Surawicz Borys, Parikh Sanjay R
Indiana Heart Institute and The Care Group, St Vincent Hospital, Indianapolis, Indiana, USA.
Ann Noninvasive Electrocardiol. 2003 Oct;8(4):333-40. doi: 10.1046/j.1542-474x.2003.08411.x.
The purpose of this review article is to discuss the differences between ventricular repolarization in males and females in terms of morphology, possible mechanism, and practical significance. The interest in the subject increased when it became known that in comparison to men, women have a higher incidence of torsade de pointes (tdp) and a greater lengthening of QT-interval after administration of class III antiarrhythmic drugs. Before puberty, the QT intervals and the patterns of ventricular repolarization in boys and girls are similar. At puberty, in boys the QT interval shortens, and a typical male pattern of ventricular repolarization develops. This pattern is characterized by a higher amplitude of the J-point, a shorter and steeper ST segment course, a steeper ascent, and a higher amplitude of the T wave. This pattern is prevalent in >90% of young males. With increasing age the prevalence of the male pattern in males declines gradually and drops to 14% in the oldest age group. The rise and fall of the prevalence of the male pattern appears to parallel the rise and decline of testosterone in males. The female pattern of ventricular repolarization is prevalent in about 80% of females in all age groups. The hormonal effects on ventricular repolarization have been studied in normal and castrated rabbits of both sexes. The available evidence indicates that the females have greater divergence of L calcium current among different layers of the myocardium and a lower density of the repolarizing Kr and Ks currents. The clinical significance of the repolarization differences among genders remains to be determined. Of particular interest is the question whether the males with female pattern are at the same risk of tdp as the females or whether the females with male pattern are at lower risk of tdp than the females with female pattern.
这篇综述文章的目的是从形态学、可能的机制及实际意义方面探讨男性和女性心室复极的差异。当人们得知与男性相比，女性尖端扭转型室速（tdp）的发生率更高，且在使用Ⅲ类抗心律失常药物后QT间期延长更明显时，对该主题的关注度有所增加。青春期前，男孩和女孩的QT间期及心室复极模式相似。青春期时，男孩的QT间期缩短，并形成典型的男性心室复极模式。这种模式的特征是J点振幅更高、ST段行程更短且更陡峭、上升更陡峭以及T波振幅更高。这种模式在超过90%的年轻男性中普遍存在。随着年龄增长，男性中男性模式的患病率逐渐下降，在最年长年龄组中降至14%。男性模式患病率的上升和下降似乎与男性睾酮水平的上升和下降平行。女性心室复极模式在所有年龄组中约80%的女性中普遍存在。已经在正常和去势的雌雄兔中研究了激素对心室复极的影响。现有证据表明，女性心肌不同层之间的L型钙电流差异更大，而复极化的Kr和Ks电流密度更低。不同性别间复极差异的临床意义仍有待确定。特别值得关注的问题是，具有女性模式的男性发生tdp的风险是否与女性相同，或者具有男性模式的女性发生tdp的风险是否低于具有女性模式的女性。
