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¡¶ÐÄÔàÔÓÖ¾¡·[ISSN:1009-7236/CN:61-1268/R]

ÆÚÊý:

2007ÄêµÚ3ÆÚ

Ò³Âë:

329-331

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2007-06-01

ÎÄÕÂÐÅÏ¢/Info

Title:

Ventricular structure electrical remodeling and arrhythmia in elderly patients with chronic congestive heart failure

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Àî¸Õ¹; ÁõÔË¿¡²; Ê¯ÀÚ²

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Author(s):

LI Gang;  LIU Yunª²jun;  SHI Lei

Group of Cardiology, Department of Geriatrics, First Affiliated Hospital, Chongqing Medical University, Chongqing 400016, China

¹Ø¼ü´Ê:

ÐÄÁ¦Ë¥½ß;  ÐÄÂÉʧ³£;  QT¼äÆÚ;  ÐÄÊÒ

Keywords:

congestive heart failure;  arrhythmia;  QT interval;  ventricule

·ÖÀàºÅ:

R541.75

DOI:

-

ÎÄÏ×±êʶÂë:

A

ÕªÒª:

Ä¿µÄ ̽ÌÖÀÏÄêÐļ¡¹£ËÀºóÂýÐÔÐÄÁ¦Ë¥½ß£¨CHF£©»¼ÕßÐÄÊҽṹª²ÐĵçÖع¹ÓëÐÄÂÉʧ³£µÄ¹Øϵ¡£·½·¨ ÊÕ¼¯ÀÏÄêÐļ¡¹£ËÀºóCHF»¼Õß55Àý£ÛÐŦÄÜ(NYHA·Ö¼¶£©£ºII¼¶23Àý£¬ III¼¶15Àý£¬ ¢ô¼¶17Àý£Ý¼°Ðļ¡¹£ËÀºóÐŦÄÜ£¨NYHA£©I¼¶»¼Õß30Àý£¬²ÉÓó¬ÉùÐĶ¯Í¼£¬ ±ê×¼12µ¼ÁªÐĵçͼ¼°24Сʱ¶¯Ì¬Ðĵçͼ¼ì²âÆäÐÄÊÒÇ»´óС, QT¼äÆÚ£¬Ð£ÕýQT¼äÆÚ£¨QTc£©¼°ÐÄÂÉʧ³£¡£ ½á¹û ÓëÐŦÄÜI¼¶×é±È½Ï£¬CHF×éÐÄÊÒÇ»ÏÔÖøÀ©´ó£ÛCHF×飺 ×óÊÒÊæÕÅÄ©Ö±¾¶ £¨LVEDD£©£¨57¡À8£© mm, ×óÊÒÊÕËõÄ©Ö±¾¶£¨LVESD£©£¨45¡À8£©mm; ÐŦÄÜI¼¶×飺 LVEDD£¨45¡À5£©mm, LVESD £¨31¡À5£©mm£¬P<0.05£Ý¡£Á½×é¼äÐÄÊÒ¸´¼«Ö¸±êÎÞÏÔÖø²îÒì£ÛCHF×飺 QT£¨0.41¡À0.07£©s, QTc£¨0.44¡À0.06£©s£» ÐŦÄÜI¼¶×飺QT£¨0.41¡À0.04£©s, QTc£¨0.44¡À0.04£©s£Ý¡£Á½×é¼äÊÒÐÔÐÄÂÉʧ³£ÒàÎÞÏÔÖø²îÒì£ÛCHF×飺ÊÒÐÔÔ粫£¨VPB£©(219¡À598)´Î/24 h£» ÐŦÄÜI¼¶×飺VPB(345¡À504)´Î/24 h£Ý¡£½áÂÛ ÀÏÄêÐļ¡¹£ËÀºóCHFʱ£¬ÐÄÊҽṹÖع¹ÏÔÖø£¬ÐÄÊÒÇ»ÏÔÖøÀ©´ó£¬µ«ÔÚ±¾Ñо¿ÖÐÐÄÊҽṹÖع¹Î´¼ûÒýÆðÏÔÖøÐĵçÖع¹£¬ÐÄÊÒ¸´¼«ÑÓ³¤¼°ÊÒÐÔÐÄÂÉʧ³£Î´¼ûÏÔÖøÔö¼Ó¡£

Abstract:

AIM To investigate the relation between ventricular structural electrocardiological remodeling and ventricular arrhythmia in elderly patients with chronic congestive heart failure (CHF) secondary to old myocardial infarction. METHODS Fiftyª²five elderly patients with CHF secondary to old myocardial infarction (23 in cardiac function class II, 15 in class III, 17 in class IV, NYHA ) and in 30 ageª²matched elderly patients with cardiac function class I (NYHA ) secondary to old myocardial infarction were included in this study. Their ventricular chamber sizes, QT, QTc intervals and the ventricular arrhythmia were assessed respectively with echocardiography, standard 12ª²lead electrocardiography and 24ª²hour Holter recordings. RESULTS The ventricular chamber sizes were significantly larger in the elderly patients with CHF than those in cardiac function class I group £ÛCHF group: left ventricular end diastolic diameter (LVEDD) (57¡À8) mm; left ventricular end systolic diameter (LVESD) (45¡À8) mm vs. cardiac function class I group: LVEDD (45¡À5) mm; LVESD ( 31¡À5) mm, P<0.05, respectively£Ý. However, there was no difference in ventricular repolarization indices between the two groups £ÛCHF group: QT ( 0.41¡À0.07) s; QTc ( 0.44¡À0.06) s vs. cardiac function class I group: QT (0.41¡À0.04) s, QTc(0.44¡À0.04) s, respectively£Ý. The ventricular arrhythmogenesis was also not found to be significantly higher in the elderly patients with CHF than those in cardiac function class I group £ÛCHF group: ventricular premature beat (VPB) (219¡À598)1/24 h vs. cardiac function class I group: VPB(345¡À504)1/24 h£Ý. CONCLUSION The ventricular structural remodeling enlargement is significant in elderly patients with CHF secondary to old myocardial infarction. However, the ventricular structural remodeling enlargement does not cause significant prolongation of the ventricular repolarization and the increase of the ventricular arrhythmogenesis in CHF.

²Î¿¼ÎÄÏ×/References

£Û1£Ý Wakisaka Y, Niwano S, Niwano H,et al. Structural and electrical ventricular remodeling in rat acute myocarditis and subsequent heart failure£ÛJ£Ý.Cardiovasc Res, 2004, 63(4):689-699.

£Û2£Ý Faber TS, Grom A, Schopflin M,et al. Beatª²toª²beat assessment of QT/RR interval ratio in severe heart failure and overt myocardial ischemia: a measure of electrical integrity in diseased hearts£ÛJ£Ý. Pacing Clin Electrophysiol, 2003, 26(4 Pt 1): 836-842.

£Û3£Ý Davey PP, Barlow C, Hart G. Prolongation of the QT interval in heart failure occurs at low but not at high heart rates£ÛJ£Ý. Clin Sci (Lond), 2000, 98(5): 603-610.

£Û4£Ý Shastry S, Hayden MR, Lucchesi PA,et al. Matrix metalloproteinase in left ventricular remodeling and heart failure£ÛJ£Ý. Curr Cardiol Rep, 2003, 5(3): 200-204.

£Û5£Ý Dean JW, Lab MJ. Arrhythmia in heart failure: role of mechanically induced changes in electrophysiology£ÛJ£Ý. Lancet, 1989, 1(8650): 1309-1312.

£Û6£Ý Golden KL, Ren J, Dean A,et al. Norepinephrine regulates the in vivo expression of the Lª²type calcium channel£ÛJ£Ý. Mol Cell Biochem, 2002, 236(1-2): 107-114.

£Û7£Ý Marx SO, Kurokawa J, Reiken S,et al. Requirement of a macromolecular signaling complex for beta adrenergic receptor modulation of the KCNQ1ª²KCNE1 potassium channel£ÛJ£Ý. Science, 2002, 295(5554): 496-499.

£Û8£Ý Packer M, Gottlieb SS, Kessler PD. Hormoneª²electrolyte interactions in the pathogenesis of lethal cardiac arrhythmias in patients with congestive heart failure. Basis of a new physiologic approach to control of arrhythmia£ÛJ£Ý. Am J Med, 1986, 80(4A): 23-29.

£Û9£Ý Crystal E, Ovsyshcher IE. Ventricular arrhythmia in postinfarction and congestive heart failure patients£ÛJ£Ý. J Cardiovasc Electrophysiol, 1999, 10(3): 420-421.

±¸×¢/Memo

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