12导联同步动态心电图在冠心病心肌缺血诊断中的应用

目的探讨12导联同步动态心电图（DCG）在冠心病心肌缺血诊断中的价值,进一步推广在基层医院中的应用。方法选取本院就诊中疑诊为冠心病的250例作为研究对象,同时行12导联和3导联同步DCG24h监测,收集相关信息,进行统计学分析。结果 12导联同步DCG对心肌缺血诊断的阳性率明显高于3导联者,两者之间有显著差异（P〈0.05）;12导联同步DCG对下壁、侧壁心肌缺血的诊断优于3导联同步记录。结论 12导联描记在冠心病心肌缺血诊断上明显优于3导联记录,可以减少冠心病的漏诊率。     

12导联动态心电图与平板运动试验诊断冠心病心肌缺血的比较

目的探讨12导联动态心电图与平板运动试验诊断冠心病心肌缺血的诊断价值。方法对66例临床疑诊冠心病的患者行12导联动态心电图和平板运动试验检查,比较二者对心肌缺血阳性检出率。另外选择12导联动态心电图后行冠状动脉造影者53例,平板运动试验后行冠造者43例作为对照,应用诊断试验的评价方法分别计算二者诊断冠心病心肌缺血的敏感度、特异度、阳性预告值等,并对二者进行比较。结果12导联动态心电图与平板运动试验心肌缺血阳性检出率无显著性差异(p>0.05)。12导联动态心电图诊断冠心病心肌缺血的敏感度72%,特异度57%,假阳性率43%,假阴性率28%,诊断符合率66%,阳性预告值72%;平板运动试验诊断冠心病心肌缺血的敏感度68%,特异度62%,假阳性率38%,假阴性率32%,诊断符合率65%,阳性预测值59%,两种方法相比无统计学意义(p>0.05)。结论12导联动态心电图与平板运动试验均可做为非侵入性诊断冠心病的方法。     

12导联动态心电图对冠心病的诊断价值

目的　评价 12导联动态心电图 (12导联Holter)对冠心病 (CHD)的诊断价值。方法　选择 74例行冠状动脉造影 (CAG)检查的患者 ,同期内 (间隔 <1周 )接受 12导联Holter检查 ,将 12导联Holter检查的结果与CAG检查的结果进行对比分析。结果　 74例患者中经CAG证实的CHD为 4 7例 ,在 4 7例CHD患者中 ,12导联Holter检出CHD4 0例 ,12导联Holter诊断冠心病的敏感性 85 1% ,特异性 81 5 % ,精确度 83 8% ;且随着冠状动脉病变支数增多 ,12导联Holter检出CHD的阳性率增高。结论　 12导联动态心电图是目前较理想的诊断冠心病的非创伤性检查方法。     

12导联动态心电图诊断心肌缺血的临床意义

目的 探讨12导联动态心电图(DCG)对心肌缺血诊断的临床意义.方法 对771例患者的DCG检测结果进行回顾性分析.结果 发现心肌缺血性ST改变并经临床证实者174例,正常者15例,其它心电图改变者582例.132例心肌缺血者中伴有胸闷、胸痛者中42例表现为无痛性心肌缺血.结论 12导联DCG检测对心肌缺血的评价具有独特的临床意义,它的无创性及日常生活监测功能比有创的冠脉造影和运动试验更具有优越性.     

12导联同步动态心电图检出老年Ⅰ型无症状心肌缺血的临床后果

目的 探讨12导联同步动态心电图(DCG)检出无症状型心肌缺血(SMI)老年患者的临床后果。方法对54例患者进行了20个月的心肌缺血及心脏病发作事件随访。结果21例心肌缺血加重,发生部位为下壁3例、前壁4例、前侧壁6例、广泛前壁8例。缺血部位主要分布于广泛前壁、前侧壁。5例发生急性心肌梗死(AMI),2例猝死。结论心脏病发作事件在SMI中以广泛前壁最多,下壁较少。     

12导联动态心电图对诊断冠心病及高危者筛选的临床意义

目的参照冠状动脉造影（CAG）结果,探讨12导联动态心电图（DCG）对冠心病诊断的临床意义。方法总结和分析60例CAG者的DCG。结果12导联DCG与CAG诊断其敏感性72.6%,特异性78.7%,DCG诊断冠状动脉单支、双支、三支病变符合率分别为45%、90.9%、100%。DCG监测结果还表明冠状动脉狭窄支数越多,心律失常的检出率越高,且心律失常频度高、复杂性明显。结论12导联DCG对冠心病诊断敏感性及特异性较高,有重要的临床应用价值。     

12导联动态心电图ST段压低诊断冠心病的价值

目的探讨24h12导联动态心电图ST段压低诊断冠心病的临床意义。方法将163例12导联动态心电图检查有缺血性ST段压低伴或不伴典型胸痛患者分为两组（A组ST段压低伴典型胸痛者88例，B组ST段压低不伴典型胸痛或无症状者75例），并与冠状动脉造影进行对比分析。结果A组88例冠状动脉造影明显狭窄79例，其中单支病变44例，双支病变25例，3支病变10例，而B组75例冠状动脉造影明显狭窄15例。以冠状动脉造影阳性为标准，A组对冠心病的诊断阳性率为89．77％，特异性为80．00％，准确度为85．28％。而B组阳性率仅为20．00％，两组阳性率差异有非常显著性意义（χ^2=80．75，P〈0．01）。结论12导联动态心电图检查缺血性ST段压低伴有典型胸痛，诊断冠心病的价值要优于仅有ST段改变者，前者阳性率和准确度较高，具有重要的临床应用价值。     

动态心电图对冠心病心肌缺血的诊断价值

目的：参照冠状动脉造影，观察动态心电图(Holter)对冠心病心肌缺血的诊断价值。方法：选择76例曾作冠状动脉造影的患者，分析其Holter的缺血性ST段改变。结果：Holter与冠状动脉造影的诊断符合率为51.3％，其诊断冠心病的敏感性为36.5％，特异性为82.5％。多支病变及严重狭窄的冠心病可提高Holter的敏感性。结论：Holter对冠心病的诊断特异性高，而敏感性较低，多支冠脉狭窄及严重可提高其敏感性。     

148例12导联动态心电图与冠状动脉造影对比分析

目的评价24h12导动态心电图（DCG）对冠心病（CHD）的诊断价值。方法对148例可疑冠心病者24h12导DCG与冠状动脉造影（CAG）对比分析。结果148例中,经CAG证实CHD为94例,其中DCG检出80例,DCG诊断冠心病的敏感性85．1％,特异性81．5％,预测准确性83．8％,且随着冠脉病变支数增多,DCG检出CHD的阳性率增高。结论DCG监测心肌缺血的敏感性及准确性较高,对CHD的诊断有较好的参考价值。     

12导联动态心电图在冠心病诊断中的应用

2006年1月～2007年6月,我们对223例疑诊冠心病患者采用12导联同步全息动态心电图进行监测,现将结果报告如下。     

Deep Learning Algorithm Predicts Angiographic Coronary Artery Disease in Stable Patients Using Only a Standard 12-Lead Electrocardiogram

BackgroundCurrent electrocardiogram analysis algorithms cannot predict the presence of coronary artery disease (CAD), especially in stable patients. This study assessed the ability of an artificial intelligence algorithm (ECGio; HEARTio Inc, Pittsburgh, PA) to predict the presence, location, and severity of coronary artery lesions in an unselected stable patient population.MethodsA cohort of 1659 stable outpatients was randomly divided into training (86%) and validation (14%) subsets, maintaining population characteristics. ECGio was trained and validated using electrocardiograms paired with retrospectively collected angiograms. Coronary artery lesions were classified in 2 analyses. The primary classification was no to mild (< 30% diameter stenosis [DS]) vs moderate (30%-70% DS) vs severe (≥ 70% DS) CAD. The secondary classification was yes/no based on ≥ 50% DS in any vessel.ResultsIn the primary analysis, 22 patients had no angiographic CAD and were grouped mild CAD (56 patients, DS < 30%), 31 had moderate CAD (DS 30%-70%), and 113 had severe CAD (DS ≥ 70%). Weighted average sensitivity was 93.2%, and weighted average specificity was 96.4%. In the secondary analysis, 93 had significant CAD, and 128 did not. There was sensitivity of 93.1% and specificity of 85.6% in determining the presence of clinically significant disease (≥ 50% DS) in any vessel. ECGio was able to predict stenosis with average vessel error in the left anterior descending coronary artery of 18%, the left circumflex coronary artery of 19%, the right coronary artery of 18%, and the left main coronary artery of 8%.ConclusionsThis study strongly suggests that it is possible to use an artificial intelligence algorithm to determine the presence and severity of CAD in stable patients, using data from a 12-lead electrocardiogram.     

48-Lead Electrocardiogram in the Diagnosis of Non-Acute Myocardial Infarction

ABSTRACT. A 48-lead ECG including six extremity leads and seven vertical rows of six chest leads was registered in patients with myocardial infarction (MI) and controls. Patients with Wolff-Parkinson-White syndrome, bundle branch block or ventricular hypertrophy were excluded. The control group consisted of 75 healthy persons, aged 21–38, and 37 older patients who had never had MI, as verifed later at autopsy. The R wave amplitude was measured in each of the 42 chest leads and the normalized amplitude difference between each two adjacent leads (“quotient”) was calculated in horizontal and vertical direction. The ranges of these 71 quotients constituted, occasionally after exclusion of an extreme value, the reference to which 192 patients with MI were compared. The MIs were diagnosed by serum enzyme estimations, in 119 patients about one week and in 52 about one year prior to the ECG recording. In another 21 patients the diagnosis was subsequently confirmed at autopsy. The highest number of excluded extreme values in any control was three and, consequently, the presence of 4 quotients or more per ECG falling outside the reference range was used as the MI criterion of the 42 chest leads. Together with common Q wave criteria applied to the extremity leads it detected 70% of the 192 MIs. Fifty-nine per cent fulfilled the common criteria applied to the 13-lead ECG included in the 48-lead recording (extremity leads and CR_{4R–1–2–3–4–5–7}). In order to estimate the specificity of this 48-lead ECG, the control group was randomly divided into two halves. For one half, new reference ranges for the 71 quotients were estimated. The quotient values of the other half as well as of the MI patients were compared to this new reference range for each quotient. At 70% sensitivity—as found above—the specificity was 95%. The specificity of the 13-lead ECG was 96%.     

12导联动态心电图对诊断冠心病无症状性心肌缺血的临床研究

目的探讨无症状心肌缺血的临床特点和发生规律。方法对60例冠心病患者应用24h动态心电图检测。结果共检出心肌缺血1265阵次,无症状心肌缺血的发生显著高于有症状心肌缺血,占85.5%;发作高峰在上午6:00～12:00,00:00～6:00最少,但夜间缺血持续时间及ST段压低幅度明显重于白昼。结论无症状心肌缺血是冠心病最常见的表现形式,应和有症状心肌缺血给予同样重视。     

心肌缺血和冠状动脉病变对QTc离散度的影响

为探讨ＱＴｃ离散度（ＱＴｃｄ）与心肌缺血和冠状动脉（简称冠脉）病变程度的关系，分析２８例冠脉正常和５７例冠心病患者１２导联心电图的ＱＴｃｄ。结果示：冠心病组ＱＴｃｄ较冠脉正常组显著增大（４６．７±１２．６ｍｓｖｓ２６．３±１０．９ｍｓ，Ｐ＜０．０１）；不稳定型心绞痛ＱＴｃｄ明显大于稳定型心绞痛者（５４．６±１３．７ｍｓｖｓ４２．３±１４．１ｍｓ，Ｐ＜０．０５）；双支病变与单支病变以及三支病变与双支病变相比，ＱＴｃｄ均有显著增大（４８．７±１３．２ｍｓｖｓ３５．７±１１．９ｍｓ及５９．６±１５．１ｍｓｖｓ４８．７±１３．２ｍｓ，Ｐ均＜０．０５）。提示心肌缺血是引起冠心病患者ＱＴｃｄ增大的主要原因之一，ＱＴｃｄ的变化对于判断心肌缺血和冠脉病变程度有一定价值。     

心电图对冠状动脉多支病变的预测作用

冠状动脉多支病变的患者心肌缺血范围广,心功能差,易出现心脏突发事件,预后不良。发掘冠脉多支病变与心电图之间的规律性关系,对于预测冠状动脉多支病变,积极干预,改善患者预后有重要作用。     

碎裂QRS波预测冠心病心肌缺血的研究

目的探讨心电图中的碎裂QRS波（fragmented QRS,fQRS）对冠心病心肌缺血的预测价值。方法回顾性分析2012年1月至2013年12月在包头市中心医院心内科住院的临床上考虑冠心病并进行过选择性冠状动脉造影（CAG）检查的患者492例。根据患者入院以后前3日内心电图中有无碎裂QRS（fQRS）波分为两组,其中A组（有fQRS波）271例,B组（无fQRS波）221例。首先比较两组患者的一般临床资料（包括年龄、性别,合并症有无高血压、糖尿病、高脂血症）,然后比较两组患者的血管狭窄程度有无差异。结果1A、B两组患者的一般临床资料差异均无统计学意义（p≥0.05）;2A、B两组患者的冠脉血管狭窄程度不同,差异具有统计学意义（p〈0.05）,A组冠心病心肌缺血发病率高于B组,差异具有统计学意义（p〈0.05）。结论碎裂QRS波对冠心病心肌缺血的发生有较高的预测价值。     

冠心病无痛性心肌缺血的诊断和治疗分析

目的探讨冠心病无痛性心肌缺血的临床诊断及治疗。方法选取我院收治的92例冠心病患者,将其随机分为对照组和观察组,对照组患者给予复方丹参滴丸进行治疗;观察组在对照组治疗的基础上加用硝酸异山梨酯联合硝苯地平治疗。结果治疗后,观察组患者的ST段压低出现次数和持续时间明显减少,差异有统计学意义(P<0.05)。整个研究中,92例患者共监测到271次心肌缺血性发作,ST段呈0.1～0.4mV的幅度改变。结论对无痛性心肌缺血患者定期行动态心电监测,进行早期明确诊断,并进行及时有效的治疗,有助于提高患者的生活质量和生存率。     

Short-Term Estrogen Administration Ameliorates Dobutamine-Induced Myocardial Ischemia in Postmenopausal Women With Coronary Artery Disease

Objectives. This study was designed to examine whether short-term estrogen administration ameliorates dobutamine-induced myocardial ischemia in postmenopausal women with coronary artery disease (CAD).Background. Estrogen replacement therapy in postmenopausal women is associated with a marked reduction in the risk of CAD. Estrogen has been reported to have both short- and long-term effects on the cardiovascular system. However, it remains to be examined whether short-term estrogen administration ameliorates myocardial ischemia caused by increased myocardial oxygen demand in postmenopausal women with CAD.Methods. Eight postmenopausal women with proved CAD underwent dobutamine stress echocardiography (DSE). DSE was performed three times in a placebo-controlled, double-blind manner: 1) 30 min after intravenous administration of saline solution (placebo) and after 2) a low dose (1.25 mg) and 3) a high dose (10 mg) of conjugated estrogen. The effects of estrogen were compared at the maximal comparable stage of DSE, which was the maximal DSE level that the same patient achieved in all three examinations.Results. Estrogen dose-dependently ameliorated the dobutamine-induced worsening of symptoms (prolonging time to onset of symptoms by 52% [low dose] and 72% [high dose]), electrocardiographic findings (decreasing the magnitude of summed ST segment changes by 36% [low dose] and 76% [high dose]) and left ventricular wall motion (reducing the wall motion score index by 50% [low dose] and 77% [high dose], all p < 0.01 by analysis of variance). There was no significant difference in blood pressure, heart rate or rate-pressure product among the three examinations at the maximal comparable stage of DSE.Conclusions. Estrogen has short-term anti-ischemic effects on the myocardial ischemia induced by increased myocardial oxygen demand in postmenopausal women with CAD.