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目的总结左室心肌致密化不全(LVNC)患者的心律失常特点,并对 LVNC 预后的影响因素进行分析。方法连续入选自2006 年 1 月至 2010 年 8 月经超声心动图和 / 或心脏磁共振成像确诊为 LVNC 的患者共 112 例,总结其心律失常特点,并对 LVNC 患者的预后进行分析。结果在 112 例 LVNC 患者中,97.32%的患者存在不同程度的心电图异常,95 例(84.82%)存在 ST-T 改变,40 例(35.71%)伴有异常 Q 波,18 例(16.07%)合并左室高电压;窦缓 / 窦停 11 例(9.82%);一度房室阻滞 23 例(20.54%);二度房室阻滞 4 例(3.57%);三度房室阻滞 9 例(8.04%);5 例(4.46%)合并预激综合征;25 例(22.32%)伴有房颤 / 房扑;非持续性室性心动过速 35 例(31.25%);持续性室性心动过速 10 例(8.93%);室颤 6 例(5.36%,其中有 3 例为持续室速合并室颤)。对 112 例 LVNC 患者的 Cox 比例风险回归模型多因素分析表明,BMI、心衰分期和 LogCr 是预后的独立影响因素,风险比分别为 0.853(95% CI:0.743-0.979,P=0.023)、3.833(95% CI :1.297-11.330,P=0.015)和 14.107(95% CI :1.551-128.323,P=0.019)。结论心律失常是 LVNC 主要的临床表现之一,其类型较多但并无特异性,对预后没有显著影响 ;BMI、心衰分期和血清肌酐水平是 LVNC 预后的独立影响因素。
Objective To summarize the characteristics of arrhythmia in patients with LVNC and to analyze the influencing factors of prognosis in patients with LVNC. Methods A total of 112 consecutive patients with LVNC diagnosed by echocardiography and / or cardiac magnetic resonance imaging from January 2006 to August 2010 were retrospectively reviewed. The characteristics of arrhythmia were summarized and the prognosis of patients with LVNC was analyzed. Results Of the 112 LVNC patients, 97.32% had abnormal electrocardiogram (ECG), 95% (84.82%) had ST-T change, 40 (35.71%) had abnormal Q wave and 18 (16.07% Left ventricular high voltage; sinus bradycardia / sinus arrest in 11 cases (9.82%); once atrioventricular block in 23 cases (20.54%); second degree AV block in 4 cases (3.57%); third degree AV block in 9 cases (8.04%); 5 cases (4.46%) with WPW syndrome; 25 cases (22.32%) with atrial fibrillation / atrial flutter; 35 cases (31.25%) of non-sustained ventricular tachycardia; Tachycardia in 10 cases (8.93%); ventricular fibrillation in 6 cases (5.36%, of which 3 cases of sustained ventricular fibrillation with ventricular fibrillation). Multivariate analysis of the Cox proportional hazards regression model in 112 patients with LVNC showed that BMI, heart failure stage and LogCr were independent prognostic factors with hazard ratios of 0.853 (95% CI: 0.743-0.979, P = 0.023), 3.833 (95% CI: 1.297-11.330, P = 0.015) and 14.107 (95% CI: 1.551-128.323, P = 0.019). Conclusions Arrhythmia is one of the major clinical manifestations of LVNC. The types of LVNC are many but not specific, and have no significant effect on prognosis. BMI, heart failure stage and serum creatinine level are independent prognostic factors of LVNC.