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Kokyu to Junkan Volume 44, Issue 6 （June 1996）

呼吸と循環 44巻6号（1996年6月発行）

Japanese English

研究

肥大型心筋症における心室頻拍の予測—心拍変動スペクトル解析と加算平均心電図の併用 Prediction of Ventricular Tachycardia in Patients with Hypertrophic Cardiomyopathy:Combined Use of Heart Rate Variability and Signal Averaged Electrocardiogram 井上省三 ¹ , 鼠尾祥三 ¹ , 河原洋介 ¹ , 田中淳二 ¹ , 田村敬二 ¹ , 斎藤靖浩 ¹ , 末綱竜士 ¹ , 寒川昌信 ¹ , 沢山俊民 ¹ Shozo Inoue ¹ , Shoso Nezuo ¹ , Yosuke Kawahara ¹ , Junji Tanaka ¹ , Keiji Tamura ¹ , Yasuhiro Saito ¹ , Ryouji Suetsuna ¹ , Masanobu Samukawa ¹ , Toshitami Sawayama ¹ ¹川崎医科大学循環器内科 ¹Division of Cardiology, Department of Medicine, Kawasaki Medical School キーワード：肥大型心筋症 , 心拍変動スペクトル解析 , 加算平均心電図 , hypertrophic cardiomyopathy , heart rate variavility , signal averaged electrocardio gram Keyword: 肥大型心筋症 , 心拍変動スペクトル解析 , 加算平均心電図 , hypertrophic cardiomyopathy , heart rate variavility , signal averaged electrocardio gram pp.647-650

発行日 1996年6月15日 Published Date 1996/6/15

DOI https://doi.org/10.11477/mf.1404901275

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Abstract 文献概要
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　VT出現の防御因子と考えられるHFと，攻撃因子と考えられるLP指標の関連をもとにVT出現を検討した．洞調律のHCM 65例を対象に①HFとVT出現の関連をみた．②同時期にLPを施行した36例でLP陽性指標を加味してHFとVTとの関連を検討した．

　VT（＋）群はVT（−）群に比しLP陽性指標のfQRS,LAS 40,RMS 40には差はなかったが，HFは低値であった（p＜0.01）．HFが高度低値でLP指標が陽性であった2例中1例はVTから心室細動を，他の1例はsustained VTによりショックに陥った．HFが高度低値でもLP指標が正常な2例はVTがなかった．また，HFが正常であればLP指標が陽性でもVT出現と関連はみられないが，HFが軽度低下すればLP指標が陽性になるとVTを生じやすい傾向があった．HCMにおけるVT予知にはHFとLP両者の指標の関連を重視すべきである．

HF in Heart Rate Variability (HRV) which reduces vulnerability to ventricular arrhythmia, is revealed as adefence against ventricular tachycardia (VT). Late Potential (LP) in Signal Averaged Electrocardiogram (SAE) which means anatomic substrates of arrhyth- mias, is revealed as causative of VT. Purpose. The aim of this study is to investigate whether the combination of LP and HF is a predictor of VT in patients with hypertrophic cardiomyopathy (HCM). Methods and Results. In 65 HCM patients, HRV was analysed from 24-h ECG recordings. In 36 out of 65 patients SAE was recorded at the same time. The relations among HF, LP and VT were assessed. HF was depressed in patients with VT, but positive-LP indexes (fQRS＞120, LAS40＞40, RMS40＜20) did not correlate with the presence of VT. Patients with severely depressed HF and positive-LP indexes, had near-miss cardiac sudden death. By contrast, in patients with severely depressed HF and normal fQRS duration, VT did not occur. Patients with mildly depressed HF and fQRS＞120ms, had mild correlation with VT. But patients with nor-mal HF and fQRS＞120ms did not correlate with VT. These findings suggest that depressed HF with positive-LP index easily developes VT. Conclusion. It is con-cluded that the combination of HRV and SAE seems to be useful as a predictor of VT in patients with HCM.