非冠状動脈性心疾患における突然死は,ペースの遅れた心室活性化と関連しています
Richard C Saumarez1, Lidia Chojnowska, Richard Derksen
1Department of Cardiology, Papworth Hospital, University of Cambridge, Cambridge CB3 8RE, UK. rcs23@eng.cam.ac.uk
Circulation
|May 14, 2003
まとめ
遅れた心筋活性化は,冠動脈疾患以外の患者の心房細動 (VF) リスクの重要な指標です. エレクトログラムの持続時間の変化を評価することで,VFの発生を予測するのに役立ちます.
科学分野:
- 心臓病学 心臓病学
- 電気生理学 電気生理学
- 医療診断 医療診断
背景:
- 静脈動 (VF) のリスクは,心筋の活性化が遅いこと,折射性の分散と関連しています.
- 室電図の持続時間 (DeltaED) とS1S2の遅延の増加は,VFのリスクのある高縮性心筋症 (HCM) 患者およびイディオパシー性VF (IVF) 患者で観察されています.
研究 の 目的:
- 非冠状動脈性心疾患の患者における遅れた心筋活性化とVF歴との関係を調査する.
- VFリスクの予測因子として,電図の持続時間の変化の可能性を評価する.
主な方法:
- 266人の非冠動脈性心疾患の患者で,DeltaEDとS1S2遅延を測定するために,ペース電図分量分析を使用した.
- 患者は,HCM,IVF,LQTS,DCMのサブグループを含む,VF歴のある患者 (n=61) とVFのない患者 (非VFグループ,n=205) とに分けられた. 心臓病のない対照群 (n=12) も含まれていた.
主要な成果:
- 過去にVFを患っていた患者は,HCM,DCM,LQTS (P<0.001) を含む様々な疾患において,VFでない患者と比較して,著しく長いDeltaEDとS1S2遅延を示した.
- HCMVFの患者は19+/-3.3 msのDeltaEDと350+/-9.7 msのS1S2遅延を示し,VFでないHCMの患者とは対照的に (DeltaED7.3+/-1.35 ms;S1S2遅延312+/-6.7 ms).
- IVFの患者は異質な心筋領域を示し,重度の異常と正常な領域の両方を示した.
結論:
- 心筋活性化の遅延または遅延は,VFの既往歴のある非冠動脈性心疾患患者の一般的な特徴です.
- 遅延性心筋活性化の評価は,これらの患者集団におけるVFリスクの将来の予測のための方法を提供することができます.
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