Effects of Atorvastatin on Ventricular Late Potentials and Repolarization Dispersion in Patients with Hypercholesterolemia

服用降血脂藥物Atorvastatin對於高血膽固醇患者心室晚期電位與再極化期離散性之影響

朱志生(Chih-Sheng Chu) ； 李坤泰(Kun-Tai Lee) ； 李碩粲(Shuo-Tsan Lee) ； 盧怡旭(Ye-Hsu Lu) ； 林宗憲(Tsung-Hsien Lin) ； 溫文才(Wen-Chol Voon) ； 許勝雄(Sheng-Hsiung Sheu) ； 賴文德(Wen-Ter Lai)

《The Kaohsiung Journal of Medical Sciences》 23卷5期 (2007/05) Pp. 217-224

摘要

越來越多文獻報導指出降血脂藥物statins的使用對於有結構性心臟病患者具有降低心律不整以及減少猝死發生的好處。本研究欲利用臨床上評估心律不整風險之心電圖參數，包括心室晚期電位、QT離散性與穿臟層離散性等，來探討statins對於沒有結構性心臟病之高膽固醇血症患者，是否也能呈現直接抗心律不整之好處。總共有82位高膽固醇病患（45位女性，平均年齡62±10歲）納入本研究並接受為期三個月的降血脂治療（atorvastatin 10毫克／天）。接受藥物前後分別記錄並分析比較其訊息平均心電圖(SAECG)參數、心電圖上QT離散性以及再極化期穿臟層離散性參數（Tpe值與百分比）。其中有12位病患於atorvastatin投藥前後更分別記錄其24小時行動式心電圖資料。研究結果顯示在atorvastatin治療三個月後，雖然病患血中總膽固醇與低密度脂蛋白膽固醇濃度皆有顯著降低（p值＜0.001），然而SAECG的參數以及心室晚期電位的改變並沒有顯著影響。此外，心電圖上再極化離散性參數如QT離散性與穿臟層離散性（Tpe值與百分比）也沒有顯著性差異。然而，24小時心電圖分析可以顯示出atorvastatin治療對於24小時QT離散性的日夜差異有減緩的效應。本研究結論為，在相對低心血管風險的高膽固醇患者，利用非侵襲性心電圖心律不整風險參數分析病患服用atorvastatin（10毫克／天）治療三個月前後，並無法反映出statins有直接抗心律不整之效果。

關鍵字

降血脂藥物atorvastatin ； 心電圖 ； 晚期電位 ； QT離散性 ； 穿臟層離散性

並列摘要

Emerging evidence suggests that statins have a favorable impact on the reduction of arrhythmia events and sudden cardiac death in patients with structural heart disease. We aimed to investigate the possibly and directly favorable effects of statins on ventricular late potentials, QT dispersion, and transmural dispersion of repolarization attained by analyzing clinical electrocardiography (ECG) risk stratification parameters in patients with hypercholesterolemia without structural heart disease. In total, 82 patients (45 females; mean age, 62±10 years) with hypercholesterolemia were enrolled in this prospective study to examine the effects of statin therapy (atorvastatin 10mg/day for 3 months) on ECG risk stratification parameters. Surface 12-lead ECG and signal-average ECG (SAECG) were recorded before and after statin treatment. The SAECG parameters, QT dispersion, Bazett-corrected QT (QTc) dispersion, T wave peak-to-end interval (Tpe), and percentage of Tpe/QT interval were calculated and compared before and after statin therapy. Twelve-lead ambulatory 24-hour ECGs were recorded in 12 patients. The results demonstrated that after statin therapy for 3 months, serum levels of total cholesterol and low-density lipoprotein cholesterol were significantly reduced (both p values ＜0.001). However, neither significant changes of each SAECG parameter nor the frequency of late potentials were demonstrated after atorvastatin therapy. In addition, no significant changes in QT dispersion, QTc dispersion, Tpe, or Tpe/QT were found. However, 24-hour ambulatory ECG revealed a flattening effect of circadian variation of QTc dispersion after atorvastatin therapy. In conclusion, the favorable antiarrhythmia effect of atorvastatin (10 mg/day) therapy cannot be directly reflected by analyzing these noninvasive ECG risk stratification parameters in low-risk patients with hypercholesterolemia.

並列關鍵字

atorvastatin ； electrocardiography ； late potentials ； QT dispersion ； transmural dispersion