Morelli S, Sgreccia A, De Marzio P, Perrone C, Ferrante L, Gurgo A M, Gurgo di Castelmenardo A M, Aguglia G, De Vincentiis G, Scopinaro F, Calvieri S
Istituto di Clinica Medica I, Dipartimento di Medicina Sperimentale, La Sapienza University, Roma, Italy.
J Rheumatol. 1997 Dec;24(12):2358-63.
To assess the role of late ventricular potentials (LVP) in detecting early myocardial involvement in patients with systemic sclerosis (SSc).
Seventy-seven patients with SSc (68 women, 9 men, mean age 50 +/- 13 yrs) and 33 control subjects (18 women, 15 men, mean age 46 +/- 10 yrs) underwent resting electrocardiogram (ECG), 24 h Holter monitoring, complete echocardiographic and Doppler echocardiographic examination, and signal averaged ECG at high pass setting of 40 Hz, with the low pass fixed at 250 Hz. Patients with SSc underwent resting myocardial scintigraphy and radionuclide angioventriculography.
The prevalence of LVP at 40 Hz was 20.5%. Compared to control subjects, patients with SSc showed higher prevalence of septal infarction pattern (p = 0.05), complex ventricular arrhythmias (p = 0.03), pulmonary arterial hypertension (p < 0.001), and LVP (p = 0.02). Forty-four patients with SSc (57.1%) had resting perfusion defects by myocardial scintigraphy. Fourteen of 15 patients with LVP showed perfusion defects compared to 29 of 58 without LVP (p = 0.002). Linear regression analysis showed that myocardial perfusion defect score was significantly correlated to either the filtered QRS duration, or the duration of low amplitude signals < 40 microV of the terminal QRS, or the root mean square voltage of the last 40 ms of the QRS complex. After a mean followup period of 20 months, 8 patients died. In 2 patients who died suddenly, LVP were present.
Signal averaged ECG is a sensitive and inexpensive technique in the clinical assessment and followup of patients with SSc.
评估晚期心室电位（LVP）在检测系统性硬化症（SSc）患者早期心肌受累中的作用。
77例SSc患者（68例女性，9例男性，平均年龄50±13岁）和33例对照者（18例女性，15例男性，平均年龄46±10岁）接受静息心电图（ECG）、24小时动态心电图监测、完整的超声心动图和多普勒超声心动图检查，以及高通设置为40Hz、低通固定为250Hz的信号平均心电图检查。SSc患者接受静息心肌闪烁显像和放射性核素心血管造影。
40Hz时LVP的患病率为20.5%。与对照者相比，SSc患者的室间隔梗死模式患病率更高（p = 0.05）、复杂性室性心律失常患病率更高（p = 0.03）、肺动脉高压患病率更高（p < 0.001）以及LVP患病率更高（p = 0.02）。44例SSc患者（57.1%）静息心肌闪烁显像显示灌注缺损。15例有LVP的患者中有14例显示灌注缺损，而58例无LVP的患者中有29例显示灌注缺损（p = 0.002）。线性回归分析显示，心肌灌注缺损评分与滤波后的QRS波时限、终末QRS波低振幅信号<40μV的时限或QRS波群最后持续40ms的均方根电压显著相关。平均随访20个月后，8例患者死亡。2例猝死患者存在LVP。
信号平均心电图是SSc患者临床评估和随访中一种敏感且廉价的技术。
