碎裂QRS波对陈旧性心肌梗死的诊断价值

目的:分析心电图碎裂QRS波对陈旧性心肌梗死的诊断价值。方法:选择78例经冠脉造影诊断为冠心病的患者,应用心肌核素断层显像技术识别心肌缺血和心肌瘢痕,并以核素显像作对照,观察碎裂QRS波、病理性Q波、碎裂QRS波合并病理性Q波对陈旧性心肌梗死诊断的敏感性、特异性、准确性、阳性预测值和阴性预测值。结果:78例患者中有65例碎裂QRS波、病理性Q波,碎裂QRS波合并病理性Q波与无灌注的心肌瘢痕有关,2例碎裂QRS波跨越冠脉心肌供血区域分布,有11例显示心肌大范围灌注不良,提示心肌缺血;碎裂QRS波诊断陈旧性心肌梗死的敏感性(81.8%)明显高于病理性Q波(37.5%)(P<0.001),特异性(85.7%)低于病理性Q波(96.2%)(P<0.05),结合碎裂QRS波和病理性Q波,对陈旧性心肌梗死的诊断具有更高的敏感性(94.4%)(P<0.001),碎裂QRS波的诊断效率(0.83)明显高于病理性Q波(0.67)(P<0.001)。结论:碎裂QRS波对陈旧性心肌梗死有重要的诊断价值,其诊断效率明显高于病理性Q波,碎裂QRS波结合病理性Q波可提高诊断的敏感性和准确性。     

心电图碎裂QRS波与病理性Q波联合诊断急性心肌梗死的临床价值

目的 分析心电图碎裂QRS波与病理性Q波联合诊断急性心肌梗死(AMI)的临床价值.方法 将我院2017年1月至2019年12月收治的112例AMI患者纳入本次研究,所有患者均给予心电图检查.以病理诊断结果为金标准,比较碎裂QRS波、病理性Q波单一及联合诊断AMI的准确度、灵敏度、特异度、阳性预测值与阴性预测值.结果 联...     

Poincare散点图、心电图QRS碎裂波在心肌梗死诊断中的应用

目的分析在心肌梗死患者临床诊断中联合应用Poincare散点图与心电图QRS碎裂波(fQRS)的诊断价值。方法选取2017年6月至2019年1月100例心肌梗死患者为回顾分析对象,依据患者的心电图QRS波形及Poincare散点图形状分为A组(有fQRS波的彗星状散点图患者,n=35)、B组(有fQRS波的非彗星状散点图患者,n=32)、C组(无fQRS波患者,n=33)。比较三组患者冠脉造影的病变范围和冠脉狭窄严重程度。结果 A组患者的多支病变发生率显著高于B组和C组患者,差异有统计学意义(P0.05);B组患者的多支病变发生率显著高于C组患者,差异有统计学意义(P0.05);A组患者的冠脉狭窄严重程度显著高于B组和C组患者。A组患者的冠脉完全闭塞占比高达57.14%(20/35),高于B组[21.88%(7/32)]和C组[18.18%(6/33)],差异有统计学意义(P0.05);B组患者和C组患者的冠脉狭窄严重程度比较差异未见统计学意义(P0.05)。结论在心肌梗死患者诊断中通过联合应用Poincare散点图与fQRS可提高诊断价值,且具有无创性和安全性高等优势,值得在临床中应用和推广。     

Poincare散点图与心电图QRS碎裂波联合应用于心肌梗死诊断的价值分析

目的探讨Poincare散点图与心电图QRS碎裂波(fQRS)联合应用于心肌梗死的诊断价值。方法选取2015年9月至2019年5月80例急性心肌梗死患者作为研究组,另选取同期收治不明原因胸痛、冠状动脉造影检查未见冠状动脉狭窄的80例患者作为对照组,两组患者均予以Poincare散点图及心电图QRS碎裂波检查,指定同一名高年资、高职称临床医生完成相关操作,准确记录相关检查结果并输入统计学软件后得出结论。结果研究组Poincare散点图非彗星状与心电图QRS碎裂波所占比例[93.75%(75/80)、31.25%(25/80)]均显著高于对照组[7.50%(6/80)、0.00%(0/80)],差异有统计学意义(P0.05)。结论 Poincare散点图与心电图QRS碎裂波联合应用于急性心肌梗死诊断工作中具有重要的临床价值。     

碎裂QRS波在急性ST段抬高型心肌梗死中的临床价值

目的探讨碎裂QRS波在急性ST段抬高型心肌梗死中的临床价值。方法回顾分析经急诊介入术的急性ST段抬高型心肌梗死362例,根据入院时是否存在f QRS波分为f QRS组和N-f QRS组,通过观察临床资料、冠状动脉造影、超声心动图以及住院期间心脏事件发生率,对比2组间的差异。结果 362例患者f QRS组132例,N-f QRS组230例,f QRS发生率36.46%,f QRS组较N-f QRS组心肌酶升高、发病到入院时间延长,差异有统计学意义(P<0.05);冠状动脉造影提示f QRS组比N-f QRS组更多见前降支、多支血管病变者(53.8%vs 38.7%,50.8%vs 33.9%,P<0.05);超声心动图显示左心室射血分数更低(P=0.001),左心室室壁瘤(P=0.001)和住院期间恶心心律失常发生率增高(P<0.05),心功能Killip 3~4级发生率高(P=0.001),但心源性死亡两组未见异常(P=0.132)。结论 f QRS波可以协助判断急性ST段抬高型心肌梗死血管病变以及心功能、恶性心律失常发生,可作为预测住院期期预后的一个心电学指标。     

碎裂QRS波群的研究现状

碎裂QRS波群(fragmented QRS complexes,fQRS)在相关疾病的预测和防治中具有明显的优势,已成为近年来备受关注的一项新的心源性猝死的预敬指标,现对其概念病理生理、发生机制及临床意义进行综述.     

心电图碎裂QRS波对冠心病的诊断价值

目的 探讨心电图碎裂QRS波对冠心病的诊断价值.方法 选择2019年1月至2019年12月济源市人民医院收治的300例疑似冠心病(CAD)患者为研究对象,均行冠状动脉造影术及心电图检查,将冠状动脉造影术的结果作为金标准,比较两组患者心电图破裂QRS波的诊断效能,比较患者间的血管支数、罪犯血管、狭窄程度心电图破裂QRS检...     

陈旧性心肌梗死患者碎裂QRS波群与室性心律失常关系的研究

碎裂QRS波群（fragmented-QRS,fQRS）系指两个或两个以上连续导联QRS波群呈三相或多相波,并排除了束支传导阻滞等,是近年来备受重视的一项新的心脏性猝死预警指标。其最常见于冠心病,尤其是心肌梗死患者。电生理研究认为,fQRS波群是心室碎裂电位的反映,标志着患者存在发生室性心律失常事件的病理基础,两者之间存在紧密的内在联系。本次研究旨在探讨fQRS波群在预测陈旧性心肌梗死患者发生室性心律失常中的价值。现报道如下。     

aVR导联QRS波形态对下壁心肌梗死的鉴别诊断意义

目的 探讨aVR导联QRS波形态对下壁心肌梗死的鉴别诊断意义.方法 分析52例Ⅲ、aVF导联均为病理性Q波患者的aVR导联QRS波形态,并与选择性冠状动脉造影结果对照.结果 aVR导联QRS波呈rS(s)型、QS(qs)型和Q(q)r型的患者分别为13例、10例和29例,三种形态与冠状动脉造影结果比较显示右冠状动脉或左回旋支有狭窄、闭塞病变的患者分别为12例、4例和0例,差异有统计学意义(χ2=35.56,P=0.000).结论 aVR导联QRS波形态对Ⅲ、aVF导联均为病理性Q波患者具有鉴别诊断意义.aVR导联QRS波呈Q(q)r型,可排除陈旧性下壁心肌梗死;aVR导联QRS波呈rS(s)型,可基本确定有陈旧性下壁心肌梗死.     

超声心动图联合心电图QRS碎裂波诊断心肌梗死的临床价值

目的探讨超声心动图检测左室功能指标联合心电图QRS碎裂波(fQRS)与冠状动脉病变及室性心律失常等临床特点的关系。方法将117例心肌梗死患者根据十二导联心电图QRS波形态分为fQRS波组(75例)及无fQRS波组(42例),其中fQRS波组又根据左室射血分数(LVEF)情况分为LVEF下降组(A组)和左室射血分数正常组(B组),无fQRS波组简称为C组。分析各组冠状动脉造影结果,采用动态心电图分析室性心律失常,并进行组间对比。结果冠状动脉造影:A组冠状动脉单支病变3例(6.7%),多支病变42例(93.3%);B组冠状动脉单支病变8例(26.7%),多支病变22例(73.3%);C组冠状动脉单支病变29例(69.04%),多支病变13例(30.96%),其中B、C组多支病变百分比较A组小,差异有统计学意义(P0.05)。A组完全性闭塞发生率(51.1%)显著高于B组(13.3%),C组(7.14%),差异均有统计学意义(均P0.05)。室性心律失常分析:室性期前收缩Lown分级Ⅲ级、ⅣA级、ⅣB级比较,其中A组ⅣB级发生率(35.6%)高于B组(3.33%)、C组(0);C组ⅣA级发生率(19%)明显低于A组(48.9%)、B组(33.3%),差异有统计学意义(均P0.05)。超声心动图检测:左室舒张末期内径A组(51.11±8.44)mm与B组(50.99±7.34)mm、C组(48.76±6.53)mm比较差异均无统计学意义。结论心肌梗死患者LVEF下降合并fQRS波者冠状动脉多支病变,冠状动脉完全性闭塞及严重室性心律失常发生率明显高于LVEF正常合并fQRS波及无fQRS波者,两项指标联合应用对高危心肌梗死预警有一定临床意义。     

aVR导联QRS波形态对下壁心肌梗死的鉴别诊断意义

Objective To investigate the value of differential diagnosis of the configuration of QRS complex in lead aVR in patients with inferior wall myocardial infarction. Methods The configuration of QRS in 52 patients with pathological Q-wave both in lead Ⅲ and aVF were analyzed and the result of selective coronary arteriography was compared. Results 13 patients with the configuration of QRS in lead aVR appeared rS ( s), while 10 patients appeared QS(qs) and 29 Q(q)r,correlated with 12,4 and 0 patients with coronary arteriography showed stenosis or occlusion lesion in fight coronary artery or left circumflex artery (χ2 = 35.56, P = 0.000). Conclusions The con-figuration of QRS in lead aVR is helpful to differential diagnosis of the patients with pathological Q-wave both in lead Ⅲ and aVF. Patients with the configuration of QRS in lead aVR appear rS(s) could be diagnosed as old myocardial infarction,but excluded from old myocardial infarction while appearing Q(q)r.     

碎裂QRS波群与陈旧性心肌梗死患者心率变异性分析及室性心律失常发生情况的关系

目的探讨碎裂QRS波群与陈旧性心肌梗死患者心率变异性分析(heart rate variability,HRV)及室性心律失常发生情况的关系。方法2018年8月至2019年10月首次就诊于河北北方学院附属第一医院心脏功能检查科的陈旧性心肌梗死患者200例,依据患者首次就诊于我院的病例库资料及常规十二导联心电图诊断分为陈旧性心肌梗死碎裂QRS波群组99例与陈旧性心肌梗死无碎裂QRS波群组101例,之后回顾性分析患者出院后1年内复查的24 h动态心电图,采用χ^(2)检验比较两组室性心律失常的发生情况,秩和检验比较两组心率变异性的差异,采用多元Logistic回归分析心率变异性不同指标的对陈旧性心肌梗死碎裂QRS波群的评估价值,绘制受试者工作特性曲线(receiver operating characteristic,ROC),通过曲线下面积(area under the curve,AUC)分析心率变异性不同指标的对陈旧性心肌梗死碎裂QRS波群的诊断准确性。结果依据室性期前收缩Lown分级,Lown分级室性期前收缩Ⅰ级、室性期前收缩Ⅲ-Ⅴ级患者室性心律失常发生率陈旧性心肌梗死碎裂QRS组均高于陈旧性心肌梗死无碎裂QRS组[室性期前收缩Ⅰ级:54.5%(54/99)与39.6%(40/101)(χ^(2)=4.484,P<0.05;室性期前收缩Ⅲ-Ⅴ级:34.3%(34/99)与9.9%(10/101)(χ^(2)=17.406,P<0.05)]。室性期前收缩0级陈旧性心肌梗死碎裂QRS组发生率为8.1%(8/99),低于陈旧性心肌梗死无碎裂QRS组48.5%(49/101)(χ^(2)=37.995,P<0.05)。室性心律失常陈旧性心肌梗死碎裂QRS波群组发生率为91.9%(91/99)高于陈旧性心肌梗死无碎裂QRS波群组51.5%(52/101)(χ^(2)=57.146,P<0.05)。室性期前收缩Ⅱ级陈旧性心肌梗死碎裂QRS组室性心律失常阳性发生例数与陈旧性心肌梗死无碎裂QRS组之间比较差异无统计学意义(P>0.05)。陈旧性心肌梗死碎裂QRS波群组较陈旧性心肌梗死无碎裂QRS波群组HRV时域指标全部窦性心搏间期的标准差(standard diviation of NN intervals,SDNN)、窦性心搏间期均值的标准差(standard diviation of average NN intervals,SDANN)偏高[SDNN:143.00(122.00,166.00)与110.00(95.00,130.50),Z=5.780,P<0.05;SDANN:112.00(100.00,136.00)与96.00(76.00,118.50),Z=4.013,P<0.05]。多元Logistic回归分析HRV不同指标显示,HRV时域指标SDNN、SDANN诊断陈旧性心肌梗死后碎裂QRS波均有统计学意义(SDNN:OR=0.949,95%CI:0.922~0.977,P<0.001;SDANN:OR=1.036,95%CI:1.005~1.068,P=0.022),HRV时域指标SDNN、SDANN的ROC曲线下面积显示,SDNN、SDANN对于陈旧性心肌梗死后碎裂QRS波具有一定诊断准确性(SDNN:AUC:0.737,95%CI:0.666~0.807,灵敏度:0.818,特异度:0.634;SDANN:AUC:0.664,95%CI:0.587~0.741,灵敏度:0.737,特异度:0.673。0.5     

Value of post-resuscitation electrocardiogram in the diagnosis of acute myocardial infarction in out-of-hospital cardiac arrest patients

Background

Diagnosis of acute myocardial infarction (AMI) in out-of-hospital cardiac arrest (OHCA) patients is important because immediate coronary angiography with coronary angioplasty could improve outcome in this setting. However, the value of acute post-resuscitation electrocardiographic (ECG) data for the detection of AMI is debatable.

Methods

We assessed the diagnostic characteristics of post-resuscitation ECG changes in a retrospective single centre study evaluating several ECG criteria of selection of patients undergoing AMI, in order to improve sensitivity, even at the expense of specificity. Immediate post resuscitation coronary angiogram was performed in all patients. AMI was defined angiographically using coronary flow and plaque morphology criteria.

Results

We included 165 consecutive patients aged 56 (IQR 48-67) with sustained return of spontaneous circulation after OHCA between 2002 and 2008. 84 patients had shockable, 73 non-shockable and 8 unknown initial rhythm; 36% of the patients had an AMI. ST-segment elevation predicted AMI with 88% sensitivity and 84% specificity. The criterion including ST-segment elevation and/or depression had 95% sensitivity and 62% specificity. The combined criterion including ST-segment elevation and/or depression, and/or non-specific wide QRS complex and/or left bundle branch block provided a sensitivity and negative predictive value of 100%, a specificity of 46% and a positive predictive value of 52%.

Conclusion

In patients with OHCA without obvious non-cardiac causes, selection for coronary angiogram based on the combined criterion would detect all AMI and avoid the performance of the procedure in 30% of the patients, in whom coronary angiogram did not have a therapeutic role.     

常规十二导联诊断急性下壁心肌梗塞的效果观察

目的：以单纯性下壁心肌梗塞为对照,探讨右室心肌梗塞合并急性下壁心肌梗塞的12导联心电图特征.材料与方法：2010年1月至2013年8月间诊治的22例右室心肌梗塞合并急性下壁心肌梗塞患者列入研究组,同期48例单纯下壁心肌梗塞患者列入对照组,回顾性观察两组患者常规12导联心电图特征,并进行比较分析.结果：ST段抬高幅度比较,研究组Ⅲ＞ⅡI的检出率为90.1％,对照组仅4.2％,研究组明显高于对照组,数据经统计学比较具有极显著差异（P＜0.01）,检验特异性为90.1％;ST段在V2导联中压低幅度和aVF导联中抬高幅度的比值比较,研究组≤0.5的患者比例为81.8％,明显高于对照组的比例4.2％,数据经统计学比较具有极显著差异（P＜0.01）,检验特异性为90％.结论：利用常规12导联心电图诊断急性下壁心肌梗塞是否合并有右室心肌梗塞具有较高的特异性和敏感性,当ST段抬高幅度出现Ⅲ＞ Ⅱ时,或ST段在V2导联中压低幅度和aVF导联中抬高幅度的比值≤0.5时,均提示较大可能性的右室心肌梗塞发生.     

非ST段抬高心肌梗死216例临床回顾性分析

目的分析216例非ST段抬高心肌梗死（NSTEMI）的临床特点。方法采用回顾性分析方法,将786例急性心肌梗死连续病例分为NSTEMI组（216例）及ST段抬高心肌梗死（STEMI）组（570例）,比较两组间的临床特点。结果两组比较：（1）STEMI患者数明显多于NSTEMI患者（P〈0.01）,比率是2.6∶1。（2）老年患者（≥65岁）、无胸痛、原发性高血压、2型糖尿病、脂质代谢紊乱、左主干冠脉病变患者、漏诊在NSTEMI组显著高于STEMI组（P〈0.05,P〈0.01）。（3）CTnT≥3.0ng/ml、接受冠脉造影检查、行经皮冠脉介入治疗或冠脉旁路移植治疗、LVEF≤55%、室壁瘤（30d）患者在STEMI组显著高于NSTEMI组（P〈0.05,P〈0.01）。（4）吸烟、冠脉无明显病变、单支至三支病变、急性左心衰竭、心源性休克、室速/室颤、Ⅱ～Ⅲ度AVB及死亡两组间无统计学差异（均P〉0.05）。（5）多元逐步回归分析显示恶性心律失常及年龄≥70岁分别是影响NSTEMI死亡的重要因素。结论NSTEMI患者年龄大、危险因素多、左主干冠脉病变多,接受规范治疗少,并发症及死亡率与STEMI患者相似,因此NSTEMI是不可忽视的预后不良的严重疾病。不典型的胸痛及心电图改变容易漏误诊。     

Electrocardiographic manifestations: acute inferior wall myocardial infarction

The 12-lead electrocardiogram (EKG) is an important tool in evaluating the patient with acute myocardial infarction (MI). Patients with acute inferior wall myocardial infarction (IWMI) represent a heterogeneous group in terms of morbidity, mortality, Emergency Department (ED) management, and site of occlusion in the culprit coronary artery. The standard 12-lead EKG, right-sided chest leads and posterior chest leads, in conjunction with clinical findings often provide the necessary information for the Emergency Physician (EP) to predict complications, morbidity and mortality. IWMI patients may have associated right ventricular infarction (RVI) or lateral and posterior wall extension. Each of these entities is associated with specific hemodynamic abnormalities and increased mortality. In addition, various atrioventricular (AV) blocks are commonly associated with IWMI. This article presents several cases of IWMI with EKGs and a discussion of EKG interpretation in the setting of IWMI.     

Prevalence of right ventricular myocardial infarction in patients with acute inferior wall myocardial infarction

The objective was to evaluate the prevalence of right ventricular myocardial infarction (RVMI) in patients with acute inferior wall myocardial infarction (IWMI) admitted to the National Institute of Cardiovascular Diseases, Karachi, Pakistan. Between August 2000 and May 2001, a total of 100 patients with acute IWMI were enrolled. History of all patients was taken, and thorough clinical examination was performed to asses the presence of signs of right ventricular infarction. Standard 12-lead electrocardiogram was recorded immediately on arrival of patients along with right precordial leads. All patients were considered for thrombolytic therapy in the absence of any contraindication and were managed with standard treatment strategies. Complications arising during the course of admission were recorded and compared between the two groups. There were 86 (86%) males and 14 (14%) females. Mean age was 56.3 +/- 13.13 years (range 33-83 years). The prevalence of RVMI in IWMI was 34%. Smoking and diabetes were more prevalent in RVMI group, while hypertension and family history of ischemic heart disease were more common in isolated IWMI. Ninety per cent of patients received thrombolytic therapy. In-hospital mortality (23.5%) was higher in RVMI group than isolated IWMI (18.1%). Other major complications were also higher in RVMI group than isolated IWMI. Right ventricular infarction was found in approximately one-third of IWMI. Right ventricular infarction was associated with considerable morbidity and mortality, and its presence defines a higher risk subgroup of patients with inferior wall left ventricular infarction.