Wang Xianpei, Zhang Lu, Gao Chuanyu, Wu Sha, Zhu Jialu
Department of Cardiology, People's Hospital of Zhengzhou University (Henan provincial people's hospital), Fuwai Central China Cardiovascular Hospital, Zhengzhou, Henan Province, China.
Department of Cardiology, People's Hospital of Zhengzhou University (Henan provincial people's hospital), Fuwai Central China Cardiovascular Hospital, Zhengzhou, Henan Province, China.
J Electrocardiol. 2019 Mar-Apr;53:52-56. doi: 10.1016/j.jelectrocard.2019.01.001. Epub 2019 Jan 3.
ST-segment elevation (STE) and an increased Tpeak-Tend interval (Tp-e) have prognostic value for malignant arrhythmia events (MAEs) in patients with ST-segment elevation myocardial infarction (STEMI) and Brugada syndrome. Whether STE could predict MAEs and has an electrophysiological relationship with Tp-e in electrocardiogram (ECG) of vasospastic angina (VA) patients needs to be elucidated.
Sixty-five patients with VA and 23 patients with VA complicated by MAEs were enrolled. The relationship of ECG parameters and MAEs (defined as ventricular tachycardia/ventricular fibrillation (VT/VF), syncope, and aborted sudden death) was analyzed by t-test, regression and receiver operating characteristic (ROC) curve analyses.
Patients with MAEs showed greater STE (P<0.001) and corrected QT dispersion (cQTd) (P=0.021), a longer corrected Tp-e interval (cTp-e) (P<0.001), and a larger Tp-e/QT ratio (P<0.001) than those in non-MAE groups. Univariate analysis revealed that cQTd (odds ratio (OR)=1.065; P=0.020), cTp-e (OR=1.159; P=0.001), Tp-e/QT (OR=1.344, P=0.002), and STE (OR=5.655, P<0.001) were significantly associated with MAEs. In the multivariate analysis, Tp-e/QT and STE remained predictors of MAEs. ROC curve analysis showed that the areas under curve (AUCs) for Tp-e/QT (AUC=0.944) and STE (AUC=0.974) were not significantly different (P>0.05), but both were significantly different than AUCs for cQTd (AUC=0.724) and cTp-e (AUC=0.841) (all P<0.05). STE was well fitted with the Tp-e/QT ratio in a multivariable linear regression model.
STE and increased Tp-e/QT ratio had related electrophysiological properties and were independent prognostic indicators of MAEs in patients with VA.
ST段抬高（STE）及T峰-T末间期（Tp-e）延长对ST段抬高型心肌梗死（STEMI）及Brugada综合征患者的恶性心律失常事件（MAE）具有预后价值。血管痉挛性心绞痛（VA）患者心电图（ECG）中STE能否预测MAE以及与Tp-e是否存在电生理关系尚待阐明。
纳入65例VA患者及23例并发MAE的VA患者。通过t检验、回归分析及受试者工作特征（ROC）曲线分析，分析ECG参数与MAE（定义为室性心动过速/心室颤动（VT/VF）、晕厥及心脏骤停）之间的关系。
与非MAE组相比，MAE患者STE（P<0.001）、校正QT离散度（cQTd）（P=0.021）更大，校正Tp-e间期（cTp-e）更长（P<0.001），Tp-e/QT比值更大（P<0.001）。单因素分析显示，cQTd（比值比（OR）=1.065；P=0.020）、cTp-e（OR=1.159；P=0.001）、Tp-e/QT（OR=1.344，P=0.002）及STE（OR=5.655，P<0.001）与MAE显著相关。多因素分析中，Tp-e/QT及STE仍是MAE的预测指标。ROC曲线分析显示，Tp-e/QT（曲线下面积（AUC）=0.944）及STE（AUC=0.974）的AUC无显著差异（P>0.05），但二者均与cQTd（AUC=0.724）及cTp-e（AUC=0.841）的AUC有显著差异（均P<0.05）。在多变量线性回归模型中，STE与Tp-e/QT比值拟合良好。
STE及Tp-e/QT比值升高具有相关电生理特性，是VA患者MAE的独立预后指标。
