Michel P L, Mandagout O, Vahanian A, Cormier B, Iung B, Luxereau P, Acar J
Cardiology Department, Hopital Tenon, Paris, France.
J Heart Valve Dis. 1992 Sep;1(1):72-9.
In order to evaluate the incidence and prognostic value of ventricular arrhythmias in patients with aortic valve disease, 24 hour ambulatory electrocardiographic recordings were obtained in 374 patients without coronary artery disease (aortic stenosis n = 194, aortic regurgitation n = 103, combined aortic stenosis and regurgitation n = 77). Following aortic valve replacement, repeat recordings were obtained in a subgroup of 96 patients at 13 +/- 4 days and 18 +/- 7 months. Ventricular arrhythmias were classified in all cases according to Lown and were compared with clinical, echocardiographic and hemodynamic data. Preoperatively, ventricular premature beats were observed in 329 patients (88%), and were found to be frequent (>30 ventricular premature beats/hour) in 83 (22%). Multiformity was found in 105 (28%), couplets in 75 (20%) and ventricular tachycardia in 45 (12%). The occurrence of ventricular arrhythmias was not related to the type or severity of the valve lesions. Patients with severe ventricular arrhythmias (Lown class 3 or 4: 36.5%) had a higher ventricular wall thickness (interventricular septum thickness 14.2 +/- 1.8 mm vs. 11.9 +/- 2.0 mm, p < 0.01, a higher LV mass (178 +/- 32 g/m2 vs. 142 +/- 35 g/m2, p < 0.001) and a lower left ventricular ejection fraction (48% +/- 9% vs. 56.5% +/- 10%, p < 0.001); while in patients with aortic regurgitation a higher end-diastolic LV volume (224 +/- 38 ml/m2 vs. 178 +/- 42 ml/m2, p < 0.02) and a higher end-systolic LV diameter (56 +/- 7 mm vs. 46 +/- 8 mm, p < 0.02) were observed.(ABSTRACT TRUNCATED AT 250 WORDS)
为评估主动脉瓣疾病患者室性心律失常的发生率及预后价值，对374例无冠状动脉疾病的患者进行了24小时动态心电图记录（主动脉瓣狭窄194例，主动脉瓣关闭不全103例，主动脉瓣狭窄合并关闭不全77例）。在主动脉瓣置换术后，对96例患者的亚组在术后13±4天和18±7个月进行了重复记录。所有病例的室性心律失常均按洛恩标准分类，并与临床、超声心动图和血流动力学数据进行比较。术前，329例患者（88%）观察到室性早搏，其中83例（22%）频发（>30次室性早搏/小时）。105例（28%）呈多形性，75例（20%）呈成对出现，45例（12%）出现室性心动过速。室性心律失常的发生与瓣膜病变的类型或严重程度无关。严重室性心律失常患者（洛恩3级或4级：36.5%）的室壁厚度更高（室间隔厚度14.2±1.8mm对11.9±2.0mm，p<0.01），左心室质量更高（左心室质量指数178±32g/m²对142±35g/m²，p<0.001），左心室射血分数更低（48%±9%对56.5%±10%，p<0.001）；而在主动脉瓣关闭不全患者中，观察到舒张末期左心室容积更高（224±38ml/m²对左心室容积指数178±42ml/m²，p<0.02）和收缩末期左心室直径更高（56±7mm对46±8mm，p<0.02）。（摘要截选于250词）
