急性前壁心肌梗死终末QRS复合物畸变与早期低剂量多巴酚丁胺应激超声心动图的关系。

Mehmet Murat Sucu, Abdulaziz Karadede, Ozlem Aydinalp, Onder Ozturk, Nizamettin Toprak
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引用次数: 9

摘要

虽然心肌梗死的损害已被证实与ST段抬高的幅度和次数有关,但其与QRS终端畸变的关系尚不清楚。探讨入院时心电图终末QRS畸变与6 +/- 2 d后早期低剂量多巴酚丁胺应激超声心动图(LDSE)结果的关系。在胸痛前6小时内入院且无梗死诊断的患者根据入院心电图分为两组,分别为QRS-缺失(n = 33)或QRS+存在(n = 29) >或= 2导联QRS末端扭曲(QRS+;J点在侧导联R波振幅的50%以上或导联存在ST段抬高而无S波(V1-V3)。在溶栓治疗或再灌注标准方面,两组间无显著差异。LDSE期间,QRS-组梗死区壁运动评分指数(WMSI)较基线显著降低(由2.93 +/- 0.65降至2.37 +/- 0.84,P = 0.02),与QRS+组相比差异有统计学意义(P = 0.005)。QRS-组梗死区运动区向低运动区改善的比例为33.5% (44/131),QRS+组为17.8% (27/151 P = 0.004)。QRS+组55.1%(10/29)患者无LDSE应答,QRS-组仅18.1%(6/33)患者无应答(P < 0.05)。多元logistic回归分析显示,基础条件下良好的左心功能(WMSI < 2)与终末QRS失真无相关性(P = 0.07), LDSE后两者存在独立相关性(P = 0.03, OR 4.48, 95% CI, 1.13-17.7)。QRS+组血浆CK水平较高(P = 0.03),射血分数较低(P = 0.01)。在两组中,基线时Selvester评分与左心室WMSI无相关性,但LDSE显著改善了这种相关性(QRS-;r = 0.39 P = 0.02, QRS+;r = 0.44 P = 0.01)入院时心电图显示终末QRS失真的患者,其脑内生存能力相对较差。这种简单的分类将有助于预测出院时的左心室功能。
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The relationship between terminal QRS complex distortion and early low dose dobutamine stress echocardiography in acute anterior myocardial infarction.

Although the damage in myocardial infarction has been demonstrated to be related with the magnitude and number of ST elevation, its relation with terminal distortion of QRS is unclear. The relationship between terminal QRS distortion in ECGs on admission and the results of early low dose dobutamine stress echocardiography (LDSE) performed 6 +/- 2 days later was investigated. Patients admitted to our clinic within the first six hours of their chest pain and without a prior infarction diagnosis were divided into two groups based on the admission electrocardiogram as the absence (QRS-, n = 33) or presence (QRS+, n = 29) of distortion of the terminal portion of the QRS in > or = 2 leads (QRS+; J point at > 50% of the R wave amplitude in lateral leads or presence of ST elevation without S wave in leads V1-V3). There were no significant differences between the groups with respect to thrombolytic therapy or reperfusion criteria. During LDSE, the infarct zone wall motion score index (WMSI) in the QRS- group was significantly decreased relative to baseline (from 2.93 +/- 0.65 to 2.37 +/- 0.84, P = 0.02), and it was significantly different compared with WMSI in the QRS+ group (P = 0.005). Improvement of akinetic regions to hypokinetic regions in the infarct zone (IZ) was found to be 33.5% (44/131) in the QRS- group and 17.8% (27/151 P = 0.004) in the QRS+ group. Furthermore, 55.1% (10/29) of the patients in the QRS+ group and only 18.1% (6/33) of those in the QRS- group did not respond to LDSE (P < 0.05). In multiple logistic regression analysis, while there was no relationship between good left ventricular functions (WMSI < 2) and terminal QRS distortion under basal conditions (P = 0.07), an independent relation was observed to exist between them after LDSE (P = 0.03, OR 4.48, 95% CI, 1.13-17.7). Moreover, plasma CK levels were higher in the QRS+ group (P = 0.03), whereas the ejection fraction was worse (P = 0.01). In both groups, there was no correlation between the Selvester score and left ventricle WMSI at baseline, but this correlation was significantly improved with LDSE (QRS-; r = 0.39 P = 0.02 and QRS+; r = 0.44 P = 0.01) The viability in the IZ is relatively less in those patients with terminal QRS distortion observed in their ECG on admission. This simple classification would be useful in predicting left ventricular function at the time of discharge.

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