2026 年第 3 期 第 21 卷

心电图T波峰-末间期和校正QT间期与肥厚型心肌病患者恶性心律失常风险的关系

Relationship between T-wave peak-end interval and corrected QT interval on electrocardiogram and risk of malignant arrhythmia in patients with hypertrophic cardiomyopathy

作者：杨晓雷王强郑孝光刘小涛

英文作者：Yang Xiaolei Wang Qiang Zheng Xiaoguang Liu Xiaotao

单位：中国人民解放军联勤保障部队第九〇六医院急诊医学科，宁波315000

英文单位：Department of Emergency Medicine the 906th Hospital of the Joint Logistics Support Force of the Chinese People′s Liberation Army Ningbo 315000 China

关键词：肥厚型心肌病；恶性心律失常；T波峰-末间期；校正QT间期

英文关键词：Hypertrophiccardiomyopathy;Malignantarrhythmia;T-wavepeak-endinterval;CorrectedQTinterval

• 摘要：

• 目的 探讨心电图参数T波峰-末间期（Tp-Te）和校正QT间期（QTc）与肥厚型心肌病（HCM）患者恶性心律失常风险的关系。方法 回顾性选取2020年3月至2024年5月中国人民解放军联勤保障部队第九〇六医院收治的333例HCM患者，根据患者24 h动态心电图结果，将发生恶性心律失常的患者纳入观察组（102例），未发生恶性心律失常的患者纳入对照组（231例）。收集患者临床资料及心电图参数。采用多因素回归模型校正混杂因素，分析Tp-Te、QTc与恶性心律失常的独立相关性；通过LOWESS平滑曲线分析其与心率变异性的关系；分层回归评估不同亚组中的关联。结果 观察组男性比例、年龄、左心室收缩末期内径、左心房容积指数、左心房内径、室间隔厚度均大于对照组，左心室舒张末期内径、左心室射血分数均小于对照组（均P<0.05）。观察组Tp-Te［（109±16）ms比（77±15）ms］、QTc［（438±36）ms比（412±34）ms］均长于对照组，R-R间期标准差（SDNN）、平均值标准差（SDANN）、相邻R-R间期差均方根（RMSSD）均短于对照组（均P<0.05）。独立相关性分析结果显示，校正混杂因素后，较低水平的SDNN、SDANN、RMSSD，较高水平的Tp-Te、QTc患者发生恶性心律失常风险更高（均P<0.05）。分层分析显示，Tp-Te和QTc在性别、年龄、心脏结构分层各亚组中均与恶性心律失常风险相关（均P<0.05）。阈值分析表明，Tp-Te、QTc影响恶性心律失常发生的拐点是92.66、424.66 ms，低于阈值时风险随参数升高而降低，高于阈值时风险随参数升高而增加。结论 Tp-Te和QTc是HCM患者恶性心律失常的独立预测指标，且存在明确的阈值效应，结合心率变异性降低，这些参数可为HCM患者的风险分层和早期干预提供关键依据，优化临床管理策略。

• Objective To investigate the relationship between electrocardiographic parameters T-wave peak-end interval (Tp-Te) and corrected QT interval (QTc) and the risk of malignant arrhythmia in patients with hypertrophic cardiomyopathy (HCM). Methods A total of 333 patients with HCM admitted to the 906th Hospital of the Joint Logistics Support Force of the Chinese People′s Liberation Army from March 2020 to May 2024 were retrospectively selected. According to the results of 24 h ambulatory electrocardiography, patients with malignant arrhythmia were included in the observation group (102 cases), and those without malignant arrhythmia were included in the control group (231 cases). Clinical data and electrocardiographic parameters of the patients were collected. Multivariate regression models were used to adjust for confounding factors and analyze the independent correlations of Tp-Te and QTc with malignant arrhythmia; LOWESS smoothing curves were applied to explore their relationships with heart rate variability; stratified regression was performed to evaluate the associations in different subgroups. Results The proportion of males, age, left ventricular end-systolic diameter, left atrial volume index, left atrial diameter, and interventricular septum thickness in the observation group were all higher than those in the control group, while the left ventricular end-diastolic diameter and left ventricular ejection fraction were lower than those in the control group (all P<0.05). The Tp-Te ［(109±16)ms vs (77±15)ms］ and QTc ［(438±36)ms vs (412±34)ms］ in the observation group were significantly higher than those in the control group, and the standard deviation of normal-to-normal R-R intervals (SDNN), standard deviation of average R-R intervals (SDANN), and root mean square of successive differences in adjacent R-R intervals (RMSSD) were lower than those in the control group (all P<0.05). Results  of independent correlation analysis showed that after adjusting for confounding factors, patients with lower levels of SDNN, SDANN, and RMSSD, as well as higher levels of Tp-Te and QTc, had a higher risk of developing malignant arrhythmia (all P<0.05). Stratified analysis showed that Tp-Te and QTc were correlated with the risk of malignant arrhythmia in all subgroups stratified by gender, age, and cardiac structure (all P<0.05). Threshold analysis indicated that the inflection points of Tp-Te and QTc affecting the occurrence of malignant arrhythmia were 92.66 ms and 424.66 ms, respectively. Below the thresholds, the risk decreased with the increase of these parameters, while above the thresholds, the risk increased with the elevation of these parameters.Conclusion sTp-Te and QTc are independent predictors of malignant arrhythmia in patients with HCM, with clear threshold effects. Combined with reduced heart rate variability, these parameters can provide key evidence for risk stratification and early intervention in HCM patients, optimizing clinical management strategies.