P波和QT间期离散度对先天性心脏病伴肺动脉高压患儿心律失常发生的预测价值
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Evaluation of ventricular repolarization parameters during migraine attacks
背景与目的
本研究旨在评估先天性心脏病伴肺动脉高压（PAH-CHD）患儿的P波离散度（PWD）和QT离散度（QTd），并研究PWD和QTd用于预测此类儿童发生心律失常的价值。
方 法
我们将40名患有PAH-CHD的儿童纳入 Ⅰ 组，将另外40名患有CHD但无PAH的儿童纳入 Ⅱ 组。年龄和性别相匹配的四十名健康儿童作为对照组。进行心电图检查以测量PWD和QTd。此外，进行24小时动态心电图监测以检测心律不齐。并进行超声心动图评估。
结 果
I组的QTd和PWD显着高于II组和对照组。QTd和PWD与平均肺动脉压、右心室直径、肺血管阻力（PVR）、PVR与全身血管阻力的比值均呈显着正相关。QTd预测PAH-CHD患儿心律失常发生的临界值为61 ms，灵敏度为93%、特异度为80%、准确率为85%；而PWD预测PAH-CHD患儿心律失常发生的临界值为32.5 ms，灵敏度为87%、特异度为80%、准确率为85%。逻辑回归分析显示，QTd和PWD都是PAH-CHD儿童心律失常发生的良好预测指标（p = 0.003和p = 0.01）。
结 论
PWD和QTd均是PAH-CHD患儿发生各种心律失常的良好预测指标。
原始文献来源及摘要
Saleh A, Shabana A, EI Amrousy D, et al. Predictive value of P-wave and QT interval dispersion in children with congenital heart disease and pulmonary arterial hypertension for the occurrence of arrhythmias.[J].J Saudi Heart Assoc,2019 ,31(2):57-63.
Objectives:
To evaluate P-wave dispersion (PWD) and QT dispersion (QTd) in children with congenital heart disease and pulmonary arterial hypertension (PAH-CHD) and to investigate the predictive value of both PWD and QTd for prediction of arrhythmias in such children.
Materials and methods:
We included 40 children with PAH-CHD as Group I. Forty other children with CHD and no PAH were included as Group II. Forty healthy children of matched age and sex served as a Control group. Electrocardiography was performed to determine PWD and QTd. Furthermore, 24-hour Holter monitoring was performed to detect the presence of arrhythmias. Echocardiographic evaluation was also performed.
Results:
QTd and PWD were significantly higher in Group I than in Group II and Control group. A significant positive correlation was present between both QTd and PWD and mean pulmonary artery pressure, right ventricular diameter, pulmonary vascular resistance (PVR), and PVR to systemic vascular resistance ratio. QTd showed 93% sensitivity, 80% specificity, and 85% accuracy for prediction of occurrence of arrhythmias in patients with PAH-CHD at a cutoff point of 61 ms, whereas PWD showed 87% sensitivity, 80% specificity, and 85% accuracy for prediction of arrhythmias at a cutoff point of 32.5 ms in such patients. Logistic regression analysis showed that both QTd and PWD were good predictors for the occurrence of arrhythmias in children with PAH-CHD (p = 0.003 and p = 0.01, respectively).
Conclusions:
PWD and QTd were good predictors for the occurrence of various arrhythmias in children with PAH-CHD.
麻醉学文献进展分享
贵州医科大学高鸿教授课题组
翻译：李华宇 编辑：冯玉蓉 审校：曹莹