Parchure N, Batchvarov V, Malik M, Camm A J, Kaski J C
Coronary Artery Disease Research Unit, Department of Cardiological Sciences, St George's Hospital Medical School, Cranmer Terrace, London SW17 0RE, UK.
Cardiovasc Res. 2001 May;50(2):379-85. doi: 10.1016/s0008-6363(00)00290-x.
We sought to compare QT dispersion in patients presenting with Prinzmetal's variant angina complicated by cardiac arrest or syncope and patients with uncomplicated variant angina.
Despite the usually benign course of treated Prinzmetal's variant angina, a proportion of vasospastic angina patients develop ventricular arrhythmias and sudden death in association with coronary spasm. Increased QT dispersion has been suggested to increase susceptibility to ventricular arrhythmias in patients with coronary artery spasm.
We studied 25 consecutive patients (mean age 58 years; 14 men) with classical Prinzmetal's variant angina and documented coronary artery spasm. None of the patients had coronary artery stenoses < or =40%. Five patients had suffered a documented cardiac arrest, two had recurrent syncope and 18 had no arrhythmic events or syncopal episodes. In all patients QT dispersion (QT maximum-QT minimum in every ECG lead) was measured on the baseline 12-lead electrocardiogram at study entry using a digitising board.
Mean (+/-S.D.) QT dispersion of study patients was 62.3+/-19.5 ms. QT dispersion in patients with cardiac arrest and syncope (79.4+/-17.3 ms) was significantly higher compared to patients with no such events (56.3+/-16.9 ms), (95% CI 7.5-38.8, P=0.005). No significant clinical, biochemical or angiographic differences were found between patients with and those without cardiac arrest or syncope.
QT dispersion is increased in patients with Prinzmetal's variant angina complicated by cardiac arrest and syncope compared to patients without such events. Increased QT dispersion may be both a substrate for sudden cardiac death and a marker of risk in patients with Prinzmetal's variant angina.
我们试图比较伴有心脏骤停或晕厥的变异型心绞痛患者与无并发症的变异型心绞痛患者的QT离散度。
尽管变异型心绞痛经治疗后通常病程良性，但一部分血管痉挛性心绞痛患者会发生室性心律失常和与冠状动脉痉挛相关的猝死。QT离散度增加被认为会增加冠状动脉痉挛患者发生室性心律失常的易感性。
我们研究了25例连续的典型变异型心绞痛且记录有冠状动脉痉挛的患者（平均年龄58岁；14例男性）。所有患者冠状动脉狭窄均<或 =40%。5例患者有记录的心脏骤停，2例有反复晕厥，18例无心律失常事件或晕厥发作。所有患者在研究入组时使用数字化板在基线12导联心电图上测量QT离散度（每个心电图导联的QT最大值 - QT最小值）。
研究患者的平均（±标准差）QT离散度为62.3±19.5毫秒。有心脏骤停和晕厥的患者的QT离散度（79.4±17.3毫秒）显著高于无此类事件的患者（56.3±16.9毫秒），（95%可信区间7.5 - 38.8，P = 0.005）。有和无心脏骤停或晕厥的患者之间在临床、生化或血管造影方面未发现显著差异。
与无心脏骤停和晕厥的变异型心绞痛患者相比，伴有心脏骤停和晕厥的变异型心绞痛患者的QT离散度增加。QT离散度增加可能既是变异型心绞痛患者心脏性猝死的基础，也是风险的标志物。
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