Stöllberger Claudia, Gerger Daniel, Jirak Peter, Wegner Christian, Finsterer Josef
Hospital Rudolf Foundation, Vienna.
Ann Noninvasive Electrocardiol. 2014 Nov;19(6):567-73. doi: 10.1111/anec.12167. Epub 2014 Jun 16.
Left ventricular hypertrabeculation/noncompaction (LVHT) is frequently associated with neuromuscular disorders (NMDs) and electrocardiographic (ECG) abnormalities. The prognostic relevance of newly developed ECG abnormalities in LVHT and its dependency on NMD is largely unknown. Aim of the following retrospective cohort study in LVHT patients was thus to assess the development of new ECG abnormalities and its dependency on NMD and survival.
Included were patients in whom (a) LVHT was diagnosed between 1995 and 2011, (b) baseline ECG recordings (bECG), and (c) follow-up ECG recordings (fECG) were available. Survival status was assessed in June 2013.
Included were 105 patients (mean age 55 years, 36 females, 67 with NMD). The interval between bECG and fECG was 3.6 years. ECG abnormalities increased in 46%, were unchanged in 44% and decreased in 11%. Increase was associated with age (59 years vs 49 years, P = 0.0169), exertional dyspnea (79% vs 53%, P = 0.013), heart failure (81% vs 47%, P = 0.0149), a left ventricular end-diastolic diameter >57 mm (76% vs 43%, P = 0.004) and a left ventricular fractional shortening <25% (68% vs 42%, P = 0.0429). New ECG abnormalities were ST-T wave abnormalities (n = 35), left anterior hemiblock (n = 6) and Q waves (n = 6). During 71 months, 40 patients died. Multivariate analysis identified age, male gender, "constant" (in bECG as well as fECG) atrial fibrillation, disappearance of atrial fibrillation, development as well as disappearance of low voltage ECG, increase of QRS width, constant QRS width >120 ms and constant tall QRS complexes as predictors for mortality.
LVHT-patients develop frequently new ECG abnormalities of prognostic relevance.
左心室致密化不全（LVHT）常与神经肌肉疾病（NMDs）及心电图（ECG）异常相关。LVHT中新出现的ECG异常的预后相关性及其对NMD的依赖性在很大程度上尚不清楚。因此，以下针对LVHT患者的回顾性队列研究的目的是评估新ECG异常的发生情况及其对NMD和生存的依赖性。
纳入的患者需满足以下条件：（a）1995年至2011年间诊断为LVHT；（b）有基线心电图记录（bECG）；（c）有随访心电图记录（fECG）。于2013年6月评估生存状态。
共纳入105例患者（平均年龄55岁，36例女性，67例患有NMD）。bECG与fECG之间的间隔为3.6年。ECG异常增加的患者占46%，无变化的占44%，减少的占11%。异常增加与年龄（59岁对49岁，P = 0.0169）、劳力性呼吸困难（79%对53%，P = 0.013）、心力衰竭（81%对47%，P = 0.0149）、左心室舒张末期直径>57 mm（76%对43%，P = 0.004）以及左心室射血分数<25%（68%对42%，P = 0.0429）相关。新出现的ECG异常包括ST-T波异常（n = 35）、左前分支阻滞（n = 6）和Q波（n = 6）。在71个月期间，40例患者死亡。多因素分析确定年龄、男性、（bECG及fECG中）“持续性”心房颤动、心房颤动消失、低电压ECG的出现及消失、QRS波宽度增加、持续性QRS波宽度>120 ms以及持续性高电压QRS波群为死亡的预测因素。
LVHT患者常出现具有预后意义的新ECG异常。
