Kawakami Y, Shimada S, Sakai Y, Suwa M, Nagao H, Hirota Y, Kawamura K, Adachi I, Narabayashi I
Third Division, Department of Internal Medicine, Osaka Medical College, Japan.
J Electrocardiol. 1997 Jan;30(1):21-9. doi: 10.1016/s0022-0736(97)80031-3.
To identify the clinical significance of the isointegral body surface map of the QRST interval (QRST map) and the occurrence of repolarization abnormalities in patients with hypertrophic cardiomyopathy (HCM), the QRST map and signal-averaged electrocardiogram were evaluated in 50 patients with HCM, in 33 of whom the results were compared with nuclear images both for radioiodine-labeled fatty acid metabolism and for radiothallium perfusion. The QRST departure map was used to determine two parameters of difference between patient and control recordings: the subnormal area (the number of lead points at which the departure index values were negative and lay more than 2 SDs from the mean of the normal control group) and the subnormal minimum (the absolute value of the minimum in the departure map). Late potentials were detected in 6 (12%) of the 50 patients; they were observed in 3 of the 5 patients with dilated-phase HCM but in only 3 (7%) of the other 45 patients. The subnormal area and minimum values were lower in nonobstructive HCM than in dilated-phase HCM. Of the 33 patients examined by myocardial imaging, 28 (33%) had a filling defect or decreased uptake, as shown on fatty acid metabolic images, and 10 of the 28 also showed abnormal myocardial perfusion images, while the 18 others showed normal perfusion images. These 28 patients showed significantly larger values of the subnormal area and minimum than patients with normal results in both image tests, regardless of whether or not myocardial perfusion imaging abnormalities were present. The localization of filling defects or of decreased uptake presented in fatty acid metabolic images corresponded to the position of the minimum on the QRST departure map. These results suggest that the QRST map is useful for detection of repolarization abnormalities in HCM and that these abnormalities are highly related to impaired fatty acid utilization of the myocardium.
为了确定肥厚型心肌病（HCM）患者QRST间期等积分体表图（QRST图）的临床意义以及复极异常的发生情况，对50例HCM患者进行了QRST图和信号平均心电图评估，其中33例患者的结果与放射性碘标记脂肪酸代谢和放射性铊灌注的核素图像进行了比较。QRST离散图用于确定患者与对照记录之间差异的两个参数：低常面积（离散指数值为负且偏离正常对照组平均值超过2个标准差的导联点数）和低常最小值（离散图中的最小值绝对值）。50例患者中有6例（12%）检测到晚电位；在5例扩张期HCM患者中有3例观察到晚电位，但在其他45例患者中仅3例（7%）观察到。非梗阻性HCM的低常面积和最小值低于扩张期HCM。在接受心肌成像检查的33例患者中，28例（33%）在脂肪酸代谢图像上显示充盈缺损或摄取减少，28例中的10例还显示心肌灌注图像异常，而其他18例显示灌注图像正常。这28例患者在两项图像检查结果正常的患者中，无论心肌灌注成像是否异常，其低常面积和最小值均显著更大。脂肪酸代谢图像中显示的充盈缺损或摄取减少的定位与QRST离散图上最小值的位置相对应。这些结果表明，QRST图有助于检测HCM中的复极异常，并且这些异常与心肌脂肪酸利用受损高度相关。
