信号平均心电图时域分析和频谱时间标测预测心律失常事件的比较

目的：评价信号平均心电图（ＳＡ－ＥＣＧ）时域分析和频谱时间标测在预测冠心病心律失常事件（ＡＥ）方面的差异。方法：１４５例冠心病患者均进行ＳＡ－ＥＣＧ检测和２４小时Ｈｏｌｔｅｒ监测，其中急性心肌梗死患者于发病后２～４周进行ＳＡ－ＥＣＧ检测，所有患者平均随访１０５±２８（４～１４）个月。结果：１发生ＡＥ１３例。２时域分析预测冠心病患者发生ＡＥ的敏感性为６９２％、特异性８４０％、阳性预测值３２１％、阴性预测值９６２％、准确性８２６％。３频谱时间标测预测冠心病患者发生ＡＥ的特异性、阴性预测值与时域分析相似，但其敏感性、阳性预测值逊于后者（１５４％比６９２％、１２５％比３２１％）。结论：ＳＡ－ＥＣＧ时域分析是一种较好的检测心室晚电位的方法，频谱时间标测的技术和方法尚需改进。     

冠心病患者左室功能与心律失常事件关系的研究

目的 研究冠心病患者左室功能、心室晚电位与心律失常事件之间关系。方法 随机选择200例确诊为冠心病患者,进行左室功能、心室晚电位和24小时动态心电图检测及随访观察。结果 冠心病患者左室功能、心室晚电位与心律失常事件之间有非常密切关系。结论 冠心病患者进行左室功能及心室晚电位检测,对预测心律失常事件的发生有重要临床价值。     

信号平均心电图频谱时间标测预测急性心肌梗塞后心律失常事件的评价

本文前瞻性地分析了信号平均心电图(SAECG)频谱时间标测(Spectrotemporal Mapping,STM)改良方法的结果对79例急性心肌梗塞(AMI)患者梗塞后发生心律失常事件(AE)的预测价值。79例患者均行SAECG STM分析,生存者均随访1年或以上,平均随访25.3±8.7月,随访率94%。住院与随访期间共12例(15%)发生AE,其中8例为持续性室速/室颤(VTs/VF)(4例复苏失败),4例为猝死。79例中24例(30%)STM结果异常即心室晚电位(LP)阳性。LP阳性组患者发生AE危险性明显高于LP阴性组(33%对7%,P<0.01)。多因素Cox分析STM、LVEF、Holter及UCG室壁活动指数4项变量,显示STM为唯一能预测AMI后AE的指标。STM结果预测AMI后AE的敏感性、特异性、准确性及阳性与阴性预测值分别为67%、76%、75%、33%及93%;预测AMI后VTs/VF的上述指标分别为88%、76%、77%、29%及98%。     

信号平均心电图正常值调查

本文对104名正常人进行信号平均心电图检测。各参数正常值为:ORS_T:75～112ms;LAS 40≤39ms,有年龄差异;RMS_(40)≥19μV。     

冠心病心室晚电位与左室功能的关系

目的：观察心室晚电位（ＶＬＰ）、心律失常事件（ＡＥ）与左室功能之间的关系。方法：１４５例冠心病患者均进行信号平均心电图（ＳＡ－ＥＣＧ）检测和２４小时ＨＯＬＴＥＲ监测，同期进行冠状动脉造影和左室造影及随访观察。结果：１１４５例冠心病患者（心绞痛５５例、陈旧性心肌梗死９０例），随访１４１±７１（４－３６）月，发生ＡＥ７例。２ＶＬＰ阳性组左室射血分数（ＬＶＥＦ）显著降低（Ｐ＜００５）。３发生ＡＥ组ＬＶＥＦ显著降低（Ｐ＜００５）。结论：左室功能障碍者ＶＬＰ阳性率高、容易发生ＡＥ。     

The signal-averaged electrocardiogram in predicting coronary artery disease

The ability to noninvasively detect coronary artery disease (CAD) in patients undergoing diagnostic cardiac catheterization was studied using a signal-averaged electrocardiogram. An initial study of 13 patients revealed that a QRS duration greater than or equal to 100 msec, a root mean square voltage in the terminal 40 msec of the QRS less than 50 microV, and a low amplitude signal (LAS) duration greater than 28 msec were suggestive of CAD. These parameters were then used prospectively to examine 40 consecutive patients with chest pain of undetermined etiology referred for cardiac catheterization. Patients with CAD had significantly longer filtered QRS and LAS durations and lower root mean square voltages compared with patients without CAD. The sensitivity, specificity, and positive predictive value of a single parameter ranged from 62% to 76%, 74% to 89%, and 75% to 87%, respectively. Thus the signal-averaged electrocardiogram may be a useful tool in evaluating patients for the presence of CAD.     

合并结缔组织病的冠心病患者冠状动脉病变特点及冠状动脉介入治疗术预后分析

目的探讨合并结缔组织病(CTD)的冠状动脉性心脏病(CAD)患者的冠状动脉病变特点,以及接受经皮冠状动脉介入治疗术(PCI)的长期预后。方法收集106例自2009年1月至2012年12月在北京友谊医院接受PCI治疗CTD患者的临床资料,回顾性分析CTD患者的临床表现和冠状动脉病变特点等,并对CTD患者进行长期随访。结果 106例患者中有92例(86.8%)具有≥1个传统冠心病危险因素。78例(73.6%)的患者冠状动脉为多支血管病变,以前降支受累为主(65.1%)。共植入5枚金属裸支架和202枚药物涂层支架。对CTD患者进行了平均时间长达3年的随访,期间共发生主要不良心血管事件(MACE)24例(22.6%),其中心源性死亡13例(12.3%)、支架内血栓形成(ST)10例(9.4%)、靶血管再次血运重建(TVR)15例(14.2%)。结论合并CTD的CAD患者冠状动脉病变以多支病变为主。此类患者接受PCI术后不良事件以ST及TVR多见。     

Prognostic value of signal-averaged electrocardiogram in Chagas disease

Background: The value of signal-averaged ECG (SAECG) in the risk stratification of Chagas disease (ChD), a potentially lethal illness prevalent in Latin America, remains controversial. The aim of this prospective longitudinal study was t o determine the prognostic value of SAECG in ChD, using multivariate models with other established prognostic predictors, and to develop a simple prediction risk score.
Methods: The study enrolled 184 ambulatory ChD patients (107 men; age: 48 ± 12 years) in sinus rhythm and without other systemic diseases. All patients underwent comprehensive evaluation that included clinical examination, ECG, chest X-ray, 24-hour Holter monitoring, echocardiogram, stress testing, and time domain SAECG. Individual medical therapy was adjusted according to a standardized treatment regimen. The association of potential risk factors obtained by noninvasive evaluation and death was tested by Cox proportional-hazards analysis.
Results: During mean follow-up time of 74 ± 17 months, 13 patients died. Three independent prognostic factors were identified: left ventricular ejection fraction <50% (HR = 5.2, P = 0.048), ventricular tachycardia at either Holter monitoring or stress testing (HR = 9.9, P = 0.036), and prolonged (>150 ms) filtered QRS complex (HR = 4.3, P = 0.035). A prognostic score developed considering the number of risk factors of each patient had an excellent performance in predicting death ( c statistic: 0.92).
Conclusions: Prolonged filtered QRS duration obtained by SAECG is an independent predictor of death in ChD. A prediction score including three risk factors, depressed left ventricular ejection fraction, ventricular tachycardia and prolonged filtered QRS complex, has shown to be useful for stratifying risk categories in ChD.     

The impact of coronary artery disease and left ventricular ejection fraction on the prognosis of patients with peripheral artery disease

The impact of the severity of coronary artery disease (CAD) and left ventricular ejection fraction (LVEF) on the prognosis of patients with peripheral artery disease (PAD) has not been systematically studied. We retrospectively analysed 622 patients with PAD (intermittent claudication (IC): n = 446; critical limb ischaemia (CLI): n = 176). The association of SYNTAX score and LVEF with mortality was analysed using the Cox proportional hazard model. In patients with IC, a high SYNTAX score was significantly associated with mortality, whereas reduced LVEF was significantly associated with mortality in patients with CLI. The prognostic impact of CAD and LVEF appears different between patients with IC and CLI.     

SYNTAX积分预测冠心病复杂病变患者经皮冠状动脉介入治疗预后的作用

目的评价SYNTAX积分对冠心病3支病变和(或)左主干病变患者PCI预后的作用。方法经冠状动脉造影证实的3支病变和(或)左主干病变并接受PCI的患者1 90例。对每例患者造影结果进行SYNTAX评分,SYNTAX评分按三分位数分为:低分组、中分组和高分组,通过门诊或电话随访患者主要不良心脑血管事件(MACCE)。结果经PCI的冠心病3支病变和(或)左主干病变190例患者中,29例出现MACCE,发生率为15.3%。SYNTAX积分低分组、中分组及高分组的MACCE发生率分别为9.1%、1 6.2%及30.9%。Cox多因素分析显示,SYNTAX积分HR=2.07,95%CI:1.25～3.44,差异有统计学意义(P=0.005)。结论 SYNTAX积分是预测PCI预后的较理想工具,该积分系统也适用于我国冠心病3支病变和(或)左主干病变患者PCI术后预后的预测。     

内皮脂肪酶检测在冠状动脉粥样硬化性心脏病患者中的意义

目的结合血清高敏C反应蛋白（high—sensitivityC—reactionprotein,hs．CRP）,探讨血清内皮脂肪酶（endotheliallipase,EL）与冠状动脉粥样硬化性心脏病（冠心病）及冠状动脉病变程度的关系。方法对入选对象行冠状动脉造影,同步进行心电图、外周血EL、hs—CRP、肌酸激酶同工酶、心肌肌钙蛋白I参数检测和常规身体检查后设正常对照组（30例）和冠心病组（85例）;再将冠心病组分为稳定型心绞痛亚组（39例）、急性冠脉综合征亚组（46例）;同时也将85例冠心病患者分为冠状动脉单支病变（34例）亚组与多支病变（51例）亚组。比较组间外周血EL、hs．CRP浓度差异,评价两者在冠心病患者中的相关性及其与冠状动脉病变程度的相关性。结果冠心病组血清EL、hs—CRP浓度显著高于正常对照组,差异有统计学意义[EL：（762．91±72．62）μg／Lvs（368．23＋42．14）μg／L,P〈0．05：hs—CRP：（12．76±3．08）mg／Lvs（2．34±1．53）mg／L,P〈0．05]。急性冠脉综合征组血清EL及hs．CRP浓度显著高于稳定型心绞痛组,差异有统计学意义[（856．44±36．85）μg／Lvs（478．26±24．53）μg／L,P〈0．05;（21．89±4．36）mg／Lvs（5．76±6．21）mg／L,P〈0．05]。冠心病组中,51例冠状动脉多支病变患者血清EL浓度明显高于34例单支病变患者,差异有统计学意义[（817．98±51．53）μg／Lvs（705．42±34．61）μg／L,P〈0．05]。所有患者血清EL浓度与hs．CRP浓度呈正相关（r=0．327,P=0．02）。结论EL在预测冠心病中有重要价值,它们在冠心病外周血中浓度的升高可以提示冠状动脉粥样斑块的不稳定,且在预测冠状动脉病变程度方面也有一定作用。