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确定和解释QT间隔
Arja Suzanne Vink1,2, Benjamin Neumann3, Krystien V V Lieve1
1Heart Center, Department of Clinical and Experimental Cardiology (A.S.V., K.V.V.L., N.H., S.e.K., M.H.A.S., H.M.J.S., A.A.M.W., P.G.P.), Amsterdam UMC, University of Amsterdam, The Netherlands.
在长QT综合征 (LQTS) 中测量QT间隔的触点和值方法具有很高的有效性,但产生不同的诊断结果. 调整的截止值对于准确的LQTS诊断和患者管理至关重要.
科学领域:
- 心脏病学
- 遗传学
- 医疗诊断
背景情况:
- 长QT综合征 (LQTS) 是一种与危及生命的心律失常相关的遗传性疾病.
- 由于QT间隔评估的方法不同,准确诊断LQTS可能具有挑战性.
- 对于 QT 间隔测量方法,特别是触点和值,其在 LQTS 中的诊断性能尚未进行直接比较.
研究的目的:
- 在LQTS诊断中比较QT间隔分析的触点和值方法.
- 使用这两种方法评估QT间隔测量之间的相似之处和差异.
- 提供数据以帮助对LQTS进行准确的QT评估.
主要方法:
- 包括来自265个家族的1484个LQTS相关基因 (LQT1,LQT2,LQT3) 确定的致病变体和基因型阴性家族成员作为对照.
- 分析心电图 (ECG) 使用触点和值方法来确定读者之间的有效性和诊断的准确性.
- 根据人群百分位数确定切断值,并根据心率,年龄和性别进行校正.
主要成果:
- 触点方法的QT间隔平均比值方法短10.4毫秒 (95%的一致度为±20.5毫秒).
- 这两种方法都显示出高的读者间和读者内有效性 (ICC>0. 96) 和诊断准确性 (AUC>0. 84).
- 目前的指导切线 (QTc间隔480毫秒) 导致两种方法的特异性相似,但灵敏度不同,触线方法的切线较低.
结论:
- QT间隔测量方法显著影响结果,尽管触点和值方法都适用于LQTS诊断.
- 由于灵敏度和特异性的变化,目前的指导标准可能导致误诊.
- 建议根据测量方法,校正公式,年龄和性别进行调整,以准确诊断LQTS. 在线计算器可提供帮助.
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