Galinier M, Vialette J C, Fourcade J, Cabrol P, Dongay B, Massabuau P, Boveda S, Doazan J P, Fauvel J M, Bounhoure J P
Cardiology Department, Rangueil University Hospital, Toulouse, France.
Eur Heart J. 1998 Jul;19(7):1054-62. doi: 10.1053/euhj.1997.0865.
Identification of patients with congestive heart failure at risk of sudden death remains problematic and few data are available on the prognostic implications of QT dispersion. We sought to assess the predictive value of QT dispersion for arrhythmic events in heart failure secondary to dilated cardiomyopathy or ischaemic heart disease.
Twelve-lead ECGs calculated for QT dispersion, 24 h Holter ECGs and signal-averaged ECGs were prospectively recorded in 205 heart failure patients in sinus rhythm. The 86 patients with ischaemic heart disease and the 119 with dilated cardiomyopathy were not significantly different as regards NYHA grades (51 vs 49% in grades III-i.v.), cardiothoracic ratio (57 +/- 7 vs 57 +/- 6%) and ejection fraction (28 +/- 8 vs 29 +/- 9%). The mean QT dispersion (66 +/- 29 vs 65 +/- 27 ms), the frequency of non-sustained ventricular tachycardia (37 vs 38%) and ventricular late potentials (41 vs 40%) were not significantly different in patients with ischaemic or dilated cardiomyopathy. QT dispersion was significantly related to other arrhythmogenic markers. During follow-up (24 +/- 16 months), 66 patients died, 22 of them died suddenly and seven presented a spontaneous sustained ventricular tachycardia. In patients with dilated cardiomyopathy, in multivariate analysis, only a QT dispersion > 80 ms was an independent predictor of sudden death (RR: 4.9, 95% CI 1.4-16.8, P < 0.02) and arrhythmic events (RR: 4.5, 95% CI 1.5-13.5, P < 0.01). In patients with ischaemic heart disease, no studied parameter was found significantly related to sudden death or arrhythmic events.
In congestive heart failure, abnormal QT dispersion can identify patients with dilated cardiomyopathy who are at high risk of arrhythmic events.
识别有猝死风险的充血性心力衰竭患者仍然存在问题，关于QT离散度的预后意义的数据很少。我们试图评估QT离散度对扩张型心肌病或缺血性心脏病继发心力衰竭时心律失常事件的预测价值。
前瞻性记录了205例窦性心律的心力衰竭患者的12导联心电图计算QT离散度、24小时动态心电图和信号平均心电图。86例缺血性心脏病患者和119例扩张型心肌病患者在纽约心脏协会分级（III-IV级中分别为51%对49%）、心胸比（57±7对57±6%）和射血分数（28±8对29±9%）方面无显著差异。缺血性或扩张型心肌病患者的平均QT离散度（66±29对65±27毫秒）、非持续性室性心动过速频率（37%对38%）和心室晚电位（41%对40%）无显著差异。QT离散度与其他致心律失常标志物显著相关。随访期间（24±16个月），66例患者死亡，其中22例猝死，7例出现自发性持续性室性心动过速。在扩张型心肌病患者中，多因素分析显示，只有QT离散度>80毫秒是猝死（相对危险度：4.9，95%可信区间1.4-16.8，P<0.02）和心律失常事件（相对危险度：4.5，95%可信区间1.5-13.5，P<0.01）的独立预测因素。在缺血性心脏病患者中，未发现所研究的参数与猝死或心律失常事件有显著相关性。
在充血性心力衰竭中，异常的QT离散度可识别出有高心律失常事件风险的扩张型心肌病患者。
