12导联DCG在冠心病心肌缺血和心律失常中的诊断价值

目的探讨12导联同步动态心电图（简称为DCG）在冠心病心肌缺血、心律失常诊断中的应用价值。方法选择220例DCG资料，分析冠心痛心肌缺血和心律失常的发生率。结果220例中203例有心肌缺血、心律失常，捡出率为92．27％；冠心病心肌缺血阳性检出率为77．17％。无症状心肌缺血（SMI）发生率高于有症状者。结论12导联同步DCG是捡出冠心病心肌缺血、心律失常的一种可靠以及简便的方法。     

12导联动态心电图在早期复极综合征诊断中的价值

目的探讨12导联同步动态心电图（DCG）对早期复极综合征（ERS）诊断的意义。方法对49例心电图有ERS特征者,进行24h全息DCG监测,分析ERS者J波及ST段变化等心电图改变。结果12导联同步DCG监测能反映出ERSJ波及ST段特征性变化,以及与心率、自觉症状的关系等,较好地反映出ERS心电图特点。结论24h12导联同步心电图是诊断ERS的有效方法。     

12导联动态心电图对无痛性心肌缺血的诊断价值

目的探讨12导联动态心电图（DCG）对无痛性心肌缺血（SMI）的诊断价值。方法将60例有冠心病危险因素但无胸痛主诉的体检者,进行12导联DCG检查,评价心肌缺血总负荷（TIB）,并进一步进行冠状动脉造影（CAG）检查,对结果进行相关性分析。结果60例中有53例提示有TIB达标,并进行CAG。45例确诊为冠心病,8例CAG未见明显异常。结论12导联DCG是临床诊断冠心病重要的无创性检查方法,通过TIB的方法可以较为客观地评价心肌缺血程度。     

动态心电图监测与冠状动脉造影对冠心病诊断价值的比较

目的探讨12导联动态心电图（DCG）监测对冠心病的诊断价值。方法选择188例可疑冠心病患者进行DCG监测记录心肌缺血,并与选择性冠状动脉造影结果进行对比分析。结果DCG诊断冠心痛的灵敏度、特异度分别为63．4％、79．8％;12导联DCG诊断冠状动脉单、双及3支血管病变的灵敏度分别为58．9％、60．5％、91．9％。结论DCG监测心肌缺血的敏感性及准确性较高,有一定的临床应用价值,且与冠脉病理解剖有关。     

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。     

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。     

89例冠脉造影阳性患者动态心电图分析

目的评价12导联同步动态心电图（DCG）（A组）及3导同步DCG（B组）对缺血性ST段改变的诊断价值。方法选择89例接受过冠状动脉造影（CAG）者,其中A组检测人数43人,B组检测人数46人,分别对其检测结果进行分析。结果B组在CAG结果证实冠状动脉三支以上病变中阳性率90％（9／10）;双支病变中阳性率76．2％（16／21）;单支病变中阳性率66．7％（8／12）;而B组检测三支以上病变中阳性率72．7％（8／11）;双支病变中阳性率52．9％（9／17）;单支病变中阳性率18．8％（3／16）。结论对冠状动脉单支病变心肌缺血的检出率较高。     

452例心悸者动态心电图分析

目的观察452例心悸者的动态心电图（DCG）变化,探讨心悸与心律失常及心肌缺血之间的关系。方法 452例者均做过3次以上常规心电图（ECG）,采用12导联DCG监测系统记录24h心电活动。结果 452例DCG检出心律失常者405例（89.6%）,ECG检出心律失常者186例（41.2%）,DCG检出心肌缺血者87例（19.2%）,ECG检出心肌缺血者20例（4.4%）。结论心悸者可能存在心律失常或心肌缺血,DCG可作为首选的无创性检查方法,为临床诊断治疗和康复提供依据。     

12导联同步动态心电图诊断冠心病心肌缺血的临床研究

目的 评价12导联同步动态心电图诊断冠心病心肌缺血的临床价值. 方法 根据ST段改变情况将170例冠状动脉造影结果可疑患者分为缺血性ST段改变组(观察组,105例)和无缺血性ST段改变组(对照组,65例),分析ST段改变与冠状动脉造影结果的关系. 结果 (1)观察组患者冠状动脉造影阳性率81.91%,对照组24.62%,差异有显著统计学意义(P<0.01);(2)12导联同步动态心电图诊断心肌缺血的敏感性和特异性分别为84.31%和72.06%,精确度79.41%;(3)12导联同步动态心电图诊断多支病变的敏感性高于单支病变,差异有统计学意义(P<0.05). 结论 同步12导联动态心电图对诊断冠心病心肌缺血的敏感性、特异性与精确度较高.可作为诊断心肌缺血的无创性检查方法.     

常规12导联和动态12导联卧位心电图对照分析

12导联动态心电图(DCG)将四肢电极移到胸部,此种电极位置的改变对12导联心电图(ECG)波形有否影响。常规12导联ECG的诊断标准在12导联DCG中可否应用?是后者分析中急待解决的问题。为此我们对45例正常人同时作两种方法的卧位记录进行对照分析。     

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。     

Comparison of epicardial potential maps derived from the 12-lead electrocardiograms with scintigraphic images during controlled myocardial ischemia

Our aim was to cross-validate electrocardiographic (ECG) and scintigraphic imaging of acute myocardial ischemia. The former method was based on inverse calculation of heart-surface potentials from the body-surface ECGs, and the latter, on a single photon emission computed tomography (SPECT). A boundary-element torso model with 352 body-surface and 202 heart-surface nodes was used to perform the ECG inverse solution. Potentials at 352 body-surface nodes were calculated from those acquired at 12-lead ECG measurement sites using regression coefficients developed from a design set (n = 892) of body-surface potential mapping (BSPM) data. The test set (n = 18) consisted of BSPM data from patients who underwent a balloon-inflation angioplasty of either the left anterior descending coronary artery (LAD) (n = 7), left circumflex coronary artery (LCx) (n = 2), or the right coronary artery (RCA) (n = 9). Body-surface potential mapping distributions at J point for 352 nodes were estimated from the 12-lead ECG, and an agreement with those estimated from 120 leads was assessed by a correlation coefficient (CC) (in percent). These estimates yielded very similar BSPM distributions, with a CC of 91.0% ± 8.1% (mean ± SD) for the entire test set and 94.1% ± 1.4%, 96.7% ± 0.8%, and 87.4% ± 10.3% for LAD, LCx, and RCA subgroups, respectively. Corresponding heart-surface potential distributions obtained by inverse solution correlated with a lower CC of 69.3% ± 18.0% overall and 73.7% ± 10.8%, 84.7% ± 1.1%, and 62.6% ± 21.8%, respectively, for subgroups. Bull's-eye displays of heart-surface potentials calculated from estimated BSPM distributions had an area of positive potentials that qualitatively corresponded, in general, with the underperfused territory suggested by SPECT images. For the LAD and LCx groups, all 9 ECG-derived bull's-eye images indicated the expected territory; for the RCA group, 6 of 9 ECG-derived images were as expected; 2 of 3 misclassified cases had very small ECG changes in response to coronary-artery occlusion, and their SPECT images showed indiscernible patterns. In conclusion, our findings demonstrate that noninvasive ECG imaging based on just the 12-lead ECG might provide useful estimates of the regions of myocardial ischemia that agree with those provided by scintigraphic techniques.     

肺心病合并冠心病心电图分析

目的探讨肺心病合并冠心病心电图的特点。方法回顾我院住院病例选择肺心病和肺心病合并冠心病各120例均行同步十二导联心电图检查,必要时进行24 h动态心电图检查对比心电图的变化。结果肺心病合并冠心病组(合并组)比肺心病组心电图改变明显,两者有显著差异结论心电图及动态心电图的某些特殊改变能提示肺心病合并冠心病。     

Feasibility and reliability of a transtelephonic 12 leads ECG

Feasibility and reliability of a 12 lead electrocardiogram (ECG), recorded by the patient himself and transmitted via telephone are mandatory for prehospital diagnosis of myocardial ischemia in patients with coronary heart disease. In this study, a 12-lead ECG recorded by patients and transmitted to the cardiology call center via telephone (Tele-ECG; model CG-7100; Card Guard) was compared with the conventional 12-lead ECG from the same patient recorded at the same time in 128 cases. The Tele-ECGs received by the call center were compared with conventional ECG by two cardiologists and one internist independently and blindly. In relation to the conventional ECG, reproducibility of PQ, QRS and QT-durations [ms] as measured in the Tele-ECG was 85%. Concordance between Tele-ECG and conventional ECG in the detection of negative T-waves was very high (Kappa value (kappa) 0.94, 0.96 and 0.97), respectively, depending on the physician. ST-segment changes were diagnosed correctly in most of the cases in Tele-ECG (kappa=0.98-0.99), as compared with the conventional ECG by all physicians. Concordance between Tele- and conventional ECG concerning the pattern of old myocardial infarction was very high (kappa=0.99) for all infarct localization. The limitations of Tele-ECG were of technical nature. In 14 cases, the peripheral electrodes were displaced; in 12 cases, there were baseline artifacts. These technical errors could be corrected in 126/128 patients (98.4%) by transtelephonic verbal communication. In conclusion, the reliability and feasibility of the 12-lead Tele-ECG-recorder used in this pilot study could be demonstrated. In an ongoing randomized controlled multicenter study, it is being investigated whether the strategy of prehospital diagnosis of acute coronary syndromes by Tele-ECG in combination with verbal communication is able to reduce pre- and in-hospital time delay, to avoid unnecessary hospital admissions and to reduce the economic burden of coronary heart disease.     

心电图运动试验对急性心肌梗塞后患者残余心肌缺血的评价

５２例急性心肌梗塞后２～１２周患者进行次极量蹬车心电图运动试验，心肌缺血发生率为４４．２％。与冠状动脉造影对比，多支病变者阳性率高于单支病变（Ｐ＜０．０１）；与运动２０１铊心肌显像对比，前者阳性率较低（Ｐ＜０．０１）；心电图运动试验中非梗塞区心肌缺血组阳性率高于梗塞周围缺血组（Ｐ＜０．０２５）；ＳＴ段抬高组左室射血分数低于ＳＴ段正常或压低组（Ｐ＜０．０１）。心电图运动试验对诊断梗塞后残余心肌缺血，特别是非梗塞区心肌缺血有一定价值，运动中ＳＴ段抬高可能预示较差的心功能。     

Referral of patients with ST-segment elevation acute myocardial infarction directly to the catheterization suite based on prehospital teletransmission of 12-lead electrocardiogram

Background

Time from symptom onset to reperfusion is essential in patients with ST-segment elevation acute myocardial infarction. Prior studies have indicated that prehospital 12-lead electrocardiogram (ECG) transmission can reduce time to reperfusion.

Purpose

Determine 12-lead ECG transmission success rates, and time saved by referring patients directly to primary percutaneous coronary intervention (pPCI) bypassing local hospitals and emergency departments.

Methods

Prehospital 12-lead ECG was recorded in patients with symptoms suggesting acute coronary syndrome during a 1-year pilot phase and transmitted to the attending cardiologist's mobile phone. Transmission success rates were determined, and prehospital and hospital delays were recorded and compared to historic controls.

Results

Transmission was attempted in 152 patients and was successful in 89%. Twenty-seven patients were referred directly for pPCI. Median hospital arrival to pPCI was 22 vs 94 minutes in the control group (P < .01).

Conclusions

Transmission of prehospital ECG is technically feasible and reduces time to pPCI in ST-segment elevation acute myocardial infarction patients.     

Comparative analysis of ischemic changes in electrocardiogram and coronary angiography results: A retrospective study

To improve the correct diagnosis rate of coronary heart disease and to explore the guiding value of electrocardiogram (ECG) ST-T ischemic changes in the clinical diagnosis of coronary heart disease.A retrospective analysis was conducted on a total of 310 cases who underwent a conventional 12-lead ECG, 12-lead dynamic ECG (DECG, Holter) with ST-T ischemic changes, and then coronary angiography (CA) within 1 week in Qingdao Sttarr Heart Hospital from June 2015 to April 2020 in the study. Ischemic ST-T changes were evaluated using conventional diagnostic criteria, and Judkins diagnostic criteria were used in CA. The sensitivity and specificity of ECG were analyzed.The specificity of ST-T changes in conventional ECG for the diagnosis of coronary heart disease is 33.7% and the sensitivity is 66.0%. The specificity of ST-T changes in Holter in the diagnosis of coronary heart disease is 55.6% and the sensitivity is 32.2%. The sensitivity of conventional ECG for the diagnosis of coronary heart disease is better than Holter, but its specificity is inferior to Holter. The negative likelihood ratios of the 2 ECGs for the diagnosis of coronary heart disease were 1.0 and 1.22, both >0.1, and the positive likelihood ratios were 0.99 and 0.73, both <10. The positive results of ST-T in conventional ECG were 128 males (65.7%), 77 females (66.9%), (P < .05), 148 cases (74.7%) in the group ≥60 years old, and 75 cases in the group less than 60 years (67%), (P > .05). The positive results of ST-T change of DECG were 135 males (69.2%), 69 females (60.0%), (P < .05), 152 cases (78.7%) in the group ≥60 years, and 83 cases (70.9%) in the group less than 60 years, (P > .05). Coronary heart disease-related factors: symptoms, hypertension, diabetes, cancer, family history, smoking history as independent variables, and a binary multivariate logistic regression analysis was performed.The sensitivity of DECG in the diagnosis of myocardial ischemia in women and the elderly was slightly higher than that in men and young cases. ST-T ischemic changes in ECG are more significant for the diagnosis of coronary heart disease in male patients. Smoking, hypertension, diabetes, and family history are all high-risk factors for coronary heart disease.     

Beat-to-beat qrs variability in the 12-lead ecg and the detection of coronary artery disease

The aim of this article was to study beat-to-beat QRS variability in patients with ischemia and old myocardial infarction using the 12-lead resting electrocardiogram (ECG). The variability analysis was based on beats that have been synchronized in time with an iterative alignment technique. The QRS variability was measured in patients submitted for myocardial scintigraphy. Those with a normal myocardial scintigraphy (called NO, n = 34, mean age 57 years, 23 women) were compared with a group with both myocardial infarction and exercise-induced ischemia (called ISCINF, n = 27, mean age 57 years, 5 women). The mean QRS variability was somewhat smaller in lead I in ISCINF than in NO, and there was no statistically significant difference in QRS variability among the groups in leads II, III, and V₁–V₆. Using a multivariate approach, the joint variability in leads I, II, III, and V₁–V₆ was used for calculating receiver operating characteristics based on a leave-one-out procedure. The sensitivity for detecting coronary artery disease was 75% at a specificity of 50%. It is concluded that beat-to-beat QRS variability in the 12-lead ECG does not discriminate between the presence and absence of coronary artery disease sufficiently well for clinical purposes.     

A vector-based, 5-electrode, 12-lead monitoring ECG (EASI) is equivalent to conventional 12-lead ECG for diagnosis of acute coronary syndromes

AIMS: The conventional 12-lead electrocardiogram (cECG) derived from 10 electrodes using a cardiograph is the gold standard for diagnosing myocardial ischemia. This study tested the hypothesis that a new 5-electrode 12-lead vector-based ECG (EASI; Philips Medical Systems, formerly Hewlett Packard Co, Boeblingen, Germany) patient monitoring system is equivalent to cECG in diagnosing acute coronary syndromes (ACSs). METHODS: Electrocardiograms (EASI and cECG) were obtained in 203 patients with chest pain on admission and 4 to 8 hours later. Both types of ECGs were graded as ST-elevation myocardial infarction if at least 1 of the 2 consecutive recordings showed ST elevation more than 0.2 mV, as ACS if one or both showed ST elevation less than 0.2 mV, T-wave inversion, or ST depression. Otherwise, the ECG was graded negative. RESULTS: Final diagnosis was identical in 177 patients (87%; 95% confidence interval [CI], 82%-91%; kappa = 0.81; SE = 0.035). ST-elevation myocardial infarction was correctly identified or excluded by EASI with a specificity of 94% (95% CI, 89%-97%) and a sensitivity of 93% (95% CI, 86%-97%; using cECG as the gold standard). Of 118 patients with enzyme elevations, an almost identical number (72 [61% by EASI] and 73 [62% by cECG]) had ST elevations. Both techniques were equivalent in predicting subsequent enzyme elevation (identical, 108/143; 75% of ACS and ST-elevation myocardial infarction ECGs by EASI and cECG). Thus, both ECG methods had exactly the same specificity of 59% (95% CI, 48%-69%) and sensitivity of 91% (95% CI, 85%-96%) for detecting myocardial injury. CONCLUSION: EASI is equivalent to cECG for the diagnosis of myocardial ischemia.     

Supplemented standard 12-lead electrocardiogram for optimal diagnosis and reconstruction of significant body surface map patterns

In this study, based on 120-lead body surface potential maps (BSPMs), we explored the improvement in electrocardiogram (ECG) diagnosis obtained by adding additional leads and using estimation of unmeasured leads. We found that adding a few leads observed to be optimal for diagnosis or signal capture combined with the existing 12-lead ECG improves diagnostic performance. Separately, using reconstruction (estimation) of BSPMs and using diagnostic criteria derived for maps also improve diagnostic performance over that provided by the recorded 12-lead ECG alone. Combining these 2 ideas, namely, addition of optimal leads and estimation of BSPMs improves performance even more.