Hohnloser S H
Department of Cardiology, J. W. Goethe University, Frankfurt, Germany.
Prog Cardiovasc Dis. 2000 Mar-Apr;42(5):351-8. doi: 10.1053/pcad.2000.0420351.
Over the last 5 to 8 years, numerous clinical studies have been conducted evaluating the effects of coronary ischemia on disparity of ventricular repolarization (VR) as assessed by determination of QT dispersion from the surface electrocardiogram. From findings in patients with acute myocardial infarction, stable coronary disease, and vasospastic angina there is convincing evidence that acute coronary ischemia augments inhomogeneity in VR. In some studies, this was associated with the occurrence of ventricular arrhythmias. In general, therefore, these clinical observations confirm previous experimental work. One should keep in mind, however, various problems inherent to the current technology used to determine QT dispersion from the surface electrocardiogram. Whereas some of these technological limitations can be overcome in carefully designed and conducted clinical studies, these methodological shortcomings have so far precluded the routine use of QT dispersion in taking care of patients with acute coronary syndromes. It remains to be seen whether further refinements in technology will enable clinicians to incorporate assessment of disparity of VR in daily practice in an attempt to further improve care of patients with acute coronary syndromes.
在过去5至8年中，已经开展了大量临床研究，通过测定体表心电图的QT离散度来评估冠状动脉缺血对心室复极离散度（VR）的影响。从急性心肌梗死、稳定型冠心病和变异性心绞痛患者的研究结果来看，有令人信服的证据表明急性冠状动脉缺血会加剧VR的不均一性。在一些研究中，这与室性心律失常的发生有关。因此，总体而言，这些临床观察结果证实了先前的实验研究。然而，人们应该记住，目前用于从体表心电图测定QT离散度的技术存在各种固有问题。虽然其中一些技术限制可以在精心设计和实施的临床研究中克服，但这些方法学上的缺点迄今为止妨碍了QT离散度在急性冠状动脉综合征患者护理中的常规应用。技术的进一步改进是否能使临床医生在日常实践中纳入VR离散度评估，以进一步改善急性冠状动脉综合征患者的护理，还有待观察。
