T-WAVE HUMPS AS A POTENTIAL ELECTROCARDIOGRAPHIC MARKER OF THE LONG QT SYNDROME
T-WAVE HUMPS AS A POTENTIAL ELECTROCARDIOGRAPHIC MARKER OF THE LONG QT SYNDROME
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DOI：
10.1016/0735-1097(94)90024-8
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发表时间：
1994-09-01
影响因子：
24
通讯作者：
TAGGART, T
中科院分区：
文献类型：
--
作者：
LEHMANN, MH;SUZUKI, F;TAGGART, T
目标.本研究试图确定长QT综合征家系和对照组中T波"驼峰"（T2，在初始T波峰值之后，T1）的患病率和心电图（ECG）导联分布。除了心率校正QT间期（QTc）延长外，T波异常也被认为是常见的长QT综合征的另一个方面，这可能有助于受影响者的诊断。收集了13个长QT综合征家系254名成员（每个家系有2~4代患病成员）和2,948名健康对照者（年龄≥ 16岁，QTc间期0.39~0.46 s）的心电图并进行分析。在不了解QTc间期或家庭成员状况的情况下阅读来自长QT综合征家庭的描记（210名血亲和44名配偶）。我们发现，T2存在于53%，27%和5%的血亲中，（大于或等于0.47 s），"边界"（0.42至0.46秒）和"正常"（小于或等于0.41 s）QTc间期（p <0.0001），但仅5%和0%的配偶分别具有临界和正常QTc间期（p = 0.06 vs.血亲）。在T2的血亲中，平均[+/-SD]最大T1T2间期为0.10 +/-0.03 s，与QTc间期相关（p <0.01）; 23%的患者出现完全不同的U波。T2仅限于10%的V-2和V-3导联，而90%的T2血亲涉及V-4、V-5、V-6或肢体导联。在具有临界QTc间期的血亲中，50%有主要症状的患者与20%无主要症状的患者在至少一个左胸或肢体导联中表现为T2（p = 0.05）。在19%、6%和0%的血液亲属中分别观察到T2振幅> 1 mm（III级），其QTc间期延长、临界和正常，至少有一个左胸或肢体导联为T2。在2,948名对照受试者中，0.6%的T2局限于V-2和V-3导联，0.9%的T2累及一个或多个左胸导联（但无肢体导联）。在37例QTc间期为0.42~0.46 s的无症状成年血亲中，9例（24%; 5例肢体导联受累）在左胸导联或肢体导联发现T2，而对照组中仅1.9%的QTc间期为临界值（p <0.0001）。这些发现与以下假设一致：在长QT综合征家族中，即使在QTc间期处于临界值的无症状血亲中，涉及左心前区或（特别是）肢体导联的T波驼峰也表明存在长QT综合征特征。
Objectives. This study attempted to determine the prevalence and electrocardiographic (ECG) lead distribution of T wave ''humps'' (T2, after an initial T wave peak, T1) among families with long QT syndrome and control subjects.Background. T wave abnormalities have been suggested as another facet of familiar long QT syndrome, in addition to prolongation of the rate-corrected QT interval (QTc), that might aid in the diagnosis of affected subjects.Methods. The ECGs from 254 members of 13 families with long QT syndrome (each with two to four generations of affected members) and from 2,948 healthy control subjects (age greater than or equal to 16 years, QTc interval 0.39 to 0.46 s) were collected and analyzed. Tracings from families with long QT syndrome were read without knowledge of QTc interval or family member status (210 blood relatives and 44 spouses).Results. We found that T2 was present in 53%, 27% and 5% of blood relatives with a ''prolonged'' (greater than or equal to 0.47 s), ''borderline'' (0.42 to 0.46 s) and ''normal'' (less than or equal to 0.41 s) QTc interval, respectively (p < 0.0001), but in only 5% and 0% of spouses with a borderline and normal QTc interval, respectively (p = 0.06 vs. blood relatives). Among blood relatives with T2, the mean [+/-SD] maximal T1T2 interval was 0.10 +/- 0.03 s and correlated with the QTc interval (p < 0.01); a completely distinct U wave was seen in 23%. T2 was confined to leads V-2 and V-3 in 10%, whereas V-4, V-5, V-6 or a limb lead was involved in 90% of blood relatives with T2. Among blood relatives with a borderline QTc interval, 50% of those with versus 20% of those without major symptoms manifested T2 in at least one left precordial or limb lead (p = 0.05). A T2 amplitude >1 mm (grade III) was observed, respectively, in 19%, 6% and 0% of blood relatives with a prolonged, borderline and normal QTc interval with T2 in at least one left precordial or limb lead. Among the 2,948 control subjects, 0.6% exhibited T2 confined to leads V-2 and V-3, and 0.9% had T2 involving one or more left precordial lend (but none of the limb leads). Among 37 asymptomatic adult blood relatives with QTc intervals 0.42 to 0.46 s, T2 was found in left precordial or limb leads in 9 (24%; 5 with limb lead involvement) versus only 1.9% of control subjects with a borderline QTc interval (p < 0.0001).Conclusions. These findings are consistent with the hypothesis that in families with long QT syndrome, T wave humps involving left precordial or (especially) limb leads, even among asymptomatic blood relatives with a borderline QTc interval, suggest the presence of the long QT syndrome trait.