| Background and purpose:Hypertrophic Cardiomyopathy (Hypertrophic Cardiomyopathy, HCM) is a kind ofhereditary disease, malignant arrhythmia happened easily, have higher death rates, aserious threat to human life and health. The sudden death of patients with HCM,Ventricular arrhythmia (Ventricular Arrhythmias, VA) are closely related, therefore,looking for noninvasive and effective index to predict the occurrence of VA, thus carrieson the positive intervention and treatment, may reduce the occurrence of sudden death,improve the quality of life of patients, the clinical significance. Between the end of theT wave period (T peak-end interval, Tpe) refers to T wave peak and T wave inelectrocardiogram (ecg) final between the time of period, is a recently proposedmeasures of ecg. Period between several studies have confirmed that Tpe can act as aventricular across the wall after a discrete degree (Transmural Dispersion OfRepolarization, TDR) quantitative indicators, and enlargement Of TDR can increase therisk Of the occurrence Of the VA. By (1) in HCM patients and normal healthy peoplebetween the Tpe and QT dispersion degree (QTd) dispersion of QT interval, compare;(2) in HCM patients with Hypertrophic Obstructive Cardiomyopathy (Hypertrophic Nonobstructive Cardiomyopathy, HNCM) and patients with Hypertrophic ObstructiveCardiomyopathy (Hypertrophic Obstructive Cardiomyopathy, HOCM) in patients withTpe interphase and QTd comparison;(3) in patients with HCM group of patients withmalignant ventricular arrhythmia events in Tpe interphase and QTd and not group ofpatients with malignant ventricular arrhythmia events were compared, and thendiscusses the Tpe interphase and QTd of HCM patients with malignant ventriculararrhythmia happened predictive value.Methods:Were retrospectively analyzed in our hospital during2010-2012confirmed56cases of HCM patients,23cases of male33female(average age49.63±12.00years old),and at the same time of56normal cases as control group,24cases of male32female(mean age46.76±15.39years old).27patients with HCM patients includingHNCM, male18female9cases,29patients with HOCM, men and15women14cases.No statistical difference between groups between gender and age. To collect all thepatient’s body surface12-lead electrocardiogram, echocardiography and24-hourdynamic electrocardiogram (ecg), according to the results of24hours dynamicelectrocardiogram (ecg) in the presence of malignant ventricular arrhythmia events(ventricular tachycardia and/or ventricular fibrillation) occur divided into malignantventricular arrhythmia events group group (VA) and malignant ventricular arrhythmiahappened group (non VA group).11patients with VA group, male6female in5cases（mean age53.61±7.91years）, patients with non VA group45cases, male25female20cases（mean age48.54±12.72years old）. Gender and age no statistical differencebetween the two groups. All patients were measured surface12-lead electrocardiogramQT interphase and Tpe interphase, calculation of QTd=QTmax-QTmin, Tpe-c=Tpe/√RR， analysis Tpe-IIc, Tpe-V2c, Tpe-V5c, Tpe-avec, Tpe-maxc between HCMpatients and normal healthy people, with HCOM and HNCM patients in patients withHCM group with malignant ventricular arrhythmia events did not happen the differencebetween malignant ventricular arrhythmia group events. Results:1. Patients with hypertrophic cardiomyopathy compared with normal healthypeople:In patients with hypertrophic cardiomyopathy Tpe-Ⅱc (91.09±14.60), Tpe-V2c(97.40±19.68), Tpe-V5c (89.39±12.60), Tpe-avec (92.63±13.82), Tpe-maxc(101.34±17.43), QTd (38.48±14.82) significantly longer than normal healthy peopleTpe-Ⅱc (80.50±9.46), Tpe-V2c (88.60±14.66), Tpe-V5c (80.34±10.87), Tpe-avec(61.76±8.13), Tpe-maxc (90.87±13.19), QTd (16.33±6.76), the P value respectively,0.007,0,0,0,0, differences were statistically significant.2. Hypertrophic obstructive cardiomyopathy patients with hypertrophic obstructivecardiomyopathy patients of comparison:In patients with hypertrophic obstructivecardiomyopathy Tpe-Ⅱc (96.35±11.28), Tpe-avec (96.62±10.20), Tpe-maxc(106.58±15.90), QTd (43.31±16.16) significantly longer than not hypertrophicobstructive cardiomyopathy patients Tpe-Ⅱc (85.43±15.80), Tpe-avec (88.34±15.97),Tpe-maxc (95.71±17.52), QTd (33.30±11.37), the P values were0.004,0.024,0.018,0.024, and the differences were statistically significant. And in patients with HOCMTpe-V2c (102.30±18.36), Tpe-V5c (91.20±91.20) and patients with HNCN Tpe-V2c(92.14±20.01), Tpe-V5c (87.44±15.15) compared with no differences, P value is0.052and0.268, there was no significant difference.3. In patients with hypertrophic cardiomyopathy group with malignant ventriculararrhythmia events did not happen of malignant ventricular arrhythmia groupcomparison:Group of patients with malignant ventricular arrhythmia events Tpe-Ⅱc(106.88±7.54), Tpe-V2c (110.57±15.84), Tpe-avec (104.29±7.96), Tpe-maxc(114.21±13.13), QTd (50.91±16.85) significantly longer than patients who were notmalignant ventricular arrhythmia happened group Tpe-Ⅱc (87.23±13.26), Tpe-V2c(94.18±19.31), Tpe-avec (89.77±13.49), Tpe-maxc (98.20±17.01), QTd (35.44±12.73),the P value respectively0,0.012,0.001,0.005,0.001, with significant difference, andthe comparison of Tpe-V5c (95.43±8.16) VS (87.91±13.11), P=0.076, no significantdifferences. Conclusion：1. HCM patients Tpe interphase significantly longer than normal healthy people,Tpe interphase significantly longer than HNCM HOCM patients. HCM patients due tomyocardial cell abnormal hypertrophy can lead to increase TDR, and Tpe interphase canrepresent the TDR, electrocardiogram (ecg) is in the form of Tpe between lengthened,and HOCM patients with ventricular septal hypertrophy can cause left ventricularoutflow tract obstruction, resulting in further increase TDR, Tpe interphase extendedfurther.2. HCM patients with malignant ventricular arrhythmia happened in group of Tpeinterphase was significantly longer than not malignant ventricular arrhythmia groupevents. Between Tpe period can be used as quantitative indicators of TDR, with theincrease of TDR VA risk also increases, so the Tpe interphase can be used as aprediction of malignant ventricular arrhythmia happened a simple, noninvasive andeffective measure.3. Lead measurement should choose Tpe Ⅱ c, Tpe avec, Tpe-maxc, can betterreflect the overall HCM patients with ventricular bipolar discrete degree.4. QTd HCM patients than normal healthy people significantly extended,expressing the QTd HNCM HOCM patients, malignant ventricular arrhythmiahappened group of QTd also significantly less malignant ventricular arrhythmia eventsteam leader. That HCM patients with ventricular bipolar with instability andasynchronism, prone to malignant ventricular arrhythmia, especially in patients withHOCM. |
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