中文摘要：

目的：探讨心肌病猝死高危患者中有预测价值的无创性指标。方法：回顾性分析410例心肌病住院患者的恶性心律失常[室性心动过速（VT）或心室颤动（VF）]发生率及左室射血分数（LVEF），并随访调查心源性猝死（SCD）的发生情况。测量其中心电图记录清晰的200例患者（心肌病组）的心电图参数QRS时限、QT间期和Tp—Te间期，计算QTc。取80例健康者作为心电图参数对照组，比较2组QTc分布情况。根据QRS时限将上述200例患者分为QRS≥120ms（75例）和QRS〈120ms（125例）。根据LVEF值将410例患者分为30％≤LVEF≤35％（207例），35％％LVEF≤50％（185例）和LVEF〉50％（18例）。分别对无创性指标LVEF、QTc、Tp—Te、QRS与VT／VF、SCD发生的关系进行分析。结果：410例中，245例（59．8％）发生心律失常，其中心房颤动102例（24．9％），VT／VF54例（13．2％），I度房室传导阻滞15例（3．7％），II～Ⅲ度房室传导阻滞15例（3．7％），其余并发房性期前收缩或室性期前收缩共59例（14．4％）。心肌病组中QTc≥460ms者所占比例明显高于对照组（22．0％：7．5％，P〈0．01）；Tp—Te与QTc呈正相关（P=0．009）；QRS≥120ms者的SCD发生率比QRS％120ms者明显增加（32．0％：18．4％，P〈0．05）。随着LVEF降低，SCD发生率有增高趋势，但均差异无统计学意义。结论：高度房室传导阻滞、VT／VF是心肌病高发SCD的常见原因。QTc≥460ms和Tp—Te延长、QRS≥120ms是预测心肌病患者SCD发生的有效参数；LVEF可能具有预测心肌病患者发生VT／VF的潜在价值。

英文摘要：

Objective： To explore the valuable noninvasive parameters of sudden cardiac death （SCD） in patients with cardiomyopathy. Method： The incidence of malignant arrhythmias and left ventricular ejection fraction （LVEF） were retrospectively analyzed in 410 patients with cardiomyopathy. All patients were followed up to investigate the occurrence of malignant arrthythmia and SCD. The ECG parameters including QRS width, QT and Tp-Te duration were measured in 200 available ECG, while 80 normal healthy individuals with matched age and sex were selected as control group. The 200 patients were divided into QRS≥120 ms （n= 75） and QRS〈120 ms （n=125） according to QRS width. The 410 patients were divided into 30%≤LVEF≤35% （n=207）, 35%〈LVEF ≤50% （n=185） and LVEF〉50% （n=18） according to LVEF. The relationship among LVEF, QTc, QRS and malignant arrhythmias was analyzed. Result： In 410 patients, there were 102 cases （24.9 % ） with atrial fibrillation, 54 cases （13.2 %） with malignant ventricular arrhythmia, 15 cases （3.7 %） with I degree atrioventricular block, 15 cases with II - III degree atrioventricular block （3.7%） and 59 cases （14.4%） with atrial or ventricular premature contraction. The proportion of QTc≥460 ms in cardiomyopathy group was significantly higher than that in control group （22.0% vs 7.5% , P〈0.01）. There was positive correlation between Tp-Te and QTc in cardiomyopathy group （P=0. 009）. The incidence of SCD was significantly higher in QRS≥120 ms than QRS〈120 ms （32.0% vs 18.4%, P〈0.05）. Reduced LVEF could increase the risk of SCD, whereas no significant difference was found. Conclusion： High degree atrioventricular block and malignant ventricular arrhythmia are common causes of SCD in patients with cardiomyopathy. QTc≥460 ms and Tp-Te prolongation, QRS≥120 ms can predict SCD efficiently in patients with cardiomyopathy, while the potential value of LVEF need to be demonstrated in further study.