST段抬高型心肌梗死(STEMI)患者的症状发作至球囊扩张时间(SOTBT)对QT离散度(QTd)的影响。方法:收集82例急性STEMI行直接PCI治疗患者,根据SOTBT分为<3 h组、3~6 h组、>6 h组,测量各组PCI术前、术后24 h、术后72 h心电图QTd及心率校正QT间期离散度(QTcd),比较各组间QTd及QTcd的变化差异。结果:PCI术前,SOTBT<3 h组的QTd及QTcd较SOTBT 3~6 h组和SOTBT>6 h组明显延长(P<0.05或P<0.01);3组PCI术后24 h及72 h的QTd、QTcd均较术前显著缩短(P<0.05或P<0.01);术后24 h,随着SOTBT的延长,QTd及QTcd缩短值逐渐下降,SOTBT<3 h组的变化最大,QTd缩短值为(32.5±11.2) ms,QTd平均缩短率为43.6%,QTcd缩短值为(35.5±11.8) ms,QTcd平均缩短率为44.6%,分别与其他2组相比均差异有统计学意义(P<0.01);术后72 h QTd及QTcd在术后24 h的基础上有进一步下降,但变化在各组并不显著。结论:直接PCI治疗能显著缩短急性STEMI患者的QTd,与SOTBT 3~6 h组和>6 h组相比,SOTBT<3 h组QTd缩短更显著,且在PCI术后的最初24 h缩短幅度最大,表明急诊PCI患者SOTBT越短,疗效更佳。
- QT间期离散度 /
- 症状发作至球囊扩张时间 /
- 急性心肌梗死 /
- ST段抬高
Abstract: Objective:To investigate the influence of symptom-onset-to-balloon time (SOTBT) on QT dispersion (QTd) in patients with acute ST-segment elevation myocardial infarction (STEMI).Method:Eight-two patients with acute STEMI received primary PCI were divided into 3 groups (<3 h,3~6 h,>6 h) according to SOTBT.QTd and QTcd were measured before PCI,24 hours and 72 hours after PCI respectively from the ECG,and the comparisons were carried out between the groups.Result:Before PCI,QTd and QTcd were significantly longer in SOTBT<3 h group than SOTBT 3~6 h and SOTBT>6 h groups (P<0.05 or P<0.01).QTd and QTcd in the three groups were significantly reduced both 24 hours and 72 hours after PCI than that before PCI (P<0.05 or P<0.01).24 hours after PCI,with the extension of SOTBT,the absolute QTd and QTcd reduction decreased.The maximum absolute QTd reduction (32.5±11.2) ms,maximum mean relative QTd reduction rate (43.6%),maximum absolute QTcd reduction (35.5±11.8) ms and maximum mean relative QTcd reduction rate (44.6%) were found in the group of SOTBT<3 h compared with groups of SOTBT 3~6 h and SOTBT>6 h(P<0.01).Seventy-two hours after PCI,QTd and QTcd went a further reduction on the basis of 24 hours after PCI,but the changes were not significant among the groups.Conclusion:Primary PCI is an effective method to shorten the QTd in patients with acute STEMI,and the maximum absolute QTd reduction was found in SOTBT<3 h group,which shows that the shorter SOTBT of emergency PCI,the better curative effect for patients.
- QT interval dispersion /
- symptom-onset-to-balloon time /
- acute myocardial infarction /
- ST-segment elevation

HTML全文

参考文献(17)

[1]	Day C P, McComb J M, Campbell R W.QT dispersion:an indication of arrhythmia risk in patients with long QT intervals[J].Br Heart J, 1990, 63 (6):342-344.
[2]	Glancy J M, Garratt C J, Woods K L, et al.QT dispersion and mortality after myocardial infarction[J].Lancet, 1995, 345 (8955):945-948.
[3]	韩姬玲, 武留信, 朱艳春, 等.心率变异、心室晚电位、Q-T离散度对心肌梗塞患者心脏事件发生的预测价值[J].中华心血管病杂志, 1997, 1:54-56.
[4]	姜悦, 陈威.急性心肌梗死QT离散度动态变化及其临床意义研究[J].中国病案, 2013, 14 (4):66-67.
[5]	Jiménez-Candil J, Hernández Hernández J, Aguero V L, et al.Early reduction of QT dispersion after primary percutaneous intervention in ST-segment elevation acute myocardial infarction.Mechanisms and clinical implications[J].Cardiology, 2009, 113 (3):172-179.
[6]	Malik M, Batchvarov V N.Measurement, interpretation and clinical potential of QT dispersion[J].J Am Coll Cardiol, 2000, 36 (6):1749-1766.
[7]	Elming H, Holm E, Jun L, et al.The prognostic value of the QT interval and QT interval dispersion in allcause and cardiac mortality and morbidity in a population of Danish citizens[J].Eur Heart J, 1998, 19 (9):1391-1400.
[8]	Mugnai G, Benfari G, Fede A, et al.Tpeak-to-Tend/QT is an independent predictor of early ventricular arrhythmias and arrhythmic death in anterior ST elevation myocardial infarction patients[J].Eur Heart J Acute Cardiovasc Care, 2016, 5 (6):473-480.
[9]	Ciolli A, Di L M, Bevilacqua U, et al.QT dispersion and early arrhythmic risk during acute myocardial infarction[J].G Ital Cardiol, 1999, 29 (12):1438-1444.
[10]	Mulay D V, Quadri S M.QT dispersion and early arrhythmic risk in acute myocardial infarction[J].Indian Heart J, 2004, 56 (6):636-641.
[11]	Liew R.Prediction of sudden arrhythmic death following acute myocardial infarction[J].Heart, 2010, 96 (14):1086-1094.
[12]	Pan K L, Hsu J T, Chang S T, et al.Prognostic value of QT dispersion change following primary percutaneous coronary intervention in acute ST elevation myocardial infarction[J].Int Heart J, 2011, 52 (4):207-211.
[13]	Higham P D, Furniss S S, Campbell R W.QT dispersion and components of the QT interval in ischaemia and infarction[J].Br Heart J, 1995, 73 (1):32-36.
[14]	Alici G, Sahin M, Ozkan B, et al.The comparison in reduction of QT dispersion after primary percutaneous coronary intervention according to existence of thrombectomy in ST-segment elevation myocardial infarction[J].Clin Cardiol, 2013, 36 (5):276-279.
[15]	贝春花, 李广镰, 曾冲.急性心肌梗死患者经皮冠状动脉介入治疗对QT离散度的影响[J].第一军医大学学报, 2004, 9:1055-1057.
[16]	Takase B, Nagata M.Delayed enhancement morphology on cardiac magnetic resonance imaging is correlated with signal-averaged electrocardiogram and QT dispersion in myocardial infarction[J].Angiology, 2009, 60 (4):412-418.
[17]	Fukushima N, Tsurumi Y, Jujo K, et al.Impact of myocardial reperfusion status on QT dispersion after successful recanalization of the infarct-related artery in acute myocardial infarction[J].J Interv Cardiol, 2014, 27 (3):252-259.