微伏级T波电交替和窦性心率震荡在冠心病诊断中的临床应用
|
摘要
目的探讨微伏级T波电交替和窦性心率震荡在冠心病诊断中的应用价值。方法选取2014年8月至2015年8月笔者所在医院心血管内科就诊并经冠状动脉造影及心电图检查证实冠心病患者86例作为研究对象。根据冠状动脉造影正常或冠状动脉狭窄<50%者为对照组(n=35),行冠状动脉造影证实相关冠状动脉狭窄>75%且血流分级≤3级为冠心病组(n=51),其中冠心病组又分为稳定性心绞痛组(n=27)和陈旧性心肌梗死组(n=24)。记录并比较各组患者24 h动态心电图、微伏级T波电交替(MTWA)及窦性心率震荡(HRT)参数的变化以及MTWA、HRT及MTWA+HRT预测恶性室性心律失常的灵敏度和特异度。结果冠心病组患者的MTWA和HRT阳性率分别为41.2%(21/51)和62.7%(32/51),明显高于对照组的5.7%(2/35)和17.1%(6/35),冠心病组的MTWA联合HRT阳性率为23.5%(12/51),也明显高于对照组的5.7%(2/35),组间各项指标比较差异均有统计学意义(P<0.05);心绞痛组患者的MTWA和HRT阳性率分别为74.1%(20/27)和92.6%(25/27),明显高于陈旧性心肌梗死组的4.2%(1/24)和33.3%(8/24),心肌梗死组的MTWA+HRT阳性率为40.7%(11/27),明显高于对照组的4.2%(1/24),组间各项指标比较差异有统计学意义(P<0.05);与单项指标相比,MTWA+HRT的灵敏度及特异度相对较高。MTWA灵敏度和特异度分别为53.3%(8/15)和60.9%(28/46),HRT灵敏度和特异度分别为66.6%(10/15)和39.1%(18/46),MTWA+HRT灵敏度和特异度分别为71.4%(5/7)和68.8%(22/32)。结论 MTWA、HRT均是评估冠心病患者预后的重要指标,并且对评价冠心病患者发生恶性室性心律失常及心脏性猝死方面具有更佳的预测水平,而MTWA联合HRT检测的灵敏度和特异度高于单项指标,可明显提高24 h动态心电图对冠心病的诊断价值。
Objective To discuss the application value of the microvolt T-wave alternans(MTWA) and heart rate turbulence(HRT) in the diagnosis of coronary heart disease. Methods Eighty-six patients with coronary heart disease(CHD) in Department of Cardiology in our hospital, who were confirmed coronary heart disease by coronary angiography and electrocardiogram examination, were selected as the study subjects(hospitalized from August 2014 to August 2015). Patients with normal coronary angiography or coronary artery stenosis <50% were selected as the control group(n=35), and the patients with related coronary artery stenosis >75% and blood flow classification ≤grade 3 were selected as the coronary heart disease group(CHD group, n=51), which was further divided into stable angina group(n=27)and old myocardial infarction group(n=24). The changes of 24 h dynamic electrocardiogram, MTWA, HRT were observed, and the sensitivity and specificity of MTWA, HRT and MTWA + HRT for predicting malignant ventricular arrhythmia were recorded and compared. Results The positive rates of MTWA and HRT in CHD group were significantly higher than those of the control group [41.2%(21/51) vs 5.7%(2/35), 62.7%(32/51) vs 17.1%(6/35)], and the positive rate of MTWA combined with HRT of CHD group was significantly higher than of the control group [23.5%(12/51) vs5.7%(2/35)], with significant differences in the indexes between two groups(P<0.05). The positive rates of MTWA and HRT of stable angina group were significantly higher than those of old myocardial infarction group [74.1%(20/27) vs4.2%(1/24), 92.5%(25/27) vs 33.3%(8/24)], and the positive rate of MTWA+HRT in old myocardial infarction group was significantly higher than that of the control group [40.7%(11/27) vs 4.2%(1/24)], with statistically significant differences(P<0.05). Compared with detection by single index, the sensitivity and specificity of MTWA + HRT were relatively high.The sensitivity and specificity of MTWA were 53.3%(8/15) and 60.9%(28/46), and the sensitivity and specificity of HRT were 66.6%(10/15) and 39.1%(18/46). The sensitivity and specificity of MTWA+ HRT were 71.4%(5/7) and 68.8%(22/32), respectively. Conclusion HRT, MTWA are important indicators to assess the prognosis of patients with coronary heart disease, which has a better prediction value for evaluating malignant ventricular arrhythmia and sudden cardiac death of the patients. The sensitivity and specificity of MTWA combined with HRT are higher than those of single index, and it can obviously improve the diagnostic value of 24 h dynamic electrocardiogram in diagnosis of coronary heart disease.
Objective To discuss the application value of the microvolt T-wave alternans(MTWA) and heart rate turbulence(HRT) in the diagnosis of coronary heart disease. Methods Eighty-six patients with coronary heart disease(CHD) in Department of Cardiology in our hospital, who were confirmed coronary heart disease by coronary angiography and electrocardiogram examination, were selected as the study subjects(hospitalized from August 2014 to August 2015). Patients with normal coronary angiography or coronary artery stenosis <50% were selected as the control group(n=35), and the patients with related coronary artery stenosis >75% and blood flow classification ≤grade 3 were selected as the coronary heart disease group(CHD group, n=51), which was further divided into stable angina group(n=27)and old myocardial infarction group(n=24). The changes of 24 h dynamic electrocardiogram, MTWA, HRT were observed, and the sensitivity and specificity of MTWA, HRT and MTWA + HRT for predicting malignant ventricular arrhythmia were recorded and compared. Results The positive rates of MTWA and HRT in CHD group were significantly higher than those of the control group [41.2%(21/51) vs 5.7%(2/35), 62.7%(32/51) vs 17.1%(6/35)], and the positive rate of MTWA combined with HRT of CHD group was significantly higher than of the control group [23.5%(12/51) vs5.7%(2/35)], with significant differences in the indexes between two groups(P<0.05). The positive rates of MTWA and HRT of stable angina group were significantly higher than those of old myocardial infarction group [74.1%(20/27) vs4.2%(1/24), 92.5%(25/27) vs 33.3%(8/24)], and the positive rate of MTWA+HRT in old myocardial infarction group was significantly higher than that of the control group [40.7%(11/27) vs 4.2%(1/24)], with statistically significant differences(P<0.05). Compared with detection by single index, the sensitivity and specificity of MTWA + HRT were relatively high.The sensitivity and specificity of MTWA were 53.3%(8/15) and 60.9%(28/46), and the sensitivity and specificity of HRT were 66.6%(10/15) and 39.1%(18/46). The sensitivity and specificity of MTWA+ HRT were 71.4%(5/7) and 68.8%(22/32), respectively. Conclusion HRT, MTWA are important indicators to assess the prognosis of patients with coronary heart disease, which has a better prediction value for evaluating malignant ventricular arrhythmia and sudden cardiac death of the patients. The sensitivity and specificity of MTWA combined with HRT are higher than those of single index, and it can obviously improve the diagnostic value of 24 h dynamic electrocardiogram in diagnosis of coronary heart disease.
引文
[1]曾敏,李伟,林志川,等.不同性别冠心病患者危险因素及冠脉病变程度分析[J].海南医学,2012,23(20):26-27.
[2]Heras M,Fernández-Reyes MJ,Sánchez R,et al.Serum uric acid as amarker of all-cause mortality in an elderly patient cohort[J].Nef rologia,2012,32(1):67-72.
[3]牛俊芳,李佳.急性心肌梗死微伏级T波电交替及连续心率减速力分析[J/CD].中华临床医师杂志(电子版),2013,7(12):5580-5582.
[4]Basset P,Bellocq JP,Wolf C,et al.A novel metalloproteinase genespecically expressed in stromal cells of breast carcinomas[J].Nature,1990,348(6303):699-704.
[5]Trojnarska O,Ciep ucha A,Bartczak A,et al.Microvolt T-wavealternans in adults with complex congenital heart diseases[J].Cardiol J,2014,21(2):144-151.
[6]潘婷婷,李郁.冠心病患者窦性心率震荡及T波电交替与心率变异性的相关性分析[J].心脑血管病防治,2012,12(4):272-274.
[7]李海涛,吴明,马建林,等.激活β3肾上腺素能受体对心衰家兔室性心律失常及心率变异性、心率震荡的影响[J].海南医学,2015,25(16):2344-2346.
[8]陈腾.窦性心律震荡和微伏级T波电交替对冠心病患者的影响[J].中国老年学杂志,2013,33(7):1630-1631.
[9]Hoshida K,Miwa Y,Miyakoshi M,et al.Simultaneous assessment of T-wave alternans and heart rate turbulence on holter electrocardiogramsas predictors for serious cardiac events in patients aftermyocardial infarction[J].Circ J,2013,77(2):432-438.
[10]李厚荣,何娟,杜国伟,等.窦性心率震荡对急性心肌梗死患者心源性死亡的预测价值[J].心电与循环,2012,31(5):342-344.
[2]Heras M,Fernández-Reyes MJ,Sánchez R,et al.Serum uric acid as amarker of all-cause mortality in an elderly patient cohort[J].Nef rologia,2012,32(1):67-72.
[3]牛俊芳,李佳.急性心肌梗死微伏级T波电交替及连续心率减速力分析[J/CD].中华临床医师杂志(电子版),2013,7(12):5580-5582.
[4]Basset P,Bellocq JP,Wolf C,et al.A novel metalloproteinase genespecically expressed in stromal cells of breast carcinomas[J].Nature,1990,348(6303):699-704.
[5]Trojnarska O,Ciep ucha A,Bartczak A,et al.Microvolt T-wavealternans in adults with complex congenital heart diseases[J].Cardiol J,2014,21(2):144-151.
[6]潘婷婷,李郁.冠心病患者窦性心率震荡及T波电交替与心率变异性的相关性分析[J].心脑血管病防治,2012,12(4):272-274.
[7]李海涛,吴明,马建林,等.激活β3肾上腺素能受体对心衰家兔室性心律失常及心率变异性、心率震荡的影响[J].海南医学,2015,25(16):2344-2346.
[8]陈腾.窦性心律震荡和微伏级T波电交替对冠心病患者的影响[J].中国老年学杂志,2013,33(7):1630-1631.
[9]Hoshida K,Miwa Y,Miyakoshi M,et al.Simultaneous assessment of T-wave alternans and heart rate turbulence on holter electrocardiogramsas predictors for serious cardiac events in patients aftermyocardial infarction[J].Circ J,2013,77(2):432-438.
[10]李厚荣,何娟,杜国伟,等.窦性心率震荡对急性心肌梗死患者心源性死亡的预测价值[J].心电与循环,2012,31(5):342-344.