Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
J Cardiovasc Electrophysiol. 2011 Dec;22(12):1351-8. doi: 10.1111/j.1540-8167.2011.02129.x. Epub 2011 Jul 7.
Patients with nonischemic cardiomyopathy (NICM) and ventricular tachycardia (VT) usually have basal-lateral scar in the left ventricle (LV). We sought to determine electrocardiogram (ECG) characteristics that may help identify NICM patients with basal-lateral scar and VT.
Phase I, study patients (n = 25) had NICM, VT, and endocardial/epicardial basal-lateral LV low voltage consistent with scar on detailed mapping. ECGs were compared to controls (n = 18) with NICM, and comparable age and gender without VT/known scar. All patients had either sinus or paced atrial rhythm ECGs without bundle-branch block or ventricular pacing. In phase II, criteria were evaluated prospectively, blinded to clinical data, using ECGs from 15 NICM patients, of which 7 patients had VT and endocardial/epicardial basal-lateral LV scar on detailed mapping. Of ECG characteristics studied, V1 R and R:S ratio, and V6 S and S:R ratio were univariately associated with basal-lateral-scar associated VT. Controlling for LVEF and multicollinearity in multivariate analyses, V1 R ≥ 0.15 mV (P = 0.001) and V6 S ≥ 0.15 mV (P < 0.001), or V6 S:R ≥ 0.2 mV (P < 0.001), best predicted presence of basal-lateral scar. In Phase II, the former criteria best identified those with NICM and VT because of basal-lateral scar, with sensitivity and specificity 0.86 and 0.88, respectively.
Among patients with NICM, VT, and normal QRS duration, V1 R ≥ 0.15 mV and V6 S ≥ 0.15 mV predicted presence of basal-lateral LV areas of bipolar low voltage. This ECG information may have important value in defining presence of LV scar and possible risk for VT in NICM patients.
患有非缺血性心肌病（NICM）和室性心动过速（VT）的患者通常在左心室（LV）的基底外侧有瘢痕。我们试图确定心电图（ECG）特征，以帮助识别具有基底外侧瘢痕和 VT 的 NICM 患者。
第一阶段，研究患者（n = 25）患有 NICM、VT 和心内膜/心外膜基底外侧 LV 低电压，与详细映射上的瘢痕一致。将心电图与对照组（n = 18）进行比较，对照组患者患有 NICM，年龄和性别相似，无 VT/已知瘢痕。所有患者均有心房窦性或起搏节律心电图，无束支传导阻滞或心室起搏。在第二阶段，使用来自 15 名 NICM 患者的心电图，根据临床数据进行前瞻性评估，评估标准为盲法，其中 7 名患者在详细映射上心内膜/心外膜基底外侧 LV 有 VT 和瘢痕。在研究的心电图特征中，V1 R 和 R：S 比值，以及 V6 S 和 S：R 比值与基底外侧瘢痕相关的 VT 呈单变量相关。在多变量分析中控制 LVEF 和多重共线性，V1 R ≥0.15 mV（P = 0.001）和 V6 S ≥0.15 mV（P <0.001），或 V6 S：R ≥0.2 mV（P <0.001），最佳预测基底外侧瘢痕的存在。在第二阶段，前者的标准可以最好地识别出由于基底外侧瘢痕而患有 NICM 和 VT 的患者，其敏感性和特异性分别为 0.86 和 0.88。
在患有 NICM、VT 和正常 QRS 持续时间的患者中，V1 R ≥0.15 mV 和 V6 S ≥0.15 mV 预测了左心室基底外侧区域存在双极低电压。该心电图信息可能对定义 NICM 患者 LV 瘢痕的存在和可能的 VT 风险具有重要价值。
