Early repolarization is associated with symptoms in patients with type 1 and type 2 long QT syndrome
Early repolarization is associated with symptoms in patients with type 1 and type 2 long QT syndrome
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DOI：
10.1016/j.hrthm.2014.05.027
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发表时间：
2014-09-01
期刊：
影响因子：
5.5
通讯作者：
Krahn, Andrew D.
中科院分区：
文献类型：
--
作者：
Laksman, Zachary W. M.;Gula, Lorne J.;Krahn, Andrew D.
背景：早期复极（ER）与心源性死亡风险增加相关。最近的证据支持ER在许多心脏疾病中作为一种修饰因子和/或风险预测因子的作用。目的本研究的目的是确定ER在基因型阳性的长QT综合征（LOTS）患者中的患病率，并评估其在预测症状风险中的实用性。方法ER定义为与≥ 1-mV QRS-ST交界处（3点）相关的QRS模糊和/或切迹。至少2个相邻导联升高，不包括心前区导联。使用具有最显著ER的ECG进行分析。严重ER定义为3点抬高≥ 2 mm。LOTS的症状包括心源性晕厥，记录多态性室性心动过速（VT），复苏的心脏arrest.RESULTS一百一十三例（平均年龄41 +/- 19岁，63名女性）进行了审查，其中414（平均3.7 +/- 1.5）心电图进行了分析。其中，30例患者（27%）有症状史。50例患者（44%）有ER，19例患者（17%）有重大ER。在年龄、性别、长QT类型、记录到的最长QTc、QTc >500 ms的患者数量或β-受体阻滞剂的使用方面，有主要ER的患者与无主要ER的患者没有差异。结论ER > 2 mm是LOTS相关症状的最强独立预测因子，沿着女性和QTc >500 ms。
BACKGROUND Early repolarization (ER) is associated with an increased risk for death from cardiac causes. Recent evidence supports ER's role as a modifier and/or predictor of risk in many cardiac conditions.OBJECTIVE The purpose of this study was to determine the prevalence of ER among genotype-positive patients with long QT syndrome (LOTS) and evaluate its utility in predicting the risk of symptoms.METHODS ER was defined as QRS slurring and/or notching associated with >= 1-mV QRS-ST junction (3-point) elevation in at least 2 contiguous leads, excluding the anterior precordial leads. The ECG with the most prominent ER was used for analysis. Major ER was defined as >= 2-mm 3-point elevation. Symptoms of LOTS included cardiac syncope, documented polymorphic ventricular tachycardia (VT), and resuscitated cardiac arrest.RESULTS One hundred thirteen patients (mean age 41 +/- 19 years; 63 female) were reviewed, among whom 414 (mean 3.7 +/- 1.5) ECGs were analyzed. Of these, 30 patients (27%) with a history of symptoms. Fifty patients (44%) had ER, and 19 patients (17%) had major ER. Patients with major ER were not different from patients without major ER with respect to age, sex, long QT type, longest QTc recorded, number of patients with QTc >500 ms, or use of betablockade. Univariate and independent predictors of symptom status included the presence of major ER, longest QTc recorded >500 ms, and female sex.CONCLUSION ER > 2 mm was the strongest independent predictor of symptom status related to LOTS, along with female sex and QTc >500 ms.