Isma'eel Hussain, Shamseddeen Wael, Taher Ali, Gharzuddine Walid, Dimassi Adel, Alam Samir, Masri Lara, Khoury Maurice
Int J Cardiol. 2009 Mar 6;132(3):453-5. doi: 10.1016/j.ijcard.2007.08.103. Epub 2008 Mar 4.
Iron induced cardiac abnormalities remain the number one cause of death among thalassemia major (TM) patients. Signal averaged ECG (SAECG) was suggested to predict ventricular tachycardia as the underlying substrate for up to 5% incidence of sudden cardiac death among TM patients. The prevalence of ventricular late potentials (VLP) among different TM populations varied (3-31%); therefore to further clarify this we here describe the incidence of VLP among TM patients over a 7 year follow up period (1997 to 2004).
26 TM patients were randomly selected from a group of 240 TM patients. SAECG, regular ECG, echocardiography-Doppler were analyzed during the study period. Ferritin levels and cardiac complaints were registered from an interview and chart review.
Mean QRS duration increased from 89.23 (+/-10.60) ms in 1997 to 94.27 (+/-10.91) in 2004 (p<0.01), mean late amplitude signal (LAS) duration increased from 23.04 (+/-7.68) ms in 1997 to 27.69 (+/-6.82) ms in 2004 (p=0.01), whereas mean root mean square voltage RMS decreased from 80.85 (+/-51.19) mV in 1997 to 45.12 (+/-21.42) mV in 2004 (p<0.01). Changes in QRS duration and RMS voltage were found to be linearly correlated with average of ferritin over years (r=0.38, p=0.03 and r=-0.47, p=0.01 respectively); and only 1 patient developed VLP over 7 years.
The incidence of VLP is 3.8% in the TM population over 7 years, despite the presence of significant changes in all SAECG criteria. RMS voltage and QRS duration changes over time seem to be related to iron overload measured by ferritin level.
铁诱导的心脏异常仍是重型地中海贫血（TM）患者的首要死因。信号平均心电图（SAECG）被认为可预测室性心动过速，而室性心动过速是TM患者中心脏性猝死发生率高达5%的潜在基础。不同TM人群中室性晚电位（VLP）的患病率有所不同（3% - 31%）；因此，为进一步阐明这一点，我们在此描述了1997年至2004年7年随访期内TM患者中VLP的发生率。
从240例TM患者中随机选取26例患者。在研究期间对SAECG、常规心电图、超声心动图 - 多普勒进行分析。通过访谈和病历审查记录铁蛋白水平和心脏症状。
平均QRS时限从1997年的89.23（±10.60）ms增加到2004年的94.27（±10.91）ms（p<0.01），平均晚电位信号（LAS）时限从1997年的23.04（±7.68）ms增加到2004年的27.69（±6.82）ms（p = 0.01），而平均均方根电压RMS从1997年的80.85（±51.19）mV降至2004年的45.12（±21.42）mV（p<0.01）。发现QRS时限和RMS电压的变化与多年来铁蛋白的平均值呈线性相关（分别为r = 0.38，p = 0.03和r = -0.47，p = 0.01）；并且7年中只有1例患者出现VLP。
在TM人群中，7年期间VLP的发生率为3.8%，尽管所有SAECG标准都有显著变化。RMS电压和QRS时限随时间的变化似乎与通过铁蛋白水平衡量的铁过载有关。
