Yildiz Pinar, Tükek Tufan, Akkaya Vakur, Sözen Ahmet Bilge, Yildiz Alaattin, Korkut Ferruh, Yilmaz Veysel
Department of Pulmonology, Yedikule Chest Diseases and Chest Surgery Hospital, Istanbul School of Medicine, 34740 Bakirkoy, Istanbul, Turkey.
Chest. 2002 Dec;122(6):2055-61. doi: 10.1378/chest.122.6.2055.
QT dispersion (QTd) and late potentials derived from signal-averaged ECG (SAECG) have been proposed as noninvasive predictors of cardiac arrhythmias that occur in patients with COPD. In this study, we aimed to investigate QTd and SAECG in patients with COPD.
Cross-sectional study.
Teaching chest disease hospital and cardiology center in a university hospital.
Thirty patients with COPD (28 men and 2 women; mean +/- SD age, 60 +/- 9 years) and 31 age- and sex-matched control subjects (28 men and 3 women; mean age, 57 +/- 7 years) were included.
Respiratory function tests, arterial blood gas analyses, echocardiographic examinations, rhythm Holter recordings, and heart rate variability (HRV) analyses were performed in addition to the measurements of QT intervals and SAECG. Patients with COPD had higher rate of ventricular premature beats (VPBs) as compared to control subjects (924 +/- 493 beats vs 35 +/- 23 beats, p = 0.009). Eight patients with COPD (27%) had nonsustained runs of ventricular tachycardia (VT). QTd rates were significantly increased in patients with COPD as compared to control subjects (57.7 +/- 9.9 ms vs 37.5 +/- 8.2 ms, p < 0.001). On comparing patients with COPD with and without runs of VT, patients with VT had longer QTd (67 +/- 10 ms vs 55 +/- 8 ms, p = 0.001). However no difference in any HRV and late potential parameters were found between patients with COPD with and without runs of VT. VPB rates were strongly correlated with QTd in patients with COPD (r = 0.61, p < 0.001). On SAECG analysis, patients with COPD had significantly increased total QRS duration as compared to control subjects. Nine of the 30 patients with COPD (30%) had positive late potentials. However, QTd and VPB rates were also similar between patients with COPD with and without late potentials.
The development of ventricular arrhythmia in patients with COPD was associated with increased QTd. Increased QTd may be associated with autonomic changes seen in patients with COPD.
QT离散度（QTd）和信号平均心电图（SAECG）得出的晚电位已被提出作为慢性阻塞性肺疾病（COPD）患者发生心律失常的无创预测指标。在本研究中，我们旨在调查COPD患者的QTd和SAECG。
横断面研究。
大学医院的教学胸部疾病医院和心脏病中心。
纳入30例COPD患者（28例男性和2例女性；平均±标准差年龄，60±9岁）和31例年龄及性别匹配的对照者（28例男性和3例女性；平均年龄，57±7岁）。
除了测量QT间期和SAECG外，还进行了呼吸功能测试、动脉血气分析、超声心动图检查、动态心电图记录和心率变异性（HRV）分析。与对照者相比，COPD患者室性早搏（VPB）发生率更高（924±493次 vs 35±23次，p = 0.009）。8例COPD患者（27%）发生非持续性室性心动过速（VT）。与对照者相比，COPD患者的QTd率显著增加（57.7±9.9毫秒 vs 37.5±8.2毫秒，p < 0.001）。比较有和没有VT发作的COPD患者，有VT的患者QTd更长（67±10毫秒 vs 55±8毫秒，p = 0.001）。然而，有和没有VT发作的COPD患者在任何HRV和晚电位参数上均未发现差异。COPD患者的VPB率与QTd密切相关（r = 0.61，p < 0.001）。在SAECG分析中，与对照者相比，COPD患者的总QRS时限显著增加。30例COPD患者中有9例（30%）晚电位阳性。然而，有和没有晚电位的COPD患者之间的QTd和VPB率也相似。
COPD患者室性心律失常的发生与QTd增加有关。QTd增加可能与COPD患者出现的自主神经变化有关。
