Ding Xiaoxue, Zhang Saidan, Pei Zhifang
Department of Cardiology, Xiangya Hospital, Central South University, Changsha, China.
Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2013 Apr;38(4):395-9. doi: 10.3969/j.issn.1672-7347.2013.04.010.
To explore the alteration and the clinical significance of QT dispersion in acute pulmonary embolism (PE).
From May 2011 to April 2012, 42 hospitalized PE patients in Xiangya Hospital of Central South University were enrolled, and divided into a high-risk group and a non-high-risk group according to the clinic state on admission. Another 30 healthy subjects with matched age and genders were enrolled as a normal control group. QT interval was measured manually in 12- lead conventional electrocardiogram within 24 hours on admission and after the treatment. QT dispersion (QTd) and heart rate-corrected QT dispersion (QTcd) were also calculated. All patients were followed up during hospitalization, and were divided to a death group and a survival group.
QTd and QTcd in the high-risk group [(70.2±34.0), (88.1±43.3) ms] and the non-high-risk group [(49.3±21.8), (59.1±26.2) ms] were significantly higher than those in the normal control group[(33.2±12.4), (36.7±14.2) ms] (P<0.05), while QTd and QTcd in the high-risk group were significantly higher than those in the non-high-risk group (P<0.05). The interval of electrocardiogram was (5.6±2.5) days between 24 hours on admission and after the treatment (ECG). QTd and QTcd were reduced significantly after the treatment in the survival group [(41.0±16.4), (47.4±18.0)ms] compared with those on admission [(54.0±33.0), (67.2±40.5)ms] (P<0.05), but the QTd and QTcd after the treatment were also significantly higher than those in the normal control group (P<0.05). There was no significant difference in the QTd and QTcd between 24 hours on admission and after the treatment in the death group (P>0.05). Logistic regression showed that high-risk of PE, right ventricular dysfunction and high QTcd after the treatment were the main risk factors of hospital death.
QTd and QTcd are increased in PE. PE patients with right ventricular dysfunction, high-risk of PE, and high QTcd after the treatment suggest weak prognosis.
探讨急性肺栓塞（PE）患者QT离散度的变化及其临床意义。
选取2011年5月至2012年4月在中南大学湘雅医院住院的42例PE患者，根据入院时的临床状态分为高危组和非高危组。另选取30例年龄、性别匹配的健康受试者作为正常对照组。入院后24小时内及治疗后，在12导联常规心电图上手动测量QT间期，并计算QT离散度（QTd）和心率校正QT离散度（QTcd）。所有患者在住院期间进行随访，分为死亡组和存活组。
高危组[(70.2±34.0)，(88.1±43.3)ms]和非高危组[(49.3±21.8)，(59.1±26.2)ms]的QTd和QTcd显著高于正常对照组(33.2±12.4)，(36.7±14.2)ms，且高危组的QTd和QTcd显著高于非高危组(P<0.05)。入院后24小时至治疗后心电图检查的间隔时间为(5.6±2.5)天。存活组治疗后的QTd[(41.0±16.4)ms]和QTcd[(47.4±18.0)ms]较入院时[(54.0±33.0)ms，(67.2±40.5)ms]显著降低(P<0.05)，但治疗后的QTd和QTcd仍显著高于正常对照组(P<0.05)。死亡组入院后24小时与治疗后的QTd和QTcd差异无统计学意义(P>0.05)。Logistic回归分析显示，PE高危、右心室功能不全及治疗后QTcd升高是住院死亡的主要危险因素。
PE患者的QTd和QTcd升高。合并右心室功能不全、PE高危及治疗后QTcd升高的PE患者预后较差。
