经皮球囊二尖瓣成形术对P波离散度的影响及相关因素分析
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摘要
目的 评价经皮球囊二尖瓣成形术（PBMV）对P波离散度（Pd）等心电学指标的影响以及探讨其与心脏超声、血流动力学指标的相关性。方法 选择31例拟行PBMV术的风心病二尖瓣狭窄患者，于术前1天、术后24-48小时、术后4-6月通过心脏超声、12道同步心电图分别测出左房内径（LAD）、二尖瓣口面积（MVA）、平均二尖瓣跨瓣压差（MMG）、Pd、P波最大时限（Pmax）、P波最小时限（Pmin）等指标。手术过程中在球囊扩张前后通过球囊导管测出平均左房压力（MLAP）。结果 Pd、Pmax、Pmin术后较术前显著性减小，术后4-6月比术后24-48小时也有显著性减小。LAD、MMG、MLAP、MVA术后较术前都有显著性改善。在简单回归分析中，术前Pd、Pmax与LAD、MLAP、MVA有弱相关，但在多元线性回归分析中，仅Pmax与LAD有相关。术后24-48小时Pd、Pmax、Pmin减小量与LAD、MMG、MLAP、MVA改善程度无显著性相关。结论 心脏超声、血流动力学指标的改善以及Pd、Pmax、Pmin的持续减小显示出PBMV术对风心病二尖瓣狭窄患者的良好效果。但术后心电学指标的改变程度与心脏超声、血流动力学指标的改善程度无显著性相关。
Objective to estimate the effects of percutaneous balloon mitral valvuloplasty on p-wave dispersion(Pd) and other electrocardiographic variables and investigate the association of them with echocardiographic and hemodynamic parameters.Methods 31 patients with rheumatic mitral stenosis who were candidates for PBMV were selected for the study.12-lead electrocardiogram and echocardiogram were recorded for each patient 1 day before PBMV and repeated at the 24-48 hours and 4-6 months after PBMV,Pd、maximum and minimum P-wave duration(Pmax、Pmin)、left atrial diameter(LAD)、mean mitral gradient(MMG)、mitral valve area(MVA) were measured respectively.During PBMV,mean left atrial pressure(MLAP) was recorded by balloon catheter before and after inflation.Results The Pd、Pmax、Pmin after PBMV were significantly lower than those before PBMV，there were also statistically significant decrease 4-6 months than 24-48 hours after PBMV.Statistically significant improvement in LAD、MMG、MLAP、MVA was achieved after PBMV.In simple regression，Pd、Pmax were weakly related to LAD、MLAP、MVA before PBMV，but in multiple regression，only Pmax was related to LAD.There was no Statistically significant correlation between the decrease in
Pd、Pmax、Pmin and the improvement in LAD、MMG、MLAP、MVA at the 24-48 hours after PBMV .Conclusion The continuous decrease of Pd、Pmax、Pmin and the improvement in echocardiographic and hemodynamic parameters after PBMV showed the good results in PBMV for patients with rheumatic mitral stenosis，but the changes of electrocardiographic variables were not parallel to the improvement in echocardiographic and hemodynamic parameters after PBMV.
Objective to estimate the effects of percutaneous balloon mitral valvuloplasty on p-wave dispersion(Pd) and other electrocardiographic variables and investigate the association of them with echocardiographic and hemodynamic parameters.Methods 31 patients with rheumatic mitral stenosis who were candidates for PBMV were selected for the study.12-lead electrocardiogram and echocardiogram were recorded for each patient 1 day before PBMV and repeated at the 24-48 hours and 4-6 months after PBMV,Pd、maximum and minimum P-wave duration(Pmax、Pmin)、left atrial diameter(LAD)、mean mitral gradient(MMG)、mitral valve area(MVA) were measured respectively.During PBMV,mean left atrial pressure(MLAP) was recorded by balloon catheter before and after inflation.Results The Pd、Pmax、Pmin after PBMV were significantly lower than those before PBMV，there were also statistically significant decrease 4-6 months than 24-48 hours after PBMV.Statistically significant improvement in LAD、MMG、MLAP、MVA was achieved after PBMV.In simple regression，Pd、Pmax were weakly related to LAD、MLAP、MVA before PBMV，but in multiple regression，only Pmax was related to LAD.There was no Statistically significant correlation between the decrease in
Pd、Pmax、Pmin and the improvement in LAD、MMG、MLAP、MVA at the 24-48 hours after PBMV .Conclusion The continuous decrease of Pd、Pmax、Pmin and the improvement in echocardiographic and hemodynamic parameters after PBMV showed the good results in PBMV for patients with rheumatic mitral stenosis，but the changes of electrocardiographic variables were not parallel to the improvement in echocardiographic and hemodynamic parameters after PBMV.
引文
1 郭继鸿.P波离散度.临床心电学杂志，1999，8（3）：189-192.
2 Dilaveris PE,Gialafos EJ,Siderris SK,et al.Simple electrocardiographic markers for the prediction of paroxysmal idiopathic atrial fibrillation[J]. Am Heart J,1998,135:733-738.
3 Aytemir K,Ozer N,Atalar E,et al.P wave dispersion on 12-lead electrocardiography in patients with paroxysmal atrial fibrillation[J]. PACE,2000,23:1109-1113.
4 Rowe JC,Bland F,Sprague HB,et al.Course of mitral stenosis without surgery:10 and 20 year perspectives.Ann Intern Med ,1960,52:741-749.
5 Klaus-Ulrich Thiedemann,Victor J,Ferrans.Left atrial ultrastructure in mitral valvular disease[J].Am J Pathol,1977,89(3):575-592.
6 Goodenough DA,Goliger JA,Paul DL.Connexins,connexon and intercellular communication[J].Annu Rev Biochem,1996,65:475-502.
7 Inoue K,Owaki T,Nakamure T,et al.Clinical application of transvenous mitral commissurotomy by a new balloon catheter.J Thorac Cardiovasc Surg,1984;87:394-402.
8 Unal N, Mese T, Hudaoglu S,et al.Percutaneous transvenous balloon mitral valvuloplasty: mid-term results in adolescents.Turk J Pediatr 1999,41(3):341-8.
9 Paul N,Casale,william J,et al.Percutaneous balloon valvotomy for patients with mitral stenosis:initial and follow-up results.Am Heart J, 1991,121(2 Pt 1):476-9.
10 Zaki A, Salama M, El Masry M, Elhendy A.Five-year follow-up after percutaneous balloon mitral valvuloplasty in children and adolescents.Am J Cardiol,1999,83(5):735-9.
11 Pektas O, Isik E, Coskun M,et al.Late hemodynamic changes in percutaneous
mitral valvuloplasty. Am Heart J, 1990,119(1):112-20.
12 Hasan Turhan,MD,Ertan Yetkin,MD,Kubilay Senen,MD,et al.Effects of Percutaneous Mitral Balloon Valvuloplasty on P-wave dispersion in patients with Mitral Stenosis[J].Am J Cardiol,2002, 89:607-609.
13 Imamura Y,Ando H,Ashihara T,et al.Myocardial adrenergic nervous activity is intensified in patients with heart failure without left ventricular volume or pressure overload.J Am Coll Cardiol 1996, 28:371-375.
14 Tukek T,Akkaya V,Demirel S,et al.Effect of Valsalva maneuver on surface electrocardiographic p-wave dispersion in paroxysmal atrial fibrillation.Am J Cardiol 2000;85:896-899.
15 Ashino K,Gotoh E,Sumita S,et al.Percutaneous transluminal Mitral Valvuloplasty normalizes baroreflex sensitive and sympathetic activity in patients with mitral stenosis.Circulation,1997,96:3443-3449.
16 Josephon ME,Kastor JA,Morganroth J.Electrocardiographic left atrial enlargement：electrophysiological、echocardiographic and hemodynamic correlates.Am J Cardiol,1977,39:967-971.
17 Trevino AJ,Ibarra M,Garcia A,et al.Immediate and long term results for balloon mitral commissurotomy for rheumatic mitral stenosis. Comparison between Inoue and double balloon techniques.Am Heart J，1996,131:530-536.
18 Arora R,Kalra Gs,Murty GS,et al.Percutaneous transatrial mitral commissurotomy:immediate and intermediate results.J Am Coll Cardiol, 1993,23:1327-1332.
19 Lung B,Garbarz E,Michaud P,et al.Late results of percutaneous mitral commissurotomy in a series of 1024 patients.Circulation 1999,99(25):3272-3278.
20 Nakatani S，Nagata S，Beppu S，et al.Time related changes in mitral valve area
after balloon mitral valvuloplasty.Assessed by Doppler continuity equation method.Circulation,1988,78(supplⅡ)Ⅱ-487.
2 Dilaveris PE,Gialafos EJ,Siderris SK,et al.Simple electrocardiographic markers for the prediction of paroxysmal idiopathic atrial fibrillation[J]. Am Heart J,1998,135:733-738.
3 Aytemir K,Ozer N,Atalar E,et al.P wave dispersion on 12-lead electrocardiography in patients with paroxysmal atrial fibrillation[J]. PACE,2000,23:1109-1113.
4 Rowe JC,Bland F,Sprague HB,et al.Course of mitral stenosis without surgery:10 and 20 year perspectives.Ann Intern Med ,1960,52:741-749.
5 Klaus-Ulrich Thiedemann,Victor J,Ferrans.Left atrial ultrastructure in mitral valvular disease[J].Am J Pathol,1977,89(3):575-592.
6 Goodenough DA,Goliger JA,Paul DL.Connexins,connexon and intercellular communication[J].Annu Rev Biochem,1996,65:475-502.
7 Inoue K,Owaki T,Nakamure T,et al.Clinical application of transvenous mitral commissurotomy by a new balloon catheter.J Thorac Cardiovasc Surg,1984;87:394-402.
8 Unal N, Mese T, Hudaoglu S,et al.Percutaneous transvenous balloon mitral valvuloplasty: mid-term results in adolescents.Turk J Pediatr 1999,41(3):341-8.
9 Paul N,Casale,william J,et al.Percutaneous balloon valvotomy for patients with mitral stenosis:initial and follow-up results.Am Heart J, 1991,121(2 Pt 1):476-9.
10 Zaki A, Salama M, El Masry M, Elhendy A.Five-year follow-up after percutaneous balloon mitral valvuloplasty in children and adolescents.Am J Cardiol,1999,83(5):735-9.
11 Pektas O, Isik E, Coskun M,et al.Late hemodynamic changes in percutaneous
mitral valvuloplasty. Am Heart J, 1990,119(1):112-20.
12 Hasan Turhan,MD,Ertan Yetkin,MD,Kubilay Senen,MD,et al.Effects of Percutaneous Mitral Balloon Valvuloplasty on P-wave dispersion in patients with Mitral Stenosis[J].Am J Cardiol,2002, 89:607-609.
13 Imamura Y,Ando H,Ashihara T,et al.Myocardial adrenergic nervous activity is intensified in patients with heart failure without left ventricular volume or pressure overload.J Am Coll Cardiol 1996, 28:371-375.
14 Tukek T,Akkaya V,Demirel S,et al.Effect of Valsalva maneuver on surface electrocardiographic p-wave dispersion in paroxysmal atrial fibrillation.Am J Cardiol 2000;85:896-899.
15 Ashino K,Gotoh E,Sumita S,et al.Percutaneous transluminal Mitral Valvuloplasty normalizes baroreflex sensitive and sympathetic activity in patients with mitral stenosis.Circulation,1997,96:3443-3449.
16 Josephon ME,Kastor JA,Morganroth J.Electrocardiographic left atrial enlargement：electrophysiological、echocardiographic and hemodynamic correlates.Am J Cardiol,1977,39:967-971.
17 Trevino AJ,Ibarra M,Garcia A,et al.Immediate and long term results for balloon mitral commissurotomy for rheumatic mitral stenosis. Comparison between Inoue and double balloon techniques.Am Heart J，1996,131:530-536.
18 Arora R,Kalra Gs,Murty GS,et al.Percutaneous transatrial mitral commissurotomy:immediate and intermediate results.J Am Coll Cardiol, 1993,23:1327-1332.
19 Lung B,Garbarz E,Michaud P,et al.Late results of percutaneous mitral commissurotomy in a series of 1024 patients.Circulation 1999,99(25):3272-3278.
20 Nakatani S，Nagata S，Beppu S，et al.Time related changes in mitral valve area
after balloon mitral valvuloplasty.Assessed by Doppler continuity equation method.Circulation,1988,78(supplⅡ)Ⅱ-487.