Bastiaenen Rachel, Pantazis Antonis, Gonna Hanney, Chis-Ster Irina, Castelletti Silvia, Batchvarov Velislav N, Domenichini Giulia, Coccolo Fabio, Boriani Giuseppe, McKenna William J, Behr Elijah R, Gallagher Mark M
St. George's University Hospitals NHS Foundation Trust, London, United Kingdom; Institute of Cardiovascular and Cell Sciences, St. George's University of London, United Kingdom.
The Heart Hospital, University College London Hospitals NHS Trust, London, United Kingdom.
Heart Rhythm. 2016 Jul;13(7):1504-12. doi: 10.1016/j.hrthm.2016.03.039. Epub 2016 Mar 22.
The ventricular ectopic QRS interval (VEQSI) has been shown to identify structural heart disease and predict mortality. In arrhythmogenic right ventricular cardiomyopathy (ARVC), early diagnosis is difficult using current methods, and life-threatening arrhythmias are common and difficult to predict.
The purpose of this study was to assess the utility of ventricular ectopic indices including VEQSI in ARVC diagnosis.
We studied 70 patients with ARVC [30 with definite disease (age 47 ± 12 years; 60% male), 40 with incomplete disease expression (age 44 ± 18 years; 44% male)], 116 healthy controls (age 40 ± 15 years; 56% male), and 26 patients with normal heart right ventricular outflow tract (RVOT) ectopy (age 46 ± 17 years; 27% male). The duration of the broadest ventricular ectopic beat during 12-lead Holter monitoring was recorded as VEQSI max.
VEQSI max was associated with age and gender, but not with conducted QRS duration. Adjusted VEQSI max was greater in ARVC patients than in control groups. In healthy males (44.5 years), estimated VEQSI max was 163 ms (95% confidence interval [CI] 159-167 ms); in definite ARVC 212 ms (95% CI 206-217 ms); in incompletely expressed ARVC 204 ms (95% CI 199-210 ms); and in normal heart RVOT ectopy 171 ms (95% CI 165-178 ms). VEQSI max >180 ms had 98% sensitivity and specificity for diagnosis of ARVC (area under the curve 0.99, 95% CI 0.980-0.998). In our incompletely expressed ARVC patients, VEQSI max >180 ms identified 88% as affected.
VEQSI max distinguishes ARVC patients, including those with incomplete disease expression, from healthy controls and patients with normal heart RVOT ectopy.
室性异位QRS间期（VEQSI）已被证明可用于识别结构性心脏病并预测死亡率。在致心律失常性右室心肌病（ARVC）中，使用当前方法进行早期诊断很困难，且危及生命的心律失常很常见且难以预测。
本研究的目的是评估包括VEQSI在内的室性异位指标在ARVC诊断中的效用。
我们研究了70例ARVC患者[30例确诊患者（年龄47±12岁；60%为男性），40例疾病表现不完全患者（年龄44±18岁；44%为男性）]，116例健康对照者（年龄40±15岁；56%为男性），以及26例右室流出道（RVOT）正常的室性异位患者（年龄46±17岁；27%为男性）。12导联动态心电图监测期间最宽室性异位搏动的时长记录为VEQSI最大值。
VEQSI最大值与年龄和性别相关，但与传导的QRS间期无关。调整后的VEQSI最大值在ARVC患者中高于对照组。在健康男性（44.5岁）中，估计的VEQSI最大值为163毫秒（95%置信区间[CI]159 - 167毫秒）；在确诊的ARVC患者中为212毫秒（95%CI 206 - 217毫秒）；在疾病表现不完全的ARVC患者中为204毫秒（95%CI 199 - 210毫秒）；在右室流出道正常的室性异位患者中为171毫秒（95%CI 165 - 178毫秒）。VEQSI最大值>180毫秒对ARVC诊断的敏感性和特异性均为98%（曲线下面积0.99，95%CI 0.980 - 0.998）。在我们疾病表现不完全的ARVC患者中，VEQSI最大值>180毫秒可识别出88%的患病者。
VEQSI最大值可将ARVC患者（包括疾病表现不完全的患者）与健康对照者及右室流出道正常的室性异位患者区分开来。
