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心电图T波振幅与儿童扩张性心肌病左室射血分数的关系
谭成, 易秀英, 陈颖, 王双双, 纪青, 李芳, 邹润梅, 王玉汶, 王成
中国当代儿科杂志 ›› 2020, Vol. 22 ›› Issue (4) : 374-379.
PDF(1698 KB)
PDF(1698 KB)
心电图T波振幅与儿童扩张性心肌病左室射血分数的关系
Association of T-wave amplitude on electrocardiogram with left ventricular ejection fraction in children with dilated cardiomyopathy
目的 探讨心电图T波振幅与儿童扩张性心肌病左室射血分数（LVEF）的关系。方法 回顾性分析2009年5月至2018年6月诊断为扩张性心肌病的44例儿童的临床资料。根据LVEF分为LVEF ≥ 50%组（n=26）和LVEF<50%组（n=18），且对治疗后25例进行3~42个月（平均14±9个月）的随访。采用广东中山SR-1000A心电综合自动分析仪描记仰卧位12导联体表心电图，程序自动分析结合人工干预测量12导联心电图T波振幅。结果 （1）T波振幅比较：LVEF<50%组较LVEF ≥ 50%组Ⅱ、V4、V5、V6导联T波振幅明显降低（P < 0.05）。LVEF增高组（治疗后较治疗前LVEF增加>5%）治疗后aVR、V5、V6导联T波振幅明显增高（P < 0.05）；LVEF不变组（治疗后较治疗前LVEF增加≤ 5%）治疗后aVR导联T波振幅明显降低（P < 0.05）。（2）受试者工作特征曲线评价：Ⅱ、V4、V5、V6导联T波振幅对扩张性心肌病患儿LVEF<50%具有预测价值（P < 0.05）。当同时出现Ⅱ导联T波振幅≤ 0.20 mV、V4导联T波振幅≤ 0.40 mV、V5导联T波振幅≤ 0.3 mV、V6导联T波振幅≤ 0.30 mV时，预测扩张性心肌病患儿LVEF<50%的灵敏度为88.2%，特异度为76.0%。结论 心电图T波振幅可作为评估儿童扩张性心肌病左室收缩功能的指标。
Objective To study the association of T-wave amplitude on electrocardiogram (ECG) with left ventricular ejection fraction (LVEF) in children with dilated cardiomyopathy. Methods A retrospective analysis was performed for the clinical data of 44 children who were diagnosed with dilated cardiomyopathy from May 2009 to June 2018. According to LVEF, they were divided into two groups: LVEF ≥50% group (n=26) and LVEF <50% group (n=18). After treatment, 25 children were followed up for 3-42 months (mean 14±9 months). The Guangdong Zhongshan SR-1000A ECG Automatic Analyzer was used to obtain the 12-lead body surface ECG results in the supine position. T-wave amplitude on ECG was evaluated by software and manual measurement. Results Compared with the LVEF ≥50% group, the LVEF <50% group had a significant reduction in the T-wave amplitude in leads II, V4, V5 and V6 (P < 0.05). The increased-LVEF group (an increase in LVEF>5% after treatment) had a significant increase in the T-wave amplitude in leads aVR, V5, and V6 after treatment (P < 0.05), while the unchanged-LVEF group (an increase in LVEF ≤ 5% after treatment) had a significant reduction in the T-wave amplitude in lead aVR after treatment (P < 0.05). The receiver operating characteristic curve analysis showed that the T-wave amplitude in leads II, V4, V5 and V6 had a certain value in predicting LVEF <50% in children with dilated cardiomyopathy (P < 0.05). A combination of T-wave amplitude of ≤0.20 mV in lead II, ≤0.40 mV in lead V4, and ≤0.30 mV in leads V5 and V6 had a sensitivity of 88.2% and specificity of 76.0% in the predication of LVEF <50% in children with dilated cardiomyopathy. Conclusions T-wave amplitude on ECG can be used as the indexes for the evaluation of the left ventricular systolic function in children with dilated cardio myopathy.
扩张性心肌病 / 心电图 / T波振幅 / 左室射血分数 / 儿童
Dilated cardiomyopathy / Electrocardiogram / T-wave amplitude / Left ventricular ejection fraction / Child
[1] Lipshultz SE, Sleeper LA, Towbin JA, et al. The incidence of pediatric cardiomyopathy in two regions of the United States[J]. N Engl J Med, 2003, 348(17):1647-1655.
[2] Nugent AW, Daubeney PE, Chondros P, et al. The epidemiology of childhood cardiomyopathy in Australia[J]. N Engl J Med, 2003, 348(17):1639-1646.
[3] Weintraub RG, Semsarian C, Macdonald P. Dilated cardiomyopathy[J]. Lancet, 2017, 390(10092):400-414.
[4] Wittlieb-Weber CA, Lin KY, Zaoutis TE, et al. Pediatric versus adult cardiomyopathy and heart failure-related hospitalizations:a value-based analysis[J]. J Card Fail, 2015, 21(1):76-82.
[5] Daubeney PE, Nugent AW, Chondros P, et al. Clinical features and outcomes of childhood dilated cardiomyopathy:results from a national population-based study[J]. Circulation, 2006, 114(24):2671-2678.
[6] Fadl S, Wåhlander H, Fall K, et al. The highest mortality rates in childhood dilated cardiomyopathy occur during the first year after diagnosis[J]. Acta Paediatr, 2018, 107(4):672-677.
[7] Goldberger JJ. Sudden cardiac death risk stratification in dilated cardiomyopathy:climbing the pyramid of knowledge[J]. Circ Arrhythm Electrophysiol, 2014, 7(6):1006-1008.
[8] Lee TM, Hsu DT, Kantor P, et al. Pediatric Cardiomyopathies[J]. Circ Res, 2017, 121(7):855-873.
[9] Bharucha T, Lee KJ, Daubeney PE, et al. Sudden death in childhood cardiomyopathy:results from a long-term national population-based study[J]. J Am Coll Cardiol, 2015, 65(21):2302-2310.
[10] Alvarez JA, Orav EJ, Wilkinson JD, et al. Competing risks for death and cardiac transplantation in children with dilated cardiomyopathy:results from the pediatric cardiomyopathy registry[J]. Circulation, 2011, 124(7):814-823.
[11] Foerster SR, Canter CE, Cinar A, et al. Ventricular remodeling and survival are more favorable for myocarditis than for idiopathic dilated cardiomyopathy in childhood:an outcomes study from the Pediatric Cardiomyopathy Registry[J]. Circ Heart Fail, 2010, 3(6):689-697.
[12] Kurl S, Mäkikallio TH, Laukkanen JA. T-wave inversion and mortality risk[J]. Ann Med, 2015, 47(1):69-73.
[13] Tikkanen JT, Kenttä T, Porthan K, et al. Electrocardiographic T wave abnormalities and the risk of sudden cardiac death:the Finnish perspective[J]. Ann Noninvasive Electrocardiol, 2015, 20(6):526-533.
[14] Aro AL, Anttonen O, Tikkanen JT, et al. Prevalence and prognostic significance of T-wave inversions in right precordial leads of a 12-lead electrocardiogram in the middle-aged subjects[J]. Circulation, 2012, 125(21):2572-2577.
[15] Laukkanen JA, Di Angelantonio E, Khan H, et al. T-wave inversion, QRS duration, and QRS/T angle as electrocardiographic predictors of the risk for sudden cardiac death[J]. Am J Cardiol, 2014, 113(7):1178-1183.
[16] 王成, 谢振武, 刘利群, 等. 氢氯噻嗪、依那普利、美托洛尔、螺内酯联合治疗扩张型心肌病疗效评估[J]. 实用儿科临床杂志, 2005, 20(10):992-994.
[17] Wang Y, Xu Y, Zou R, et al. Effect of levocarnitine on the therapeutic efficacy of conventional therapy in children with dilated cardiomyopathy:results of a randomized trial in 29 Children[J]. Paediatr Drugs, 2018, 20(3):285-290.
[18] Towbin JA, Lowe AM, Colan SD, et al. Incidence, causes, and outcomes of dilated cardiomyopathy in children[J]. JAMA, 2006, 296(15):1867-1876.
[19] Tanai E, Frantz S. Pathophysiology of heart failure[J]. Compr Physiol, 2015, 6(1):187-214.
[20] Masarone D, Valente F, Rubino M, et al. Pediatric heart failure:a practical guide to diagnosis and management[J]. Pediatr Neonatol, 2017, 58(4):303-312.
[21] Conrath CE, Opthof T. Ventricular repolarization:an overview of (patho)physiology, sympathetic effects and genetic aspects[J]. Prog Biophys Mol Biol, 2006, 92(3):269-307.
[22] Rosen MR. The electrocardiogram 100 years later:electrical insights into molecular messages[J]. Circulation, 2002, 106(17):2173-2179.
[23] Cho JH, Zhang R, Kilfoil PJ, et al. Delayed repolarization underlies ventricular arrhythmias in rats with heart failure and preserved ejection fraction[J]. Circulation, 2017, 136(21):2037-2050.
[24] Hoppe UC, Marbán E, Johns DC. Molecular dissection of cardiac repolarization by in vivo Kv4.3 gene transfer[J]. J Clin Invest, 2000, 105(8):1077-1084.
[25] 吴杰. T波与复极的关系[J]. 临床心电学杂志, 2013, 22(2):83-84.
[26] Pelto H, Owens D, Drezner J. Electrocardiographic findings suggestive of cardiomyopathy:what to look for and what to do next[J]. Curr Sports Med Rep, 2013, 12(2):77-85.
[27] Chen S, Motonaga K S, Hollander S A, et al. Electrocardiographic repolarization abnormalities and increased risk of life-threatening arrhythmias in children with dilated cardiomyopathy[J]. Heart Rhythm, 2016, 13(6):1289-1296.
[28] 王成, 谢振武, 郑慧芬, 等. 小儿扩张型心肌病同步12导联心电图P、QRS、T波综合振幅及ST段变化[J]. 中国急救医学, 2006, 26(4):252-254.
[29] Everitt MD, Sleeper LA, Lu M, et al. Recovery of echocardiographic function in children with idiopathic dilated cardiomyopathy:results from the pediatric cardiomyopathy registry[J]. J Am Coll Cardiol, 2014, 63(14):1405-1413.
