老年冠脉旁路移植术后心电图出现异常Q波的临床评价

冠脉旁路移植术(CABG)目前已成为冠心病的主要治疗手段之一[1].心电图作为一种判断心肌电活动的有效、简单、无创的检查方法,一直以来广泛用于CABG手术患者的心电图变化分析[2],但对于患者术后心电图出现新的Q波改变,是否可作为出现围术期心肌梗死的诊断依据,尚待进一步研究证实.本文回顾性分析CABG术后出现新的Q波改变的临床意义. 1 资料与方法 1.1 临床资料 我科自2006年1月至2011年1月收治的CABG术后出现异常Q波的患者20例作为观察组,其中男17例,女3例;年龄62～76[平均(68.9±6.7)]岁;8例合并高血压、6例合并糖尿病、7例有陈旧性心肌梗死病史.     

双源CT评价冠状动脉搭桥术后桥血管通畅率的临床研究

目的比较非体外循环下冠状动脉旁路移植术（OPCABG）与常规冠状动脉旁路移植术（常规CABG）术后5年血管桥的通畅率。方法2006年1月至2008年1月间40例单独行冠状动脉旁路移植术（CABG）的患者资料回顾性地被分为OPCABG组和常规CABG组。OPCABG组通过胸骨正中切口,在非体外循环心脏不停跳下完成CABG;常规CABG组建立常规体外循环心脏停搏下完成CABG。两组术前的一般情况无明显差异。利用双源CT造影检查及CT图像后处理,研究两种术式各条血管桥的通畅情况。结果常规CABG组及OPCABG组左乳内动脉（uMA）到前降支（LAD）的通畅率都达到100％,静脉桥的通畅率分别为93．87％和94．23％,组间比较差异均无统计学意义。结论OPCABG旁路血管桥的3~5年通畅率可以和常规CABG相媲美。OPCAB治疗冠心病的初期结果显示可以减少术后并发症,减少患者术后呼吸机辅助时间、ICU留观时间和住院时间,降低住院费用。     

冠状动脉旁路移植术治疗冠心病合并中度缺血性二尖瓣反流的近远期疗效分析

目的：评估单纯冠状动脉旁路移植术（CABG）治疗冠心病合并中度缺血性二尖瓣反流的近远期效果，以探讨最佳的治疗方案。方法：2009年1月至2018年12月，共有822例冠心病合并中度缺血性二尖瓣反流的患者在首都医科大学附属北京安贞医院接受治疗，其中750例行单纯冠状动脉旁路移植术（CABG组），72例同期行二尖瓣修复（MVP）或二尖瓣置换术（MVR）(CABG+MV组)，通过倾向性评分匹配后（5:1匹配），共有384例患者纳入分析，其中CABG组320例，CABG+MV组64例。通过对比，评估两组患者外科治疗术后的效果。结果：两组患者均成功接受了手术治疗。围术期患者死亡19例，其中CABG组17例（5.3%）,CABG+MV组2例（3.1%），两组间比较差异无统计学意义（P=0.461）。围术期发生MACCE事件21例，其中CABG组18例（5.6%）,CABG+MV组3例（4.7%），两组间比较差异无统计学意义（P=0.763）。患者术后随访时间为（51.48±21.59）个月，期间死亡59例，其中CABG组50例（15.6%）,CABG+MV组9例（14.1%），两组间比较差异无统计...     

微创冠脉旁路移植术与冠脉旁路移植术治疗冠脉多支血管病变的疗效对比

目的:比较微创冠状动脉旁路移植术(MIDCAB)与冠脉旁路移植术(CABG)对老年冠心病多支病变患者的近中期疗效。方法:入选2016年至2018年于我院适合接受MIDCAB的冠脉多支病变患者72例为MIDCAB组,另外同期不宜行经皮冠脉介入治疗(PCI)的择期体外循环CABG的96例多支病变患者为CABG组。比较两组临床资料和随访2年的主要不良心脑血管事件(MACCE)。结果:MIDCAB组男性比例显著高于CABG组(83.3%比67.7%,P=0.022);与CABG组比较,MIDCAB组左前降支近端病变(61.5%比34.7%)、慢性完全闭塞病变比例(57.3%比34.7%)显著减少(P均0.01),两组其余无显著差异,P均0.05。术后随访2年,两组全因死亡率以及MACCE发生率均无显著差异,P均0.05。结论:冠脉多支病变患者行微创冠状动脉旁路移植术与冠状动脉旁路移植术的近中期疗效无显著差异,推荐对适宜患者进行微创冠状动脉旁路移植术。     

冠状动脉旁路移植术心电图对比分析

为探讨冠状动脉旁路移植术对心电图的影响,观察５４例患者冠状动脉旁路移植术前后体表心电图。结果显示术后心律失常、ＳＴ－Ｔ改变随着病情恢复逐渐减少,３～６个月复心电图时ＳＴ－Ｔ改变与术前相比差异有显著意义（Ｐ〈０．０１）。术后部分患者出现一过性一度房室传导阻滞和左心房负荷过重。冠状动脉旁路移植术后心电图示：在心肌梗死区域相关的所有导联随着Ｑ波消失或缩小并伴有ｒ波增长占１５．４％,部分导致Ｑ波消失或缩小     

经皮冠状动脉介入术和冠状动脉旁路移植术对80岁以上左前支慢性闭塞患者的疗效比较

目的：比较经皮冠状动脉（冠脉）介入术（percutaneous coronary intervention,PCI）和冠脉旁路移植术（coronary artery bypass grafting,CABG）对80岁以上老年单纯左前降支慢性闭塞患者的临床疗效。方法：自2016年1月至2020年7月,73例在我院接受PCI和CABG的80岁以上单纯左前降支慢性闭塞病变的患者为研究对象,42例患者接受PCI(PCI组),31例患者接受CABG(CABG组)。详细记录2组患者的临床特征、生化指标、住院期间和1年随访期间的主要心脏不良事件（包括死亡、心绞痛复发及因心肌缺血所致的再次血运重建等）。结果：2组患者年龄、性别构成、吸烟、高血压、糖尿病、高血脂、脑卒中、陈旧性心肌梗死、既往PCI史、外周血管疾病史及SYNTAX评分差异无统计学意义（均P>0.05）,PCI组和CABG组的手术成功率（90.5%比97.1%,P=0.473）和再次血运重建率（7.89%比2.86%,P=0.667）差异无统计学意义。与CABG组相比,PCI组的费用[（7.34±1.54）万元比（11.77±1.34...     

冠状动脉旁路移植术后心电图及心肌代谢标记物改变的临床评价

目的探讨冠状动脉旁路移植（CABG）术后心电图及心肌代谢标记物改变的临床意义，评价其在围术期心肌缺血及心梗早期诊断中的价值。方法对142例CABG术后患者进行心电图检测，每天1次，如果有心电图改变，则每天2次，连续3—5d。检测术后4—6h心肌酶谱和心肌肌钙蛋白I（cTnI），如果有异常，则连续检测3d，每天1次。结果在142例病人中，心电图单纯ST-T改变41例，其中ST段上移32例，ST段下移9例，出现Q波者10例，其中单纯Q波者7例，伴ST段抬高3例，无阳性改变91例。CK-MB阳性8例。cTnI阳性5例。诊断围术期心梗2例。结论CABG术后心电图及心肌代谢标记物的改变须综合分析，结合麻醉、手术过程和病人病情特点可有效提高围术期心肌缺血及心梗的早期诊断。     

急性冠脉综合征患者冠状动脉旁路移植术后血清NT-proBNP、Cys-C、cTnⅠ水平变化及其与预后的关系

目的 研究急性冠脉综合征（ACS）患者冠状动脉旁路移植术（CABG）后血清N末端B型脑钠肽前体（NT-proBNP）、胱抑素C(Cys-C)和心肌肌钙蛋白Ⅰ(cTnⅠ)水平变化及其与早期预后的关系。方法 选取2018年1月至2021年12月拟行CABG的179例ACS患者开展前瞻性研究,于术前1 d及术后1～3 d分别采集晨起外周静脉血3 mL,检测血清NT-proBNP、Cys-C、cTnⅠ水平。随访6个月内主要不良心血管事件（MACE）发生情况,并将患者分为MACE组和对照组,比较两组基线资料及术后血清NT-proBNP、Cys-C、cTnⅠ水平变化,采用logistic回归模型分析各指标与预后的关系及其对MACE的预测价值。结果 179例ACS患者CABG术后6个月内发生MACE者43例（24.02%）,包括急性心肌梗死26例（14.53%）,靶血管重建12例（6.70%）及心源性死亡5例（2.79%）。MACE组年龄≥65岁、手术时间≥3.5 h及体外循环患者占比明显高于对照组（P<0.05）,两组其他基线资料比较差异均无统计学意义（P>0.05）;MACE组术后血...     

冠状动脉内膜剥脱术在冠心病外科治疗的中远期疗效研究

的：探讨冠状动脉内膜剥脱在弥漫性冠状动脉病变患者外科治疗的中远期疗效。方法:2013年12月-2019年12月,安贞医院单一医疗组共实行58例冠状动脉旁路移植术(CABG)联合冠状动脉内膜剥脱术(CE),行常规旁路移植术388例,通过1:1倾向性评分匹配(PSM)得到CE+CABG组和CABG组各58例,分析两组患者的围术期资料。术后随访9~74个月评价桥血管通畅性,绘制生存分析曲线,评价患者中远期疗效。结果:两组在术后30d病死率、围术期心肌梗死、卒中、主动脉内球囊反搏使用率,重症监护室时间、血管移植数等,差异无统计学意义。手术时间有明显差异(P<0.01)。随访9~74个月,CE+CABG组1例死亡,CABG组无死亡,两组中远期生存率无明显差异,中远期桥血管通畅率无明显差异。结论:CE+CABG能实现弥漫性冠状动脉病变血运重建,CE+CABG组与单独CABG组中远期疗效无明显差异。     

间歇性异常Q波26例分析

急性心肌梗死时,在心电图上可以出现异常Q波或QS波,这种波对急性心肌梗死的诊断价值较高,故临床上称之为梗死性Q波（或QS波）.但是,同样的波形也可以出现于非心肌梗死性疾病中,称为非梗死性Q波（或QS波）,两者仅从心电图图形上难以区分.     

Relation between QRS changes and left ventricular function after coronary artery bypass grafting

Preoperative and serial postoperative electrocar-diograms (ECGs) were reviewed in 104 patients undergoing rest and exercise radionuclide angiocardiography before and 1 to 12 months after coronary artery bypass grafting (CABG). Five patient groups were defined by ECG findings before and after CABG: Group I—normal ECG before and no ECG change after CABG; Group II—prior myocardial infarction by ECG before but no QRS change after CABG; Group III—all patients with a minor QRS change (< 0.04-second Q wave, loss of R-wave amplitude) after CABG; Group IV—all patients with a major QRS change (≥ 0.04-second Q wave) after CABG; Group V—all patients without new Q waves or loss of R-wave amplitude but with a major QRS change (conduction disturbance) after CABG. Mean resting ejection fraction changed little after CABG in all groups, although the 0.03 increase in Group I was significant (p < 0.05). Group IV had the largest decrease in resting ejection fraction after CABG (0.04), but this was not statistically significant. Mean exercise ejection fraction increased significantly (p < 0.0001) in Groups I, II and III but not in Groups IV and V. QRS changes do not consistently reflect impairment of left ventricular (LV) function after CABG.     

冠脉造影正常心电图提示缺血改变患者的临床病因分析

目的 探讨心电图有缺血性改变(ST-T异常或有病理性Q波)的冠状动脉造影正常患者可能存在的病因及其发病机理.方法选择曾在我院住院,心电图有缺血性改变(ST-T异常或有病理性Q波),伴或不伴胸闷、胸痛临床症状而冠状动脉造影正常的患者608例(其中心电图ST-T异常526例,异常Q 波52例,同时有ST-T异常和异常Q 波30例,心电图异常伴胸闷、胸痛的446例).冠脉造影显示病变狭窄≥50%诊断为冠心病,＜50%定义为冠脉造影正常.结果 608例冠脉造影正常患者中,高血压365例、心血管神经症84例、X综合征41例、心瓣膜病26例,这些疾病为患者主要病因,患者心电图异常或出现胸闷、胸痛症状可能与上述疾病有关.结论高血压、心血管神经症、X综合征、心瓣膜病为心电图有缺血性改变,伴或不伴胸闷、胸痛临床症状而冠脉造影正常患者的主要病因,患者心电图异常或出现胸闷、胸痛症状可能与这些疾病有关.     

Association between new electrocardiographic abnormalities after coronary revascularization and five-year cardiac mortality in BARI randomized and registry patients

There are few data comparing the relative frequency of new electrocardiographic (ECG) abnormalities after coronary artery bypass grafting (CABG) compared with percutaneous transluminal coronary angioplasty (PTCA) and their association with long-term cardiac mortality. The study population consisted of 3,373 patients who were either randomized or eligible to be randomized to CABG or PTCA in the BARI trial. The frequency of new postprocedural ECG abnormalities was significantly greater after a CABG procedure than after PTCA. The incidence of new postprocedural major Q waves, ST-segment elevation, and T-wave abnormalities were significantly more frequent after CABG. After PTCA (n = 1,869), the 5-year cardiac mortality rates associated with the new development of major Q waves, ST-segment elevation, ST-segment depression, T-wave abnormalities, or no abnormality was 18.1%, 8.5%, 8.9%, 6.0%, and 5.4%, respectively. After CABG (n = 1,427), 5-year cardiac mortality rates were 8.0%, 4.2%, 3.8%, 2.8%, and 3.7%, respectively. The adjusted relative risk of 5-year cardiac mortality for new Q-wave abnormalities was 2.6 after CABG (p <0.04) and 4.6 after PTCA (p <0.01). Thus, patients who undergo CABG have more postinitial procedural ECG abnormalities than patients who undergo PTCA. Cardiac mortality is significantly increased by the new development of postprocedural Minnesota code Q-wave abnormalities regardless of whether patients undergo CABG or PTCA.     

Electrocardiogram in centenarians

BACKGROUND: Electrocardiographic abnormalities in the very elderly have not yet been fully assessed. AIM: To evaluate ECG recordings obtained from centenarians. METHODS: ECG tracings recorded at place of residence of 35 subjects aged 100-112 years (mean 101.7 years) were examined using the Minnesota code. RESULTS: Entirely normal ECG recordings were found in 5.7% of centenarians. The most frequently encountered abnormalities included leftward QRS axis deviation (45.7%), abnormal T wave morphology (42.9%), ST segment depression (34.3%), extrasystolic beats (28.6%), left anterior haemiblock (25.7%) and first degree atrio-ventricular block (17.1%). Other, less frequently present abnormalities, included Q wave or QS complex, atrial fibrillation, right or left bundle branch block, left ventricular hypertrophy or low QRS voltage. CONCLUSIONS: In the majority of centenarians ECG shows numerous but usually benign abnormalities. Only very few centenarians have entirely normal ECG.     

Prognostic significance of the electrocardiogram after Q wave myocardial infarction. The Framingham Study

The prognostic value of abnormalities on the electrocardiogram (ECG) present 1 year after initial myocardial infarction (MI) is examined in relation to reinfarction and coronary death throughout 32 years (mean, 10.1 years) of follow-up in the Framingham Heart Study. Resting 12-lead ECGs were available in 251 survivors (190 men and 61 women) of clinically recognized Q wave MI. The ECG reverted to normal in 31 (12.4%) cases and was abnormal but without Q waves in 37 (14.7%). Q waves persisted without other significant abnormalities in 108 (43.0%) and with other abnormalities in 75 (29.9%) cases. Electrocardiographic abnormalities at follow-up were more common in women and in those persons whose initial MI was anterior as compared with inferior. Nonspecific T wave, ST segment changes, and electrocardiographic left ventricular hypertrophy on the ECG before or after MI were powerful predictors (p less than 0.01) of coronary death. The relation of these residual post-MI electrocardiographic findings to reinfarction and coronary death was assessed by Cox regression analysis. The follow-up electrocardiographic status was unrelated to the risk of subsequent reinfarction. Subjects who lost Q wave evidence of MI but whose ECG continued to show evidence of repolarization abnormalities, left ventricular hypertrophy, or blocked intraventricular conduction were at a 3.5-fold increased risk (p less than 0.01) of coronary death as compared with those reverting to a normal ECG. Persons with a persistent Q wave MI accompanied by these abnormalities were at a 2.7-fold excess risk (p = 0.01) of coronary death as compared with those with a normalized ECG. These findings remained significant when considering age and standard coronary risk factors. The presence of other electrocardiographic abnormalities without persistent Q waves yields a worse prognosis than a Q wave persisting alone. The prognostic value of a follow-up ECG with abnormalities other than a persistent Q wave MI also remained after considering the effects of left ventricular hypertrophy and cardiac enlargement on x-ray, functional classification, and diuretic usage. Specific electrocardiographic abnormalities present before infarction, however, were potent indicators of long-term prognosis prognosis and diminished the importance of the follow-up ECG. Although survival after initial MI is improved only if the ECG reverts to normal, information on electrocardiographic abnormalities before MI can be especially useful in evaluating long-term risk.     

冠心病冠状动脉搭桥术后心电图的动态变化

目的　探讨冠心病冠状动脉搭桥术 (CABG)后心电图的动态变化。方法　回顾性比较 2 9例冠心病 CABG成功者术前与术后 1周、2～ 3周、2月及 3月等不同阶段 12导联心电图的变化。结果　与术前 (5 .6± 2 .6天 )比较 ,异常 Q波和 T波低平、双向的发生在术后第 1周显著增多 (16 .7%与 11.5 % ,P<0 .0 5 ,8.0 %与 2 .6 % ,P<0 .0 1) ,此后 ,异常 Q波的发生显著减少 (P<0 .0 5 ) ,T波低平或双向的发生则持续到第 2～ 3周后恢复到术前水平。 ST段压低 >1.0 m m和 T波倒置在术后第 2～ 3周、第 2月显著增多(5 .5 %、6 .3%与 2 .3% ,P<0 .0 5 ;31.3%、2 7.0 %与 17.8% ,P<0 .0 1) ,此后 ST段压低者减少到术前水平 ,T波倒置非常显著地减少 (9.2 %与 17.8% ,P<0 .0 1)。结论　冠心病病人 CABG术后出现早期一过性异常 Q波、T波低平或双向、ST段压低变化 ,此后上述改变逐渐减少恢复到术前水平。     

Relationship between electrocardiographic patterns and angiographic features in isolated left circumflex coronary artery disease.

The relation of electrocardiographic (ECG) patterns to clinical and angiographic features was assessed in 89 patients with isolated left circumflex coronary artery (LCx) disease (46 with and 43 without myocardial infarction). ECG abnormalities were present in 75 patients; there were isolated Q waves in 20, an abnormal R wave in lead V1 with or without inferior and/or lateral Q waves in 21, and isolated ST-T wave changes in 34 cases. Inferior abnormalities on the electrocardiogram were similar in patients with proximal or distal stenoses of the LCx, but an abnormal R wave in lead V1 correlated with proximal LCx stenosis (p less than 0.01). Lateral abnormalities were more common in stenoses of the obtuse marginal branch and proximal LCx than in distal stenosis (all p less than 0.01). Compared with patients without myocardial infarction with or without ST-T-wave changes and those with infarction without an abnormal R wave in lead V1, patients with LCx-related infarction and an abnormal R wave in lead V1 associated with inferior and/or lateral Q waves had larger left ventricular end-diastolic and end-systolic volumes, lower ejection fraction, higher incidence of total occlusion of proximal LCx without collateral vessels, and more cardiac events during follow-up. This study suggests that an abnormal R wave in lead V1 associated with lateral abnormalities on the standard electrocardiogram may be clinically useful in predicting proximal LCx stenosis and identifying a subset of postinfarction patients with left ventricular dysfunction due to a large infarct size.     

Myonecrosis After Revascularization Procedures

The detection of elevated cardiac enzyme levels and the occurrence of electrocardiographic (ECG) abnormalities after revascularization procedures have been the subject of recent controversy. This report represents an effort to achieve a consensus among a group of researchers with data on this subject. Creatine kinase (CK) or CK-MB isoenzyme (CK-MB) elevations occur in 5% to 30% of patients after a percutaneous intervention and commonly during coronary artery bypass graft surgery (CABG). Although Q wave formation is rare, other ECG changes are common. The rate of detection is highly dependent on the intensity of enzyme and ECG measurement. Because most events occur without the development of a Q wave, the ECG will not definitively diagnose them; even the ECG criteria for Q wave formation signifying an important clinical event have been variable. At least 10 studies evaluating >10,000 patients undergoing percutaneous intervention have demonstrated that elevation of CK or CK-MB is associated not only with a higher mortality, but also with a higher risk of subsequent cardiac events and higher cost. Efforts to identify a specific cutoff value below which the prognosis is not impaired have not been successful. Rather, the risk of adverse outcomes increases with any elevation of CK or CK-MB and increases further in proportion to the level of intervention. This information complements similar previous data on CABG. Obtaining preprocedural and postprocedural ECGs and measurement of serial cardiac enzymes after revascularization are recommended. Patients with enzyme levels elevated more than threefold above the upper limit of normal or with ECG changes diagnostic for Q wave myocardial infarction (MI) should be treated as patients with an MI. Patients with more modest elevations should be observed carefully. Clinical trials should ensure systematic evaluation for myocardial necrosis, with attention paid to multivariable analysis of risk factors for poor long-term outcome, to determine the extent to which enzyme elevation is an independent risk factor after considering clinical history, coronary anatomy, left ventricular function and clinical evidence of ischemia. In addition, tracking of enzyme levels in clinical trials is needed to determine whether interventions that reduce periprocedural enzyme elevation also improve mortality.     

Mechanisms of abnormal Q waves in hypertrophic cardiomyopathy assessed by intracoronary electrocardiography

INTRODUCTION: To clarify the mechanisms of abnormal Q waves in hypertrophic cardiomyopathy (HCM), local epicardial electrical activities were assessed by intracoronary electrocardiography (ECG). METHODS AND RESULTS: Unipolar intracoronary ECG was recorded by introducing a guide wire for angioplasty into the left anterior descending artery (LAD) in 20 patients with HCM and 10 control subjects. Intracoronary ECG showed no Q waves in any control subjects. Intracoronary ECG showed no Q waves in 8 HCM patients without abnormal Q waves on surface ECG. In 12 HCM patients with abnormal Q waves on surface ECG, 4 showed Q waves on intracoronary ECG associated with regional wall-motion abnormalities, suggesting Q waves are formed by loss of electrical forces due to transmural myocardial fibrosis. The remaining 8 patients, who did not have Q waves on intracoronary ECG, showed greater thickening of the basal free wall than the apical free wall, with no wall-motion abnormalities. Intracoronary ECG was characterized by increased R or R' waves and prolonged R peak times at the proximal LAD, suggesting Q waves are formed by increased electrical forces of hypertrophied basal septal and/or ventricular free wall, unopposed by apical forces. CONCLUSION: The study findings provide evidence for two mechanisms of abnormal Q waves in HCM: (1) loss of electrical forces due to transmural myocardial fibrosis, and (2) altered direction of resultant initial QRS vector due to increased electrical forces of disproportionate hypertrophy of the basal septal and/or ventricular free wall, unopposed by apical forces.     

冠状动脉旁路移植术后ST-T改变的临床意义及评价

目的:探讨冠状动脉旁路移植术(CABG)后ST-T改变的临床意义. 方法:对2001年12月～2002年7月500例CABG患者术后进行心电图检测,每天1次,连续3天.如果有心电图改变,则每天两次,连续3天,并记录出院时的心电图.术后4～6小时,术后第1天上午7点,检查心肌酶谱和肌钙蛋白T(cTnT),如果有不正常,则连续检查3天,每天1次.结果:在500例患者中心电图出现ST-T改变有37例,同时cTnT阳性有10例.ST段抬高合并QRS波群改变5例中4例有cTnT阳性,ST段抬高合并高尖T波8例,2例cTnT阳性.右束支阻滞2例,都有cTnT阳性改变,ST段下移1例,广泛ST段抬高1例.肌酸激酶MB同工酶高于正常3倍只有5例,其中ST段抬高合并QRS波群改变3例,ST段下移1例,右束支阻滞1例.异常T波8例,单纯ST段抬高都不合并cTnT改变.ST段抬高合并QRS波群改变5例中3例进行了再次手术并应用了主动脉球囊反搏(IABP),这3例出院时心电图表现为陈旧性心肌梗死.广泛ST段抬高2例证实有急性心包积液,在出院时,ST段恢复到基线.结论:CABG后ST-T改变需综合分析,心电图的动态表现和心肌坏死的血清心肌标记物浓度的动态变化可诊断围手术期心肌梗死.