Vogel M, Sponring J, Cullen S, Deanfield J E, Redington A N
Grown-Up Congenital Heart (GUCH) Unit, Middlesex Hospital, London, UK.
Circulation. 2001 Mar 27;103(12):1669-73. doi: 10.1161/01.cir.103.12.1669.
Abnormal depolarization-repolarization in patients with repaired tetralogy of Fallot (TOF) is a risk factor for malignant ventricular tachycardia and sudden death. It is unclear whether ECG abnormalities are associated with abnormal regional right ventricular (RV) function.
Seventy-four patients (37 patients <18 and 37 >18 years old) who had had TOF repair at 4.0 years old (0.1 to 47 years old) were examined when they were 18.7 years old (1.7 to 61.1 years old), as were 112 control subjects with normal hearts. Regional function was evaluated with tissue Doppler imaging of the RV and left ventricular (LV) free wall and the septum. Myocardial velocities were sampled continuously from base to apex. Synchronous ECG was analyzed for QRS, QT, and JT duration and QRS, QT, and JT dispersion. All 74 TOF patients had normal LV myocardial velocities. Forty-eight patients (24 patients <18 and 24 >18 years old) had reversed myocardial velocities in diastole in the RV free wall, which were associated with reversed systolic myocardial velocities in 22 and additional reverse diastolic myocardial velocities in the septum in 19. Those 48 patients had a longer QRS duration (151+/-31 versus 124+/-27 ms) and greater QRS (47+/-18 versus 29+/-12 ms), QT (73+/-27 versus 52+/-22 ms), and JT (96+/-31 versus 67+/-35 ms) dispersion. Compared with normal control subjects, all 74 TOF patients had decreased systolic and diastolic myocardial velocities and a longer isovolumic relaxation time.
RV wall-motion abnormalities are a common finding late after TOF repair and are associated with repolarization-depolarization abnormalities. These data further underscore a likely mechanoelectrical interaction as an important part of the pathogenesis of RV disease in these patients.
法洛四联症（TOF）修复术后患者的异常去极化-复极化是恶性室性心动过速和猝死的危险因素。目前尚不清楚心电图异常是否与右心室（RV）局部功能异常有关。
74例曾在4.0岁（0.1至47岁）接受TOF修复术的患者在18.7岁（1.7至61.1岁）时接受检查，另有112名心脏正常的对照者也接受了检查。通过对RV和左心室（LV）游离壁及室间隔进行组织多普勒成像来评估局部功能。从心底到心尖连续采集心肌速度。同步分析心电图的QRS、QT和JT间期以及QRS、QT和JT离散度。所有74例TOF患者的LV心肌速度均正常。48例患者（24例年龄<18岁，24例年龄>18岁）RV游离壁舒张期心肌速度反转，其中22例患者收缩期心肌速度也反转，19例患者室间隔舒张期心肌速度额外反转。这48例患者的QRS间期更长（151±31 vs 124±27 ms），QRS离散度更大（47±18 vs 29±12 ms），QT离散度（73±27 vs 52±22 ms）和JT离散度（96±31 vs 67±35 ms）也更大。与正常对照者相比，所有74例TOF患者的收缩期和舒张期心肌速度均降低，等容舒张时间更长。
RV壁运动异常是TOF修复术后晚期的常见表现，与复极化-去极化异常有关。这些数据进一步强调了机械电相互作用可能是这些患者RV疾病发病机制的重要组成部分。
