文章摘要
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,2020,(4):557~562
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
Correlation between q wave in avL and organic heart disease in patients with complete left bundle branch block
投稿时间:2019-07-06  
DOI:10.7655/NYDXBNS20200417
中文关键词: 完全性左束支传导阻滞  q波  avL导联  器质性心脏病
英文关键词: CLBBB  q waves  lead avL  organic heart disease
基金项目:国家重点研发计划(2017YFC1307803)
作者单位
张诗梦 南京医科大学第一附属医院心内科江苏 南京 210029 
张恒莉 南京医科大学第一附属医院心内科江苏 南京 210029 
崔 畅 南京医科大学第一附属医院心内科江苏 南京 210029 
顾 凯 南京医科大学第一附属医院心内科江苏 南京 210029 
陈明龙 南京医科大学第一附属医院心内科江苏 南京 210029 
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中文摘要:
      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。
英文摘要:
      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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