通过信号平均心电图预测长期β受体阻滞剂治疗扩张型心肌病的疗效。

Prediction of the effectiveness of long-term beta blocker treatment for dilated cardiomyopathy by signal averaged electrocardiography.

作者信息

Yamada T, Fukunami M, Shimonagata T, Kumagai K, Kim J, Sanada S, Ogita H, Hori M, Hoki N

机构信息

Division of Cardiology, Osaka Prefectural Hospital, Japan.

出版信息

Heart. 1998 Mar;79(3):256-61. doi: 10.1136/hrt.79.3.256.

DOI:10.1136/hrt.79.3.256

PMID:9602659

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC1728625/

Abstract

OBJECTIVE

To determine whether the effectiveness of long-term beta blocker treatment for idiopathic dilated cardiomyopathy can be predicted by signal averaged electrocardiography (ECG).

PATIENTS

31 patients with dilated cardiomyopathy and without bundle branch block were included in a retrospective study and 16 in a prospective study.

METHODS

A signal averaged ECG was recorded before beta blocker treatment, and three variables were measured from the vector magnitude: QRS duration, root mean square voltage for the last 40 ms (RMS40), and duration of the terminal low amplitude signals (< 40 microV) (LAS40). In the retrospective study, these variables were compared among good responders (showing > or = 0.10 increase in ejection fraction 12 months after start of beta blocker treatment) and poor responders without such improvement. The validity of the signal averaged ECG criteria for prediction of the response to beta blocker treatment was examined in the prospective study.

RESULTS

In the retrospective study, good responders (n = 16) had a shorter QRS duration (mean (SD): 122.9 (11) v 138 (14.4) ms, p < 0.005) and LAS40 (33.1 (8.9) v 42.5 (7.8) ms, p < 0.005), and a higher RMS40 (31.6 (16.3) v 19.0 (10.3) microV, p < 0.02) than poor responders (n = 15). Signal averaged ECG criteria for good response were defined as two or more of the following: QRS duration < 130 ms, RMS40 > 20 microV, LAS40 < 40 ms (sensitivity 81%, specificity 73%). In the prospective study, six of seven patients who met these criteria showed a good response to the beta blocker treatment, while eight of nine who did not showed a poor response (chi 2 = 6.1, p < 0.02). The signal averaged ECG criteria gave a sensitivity of 86% and a specificity of 89% for predicting the effectiveness of beta blocker treatment.

CONCLUSIONS

A signal averaged ECG might be useful in predicting the effectiveness of beta blocker treatment for dilated cardiomyopathy.

摘要

目的

确定信号平均心电图（ECG）能否预测特发性扩张型心肌病长期β受体阻滞剂治疗的疗效。

患者

31例扩张型心肌病且无束支传导阻滞的患者纳入回顾性研究，16例纳入前瞻性研究。

方法

在β受体阻滞剂治疗前记录信号平均心电图，从向量幅度测量三个变量：QRS时限、最后40毫秒的均方根电压（RMS40）以及终末低振幅信号（<40微伏）的时限（LAS40）。在回顾性研究中，比较疗效良好者（β受体阻滞剂治疗开始后12个月射血分数增加≥0.10）和无此改善的疗效不佳者的这些变量。在前瞻性研究中检验信号平均心电图标准预测β受体阻滞剂治疗反应的有效性。

结果

在回顾性研究中，疗效良好者（n = 16）的QRS时限（均值（标准差）：122.9（11）对138（14.4）毫秒，p<0.005）和LAS40（33.1（8.9）对42.5（7.8）毫秒，p<0.005）较短，RMS40较高（31.6（16.3）对19.0（10.3）微伏，p<0.02），而疗效不佳者（n = 15）则相反。疗效良好的信号平均心电图标准定义为以下两项或更多：QRS时限<130毫秒、RMS40>20微伏、LAS40<40毫秒（敏感性81%，特异性73%）。在前瞻性研究中，符合这些标准的7例患者中有6例对β受体阻滞剂治疗反应良好，而不符合的9例患者中有8例反应不佳（χ2 = 6.1，p<0.02）。信号平均心电图标准预测β受体阻滞剂治疗有效性的敏感性为86%，特异性为89%。