Can Ilknur, Onat Ahmet Mesut, Aytemir Kudret, Akdogan Ali, Ureten Kemal, Kiraz Sedat, Ertenli Ihsan, Ozer Necla, Tokgozoglu Lale, Oto Ali
Department of Cardiology, Hacettepe University, Ankara, Turkey.
Cardiology. 2007;108(4):317-21. doi: 10.1159/000099102. Epub 2007 Feb 12.
Atrial conduction abnormalities in patients with scleroderma have not been evaluated in terms of P wave duration, P wave dispersion (P(d)) and electromechanical coupling measured by tissue Doppler echocardiography.
Twenty-four patients with scleroderma and 24 control subjects underwent resting electrocardiogram (ECG), M mode and tissue Doppler echocardiography. The P wave duration was calculated in all leads of the surface ECG. The difference between the maximum (P(max)) and minimum P wave duration was calculated and defined as P(d). Interatrial and intraatrial electromechanical delays were measured with tissue Doppler tissue echocardiography.
The left ventricular dimensions, fractional shortening, and left atrial diameter did not differ between the patients and the controls. P(d) and P(max) were significantly higher in patients with scleroderma compared with controls: 51 +/- 17 versus 28 +/- 7 ms (p < 0.01) and 109 +/- 10 versus 93 +/- 6 ms (p < 0.01), respectively. There was a delay between the onset of the P wave on surface ECG and the onset of the late diastolic wave (A wave; PA) obtained by tissue Doppler echocardiography in patients with scleroderma compared with controls measured at lateral septal annulus (lateral PA; 122 +/- 8 vs. 105 +/- 7 ms, p = 0.001), septal mitral annulus (104 +/- 11 vs. 93 +/- 10 ms, p = 0.01) and tricuspid annulus (right ventricular PA; 71 +/- 9 vs. 64 +/- 7 ms, p = 0.05). Interatrial conduction time (lateral PA - right ventricular PA) was delayed in patients with scleroderma compared with controls (88 +/- 13 vs. 76 +/- 11 ms, p = 0.01). A positive correlation was detected between interatrial electromechanical delay (lateral PA - right ventricular PA) and P(d) (r = 0.5, p = 0.03).
Atrial conduction abnormalities as estimated with P(d) and P(max) are significantly higher in patients with scleroderma compared with controls. There is a delay in both intraatrial and interatrial electromechanical coupling intervals in patients with scleroderma.
尚未从P波时限、P波离散度（P(d)）以及通过组织多普勒超声心动图测量的机电耦联方面对硬皮病患者的心房传导异常进行评估。
对24例硬皮病患者和24例对照者进行静息心电图（ECG）、M型和组织多普勒超声心动图检查。计算体表ECG所有导联的P波时限。计算并定义最大P波时限（P(max)）与最小P波时限之间的差值为P(d)。采用组织多普勒组织超声心动图测量心房内和心房间的机电延迟。
患者与对照者的左心室尺寸、缩短分数和左心房直径无差异。与对照者相比，硬皮病患者的P(d)和P(max)显著更高：分别为51±17 ms与28±7 ms（p<0.01）和109±10 ms与93±6 ms（p<0.01）。与对照者相比，硬皮病患者体表ECG上P波起始与组织多普勒超声心动图获得的舒张晚期波（A波；PA）起始之间存在延迟，在外侧间隔环测量时（外侧PA；122±8 vs. 105±7 ms，p = 0.001）、间隔二尖瓣环（104±11 vs. 93±10 ms，p = 0.01）和三尖瓣环（右心室PA；71±9 vs. 64±7 ms，p = 0.05）。与对照者相比，硬皮病患者的心房间传导时间（外侧PA - 右心室PA）延迟（88±13 vs. 7,6±11 ms，p = 0.01）。在心房间机电延迟（外侧PA - 右心室PA）与P(d)之间检测到正相关（r = 0.5，p = 0.03）。
与对照者相比，硬皮病患者中用P(d)和P(max)评估的心房传导异常显著更高。硬皮病患者的心房间和心房内机电耦联间期均有延迟。
