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中华心脏与心律电子杂志 ›› 2023, Vol. 11 ›› Issue (02) : 120 -123. doi: 10.3877/cma.j.issn.2095-6568.2023.02.006

综述

Takotsubo综合征心电图的进展
黄大军, 李燕伟, 伍洲, 张嬿, 康彧, 孔令秋()   
  1. 610037 成都,成都中医药大学附属医院心内科
    610037 成都,成都中医药大学附属医院超声科
  • 收稿日期:2022-10-17 出版日期:2023-06-25
  • 通信作者: 孔令秋
  • 基金资助:
    国家自然科学基金(82274414)

Research progress of electrocardiograph in Takotsubo syndrome

Dajun Huang, Yanwei Li, Zhou Wu, Yan Zhang, Yu Kang, Lingqiu Kong()   

  1. Department of Cardiology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu 610032, China
    Department of Ultrasound, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu 610032, China
  • Received:2022-10-17 Published:2023-06-25
  • Corresponding author: Lingqiu Kong
引用本文:

黄大军, 李燕伟, 伍洲, 张嬿, 康彧, 孔令秋. Takotsubo综合征心电图的进展[J/OL]. 中华心脏与心律电子杂志, 2023, 11(02): 120-123.

Dajun Huang, Yanwei Li, Zhou Wu, Yan Zhang, Yu Kang, Lingqiu Kong. Research progress of electrocardiograph in Takotsubo syndrome[J/OL]. Chinese Journal of Heart and Heart Rhythm(Electronic Edition), 2023, 11(02): 120-123.

Takotsubo综合征(TTS)以其左心室造影表现为收缩期窄颈、心尖球形膨出,类似于“章鱼壶”样改变而得名。TTS的心电图4个不同阶段的变化具有连续性:ST段抬高、T波倒置、T波倒置进行性加深以及QT间期逐渐延长。TTS心电图的标志特征对临床诊断及结局预测有一定敏感性和特异性。本文旨在简要回顾与TTS相关的重要心电图发现及其临床指导意义。

表1 Takotsubo综合征的心电图分期
图1 1例Takotsubo综合征患者胸前导联心电图演变
表2 心肌梗死与Takotsubo综合征的心电图鉴别
作者 发表年份 患者纳入 心电图比较
Ogura等30 2003 TTS(n=13)对前壁AMI(n=13) ① TTS患者的V4~V6导联与V1~V3导联ST段抬高的比值提 高;②TTS患者QTc间期明显延长。无相互改变、无异常Q波;③∑STeV(4~6)/V(1~3)≥1对诊断TTS具有较高的敏感性和特异性
Kuisu等13 2004 TTS(n=15)对前壁AMI(n=16) 两组的左心室功能障碍均在约2周后显著缓解异:TTS在发病早期前3 d或以后的T波倒置深度和QTc间期长于前壁AMI
Inoue等31 2005 TTS(n=18)对前壁AMI(n=85);A组:第一间隔支(S1)和第一对角支(D1)的近端;B组:病变同时位于S1或D1的近端C组:病变同时位于S1和D1的远端 A组:下壁导联ST段压低,TTS低于前壁AMI;B组:异常Q波、下壁导联ST段抬高,TTS高于前壁AMI;C组:差异无明显统计学意义
Dib等32 2009 TTS患者(n=105)根据心电图分为:①ST段抬高(2个相邻导联ST段抬高1 mm)或新发左束支传导阻滞(n=36);②相邻导联T波倒置(3个相邻导联t波倒置3 mm)但无ST段移位(n=32);③非特异性ST-T异常或入院时心电图正常(n=37) 2/3的TTS患者无ST段抬高;3组5年TTS复发率差异无统计学意义
Kosuge等6 2010 TTS(n=444)对AMI(n=342) 症状发作后的前6 h,TTS与ACS在aVR和V1导联的ST段抬高差异有明显统计学意义
Guerra等22 2013 TTS(n=45)对ACS(n=45) TTS组ST段抬高较少、T波倒置明显但差异在72 h后不存在,并且在7d随访期间观察到类似的趋势
Parkkonen等20 2014 TTS(n=48)对前壁STEMI(n=96) TTS特点:V1导联ST段无抬高,V2导联ST段抬高幅度≥2 mm
Looi等24 2015 TTS(n=100)对STEMI(n=100) ① 35例TTS患者入院时出现ST段抬高。ST段相低较少,无异常Q波;②症状发生后2天所有STEMI患者均出现病理性q波,而TTS患者未出现;③与NSTE-TTS患者相比,NSTEMI患者入院时ST段压低更多(28.2%对0%,P<0.05),但T波倒置更少(33.8%对11.3%,P<0.05);④到第2天,区分NSTE-TTS和NSTEMI的ECG标准为≥6导联存在T波倒置
Gurerra等23 2015 TTS(n=58)对ACS(n=58) 第一阶段:QRS波幅呈时间相关趋势,表现为两组患者QRS波幅均先降低;第二阶段:TTS患者QRS波幅逐渐恢复至事件前水平,而ACS患者QRS波幅自入院后基本不变。在TTS患者中,住院期间QRS波电压振幅衰减(AAQRS)升高与收缩功能恢复、肌钙蛋白I和CK-MB下降呈线性正相关。
Frangieh等21 2016 TTS(n=200)对前壁AMI(n=200)

合并ST段抬高:STE-TTS对AMI:aVR的ST段抬高是STE-TTS的特征(敏感性、特异性分别为43%和95%)

非ST抬高:I、aVL、V5~V6导联的T波倒置是非ST段抬高型TTS的特征(敏感性、特异性为17%和97%)

Zorzi等25 2016 TTS(n=31)对AMI(n=30) 在多变量分析中,PR段压低和ST段最大抬高≤2 mm是TTS的唯一独立预测因子,并且这两个参数同时存在时,特异度100%
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