完全性左束支传导阻滞患者avL导联q波与器质性心脏病相关性的探讨
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国家重点研发计划(2017YFC1307803)


Correlation between q wave in avL and organic heart disease in patients with complete left bundle branch block
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    摘要:

    目的:分析完全性左束支传导阻滞(complete left bundle branch block,CLBBB)患者中avL导联q波的发生率、形态特征及其与门控单电子发射型计算机断层心肌灌注显像(single-photon emission computed tomography myocardial perfusion imaging,SPECT-MPI)检查及冠状动脉造影(coronary angiography,CAG)或冠状动脉计算机断层血管造影(coronary computed tomography angiography,CCTA)所诊断的器质性心脏病(organic heart disease,OHD)的相关性。方法:回顾性分析1 882例标准12导联心电图诊断的CLBBB患者并收集其SPECT-MPI、CAG及CCTA的信息。测量心电图中avL导联QRS时限及振幅、q波时限及振幅,分析q波与器质性心脏病的相关性。结果:最终入选了157例患者,证实伴有OHD的患者122例(77.8%),其中avL导联出现q波者56例(45.9%)。avL导联q波出现预测OHD的特异性及阳性预测值分别是97.1%和98.2%。与avL导联q波缺失且伴有OHD的CLBBB患者相比,avL导联出现q波的患者SPECT-MPI所测得的左心室收缩末容积(end systolic volume,ESV)和舒张末容积(end diastolic volume,EDV)显著升高(P均<0.001),而左心室射血分数(left ventricular ejection fraction,LVEF)显著下降(P<0.001)。散点图和线性相关性分析显示CLBBB患者avL导联q波的时限、振幅和面积与SPECT-MPI所测得的左心室ESV、EDV和LVEF无线性相关性。结论:CLBBB患者avL导联出现q波与严重的左心室病变有关,但q波的时限、振幅及面积与左心室病变严重度无线性相关性。

    Abstract:

    Objective:To determine the prevalence of q wave in avL,prescribe its characteristics,and evaluate the correlation between the q wave in avL and organic heart disease(OHD)verified by gated single-photon emission computed tomography myocardial perfusion imaging(SPECT-MPI)and coronary angiography(CAG)or coronary computed tomography angiography(CCTA)in the patients with complete left bundle branch block(CLBBB). Methods:A total of 1 882 CLBBB patients were initially involved in the study,and the results of SPECT-MPI,CAG and CCTA were collected. The prevalence,duration and amplitude of q wave as well as the duration and amplitude of QRS complex in avL were measured,on which the correlation between q wave and OHD were analyzed. Results:In this study,157 patients were involved finally,and 122 of which(77.8%)were confirmed with OHD by SPECT-MPI,CAG and CCTA. Septal q waves were present in 56 of the 122 OHD patients(45.9%)[OHD(+)q(+)group]. Specificity and positive predictive value of q wave in avL for OHD were 97.1% and 98.2% respectively. Comparing with the CLBBB patients in OHD(+)q(-)group,the CLBBB patients in OHD(+)q(+)group have larger end diastolic volume(EDV)(P<0.001)and end systolic volume(ESV)(P<0.001),but lower left ventricular ejection fraction(LVEF)(P<0.001). Scatter chart and correlation analysis showed no significant linear correlations between the duration,amplitude,areas of q wave and the left ventricular ESV,EDV and LVEF verified by SPECT-MPI. Conclusion:Occurrence of q wave in avL in CLBBB patients indicates serious left ventricular disease,but there is no linear correlation between the characteristics of q wave and the severity of left ventricular disease.

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张诗梦,张恒莉,崔 畅,顾 凯,陈明龙.完全性左束支传导阻滞患者avL导联q波与器质性心脏病相关性的探讨[J].南京医科大学学报(自然科学版),2020,(4):557-562

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  • 收稿日期:2019-07-06
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  • 在线发布日期: 2020-05-08
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