心电图 V1导联 P 波终末电势与心功能不全的相关性研究

目的：探讨 V1导联 P 波终末电势（P wave terminal force in lead V1,PtfV1）对心功能不全患者的临床价值及其与左室射血分数（left ventricular ejection fraction,LVEF）的相关性。方法选择我院心内科收治的87例心功能不全患者及85例正常体检者分别作为试验组和对照组。测量、计算入选者的体表心电图 PtfV1值和超声心动图 LVEF 值,比较这两项指标在两组间的差异。同时,比较试验组 PtfV1值在 LVEF 轻度下降（LVEF 40％～50％）、中度下降（LVEF 30％～40％）及重度下降（LVEF ＜30％）时的变化及其与对照组 PtfV1值之间的差异。结果①试验组的 LVEF 值显著低于对照组[（37．32±8．36）％ vs．（60．79±6．56）％,P ＜0．05],PtfV1值亦然[（－0．067±－0．021）mm·s vs．（－0．017±－0．009）mm·s,P ＜0．05]。②在 LVEF 轻度、中度和重度下降的试验组患者中,PtfV1值依次降低[（－0．047±－0．007）mm·s—（－0．071±－0．010）mm·s—（－0．095±－0．013）mm·s],且均低于对照组,差异均有统计学意义（P ＜0．05）,说明 PtfV1值随 LVEF 的下降而下降。结论心功能不全患者的 PtfV1值随着 LVEF 值的下降明显下降,且与心功能不全的严重程度呈正相关。因此,PtfV1可作为心功能不全严重程度的一项实用的评估指标。     

Electrocardiographic diagnosis of left atrial enlargement. Role of the P terminal force in lead V1

The ability of the electrocardiographic criterion, P terminal force in lead V1 (PTF-V1), to diagnosis left atrial enlargement (LAE) is evaluated in a group of 317 men. A left atrial index greater than 2.2 cm/m2, determined by echocardiography, is used as the standard for LAE. The value for this criterion of 0.04 mm-sec performs best, although there is no significant difference in percent correct diagnosis for values of PTF-V1 ranging from 0.03 to 0.09 mm-sec.     

PtfV_1在心衰患者的应用价值

目的探讨V1导联P波终末电势(P wave terminal force in lead V1,PtfV1)在心功能不全患者中的临床应用价值。方法 110例心功能不全患者及100例正常对照组纳入研究。测量、计算、记录所有入选者的体表心电图PtfV1数值,超声心动图左室射血分数(LVEF)以及性别、年龄、民族等相关临床指标。按照纽约心功能分级(NYHA)将病例组分为轻症组(NYHAⅠ~Ⅱ)及重症组(NYHAⅢ~Ⅳ)。按照LEVF下降程度将病历组分为LEVF轻度下降组(LVEF 40%~50%)及中重度下降组LVEF40%。分别比较心功能不全患者与正常人,NYHA分级严重程度不同的患者之间相较,LEVF下降程度不同的患者之间相较,PtfV1数值的差异。并分析PtfV1与传统评价心功能严重程度的指标LVEF之间的相关性。结果 1心功能不全患者与对照组相较,PtfV1数值明显下降(p0.05);2NYHA分级重症心功能不全患者较轻症患者的PtfV1数值明显下降(p0.05);3LVEF中重度降低患者与轻度降低的患者相较,Ptfv1数值明显下降(p0.05);4PtfV1与LVEF呈显著正相关,相关系数r=0.77,p0.01。结论 V1导联P波终末电势(PtfV1)可作为评价心功能不全患者病情严重程度的一项临床心电学指标。     

Prognostic value of an abnormal P terminal force in lead V1 at onset of acute myocardial infarction

The presence of an abnormal P terminal force of the P wave in lead V1 (PTFV1) was demonstrated on the initial electrocardiograms in 69 of the 200 patients with transmural acute myocardial infarction. 61.5% of the total cases with a lethal outcome during hospitalization belonged to this group. The mortality of the patients who presented this ECG sign of left atrial hypertension at the onset was 53.7%, thus differing significantly from that in patients without the sign (22.1%). The PTFV1 anomaly has a prognostic value in patients without complications as well as in those with heart failure at the onset of the disease. The appearance during hospitalization of major arrhythmias and disturbances of conduction and of sudden death is significantly correlated to the presence of abnormal PTFV1 on the admission electrocardiograms.     

心电图V1导联P波终末电势与HATCH评分的相关性分析

目的 通过分析心电图V1导联P波终末电势（PTFV1）与阵发性心房颤动（房颤）进展风险评估指标（HATCH评分）的相关性,为阵发性房颤患者进展风险提供新的预测指标.方法 回顾并测量大连医科大学附属第一医院2011年至2012年180例非瓣膜性阵发性房颤患者的HATCH评分及PTFV1,使用Spearman等级相关分析PTFV1与HATCH评分的相关性.结果 ①180例非瓣膜性阵发性房颤患者PTFV1与HATCH评分呈显著正相关（r=0.550,P＜0.01）;②HATCH评分1分组PTFV1略大于HATCH评分0分组,但差异无统计学意义（P＞0.05）;HATCH评分≥2分组PTFV1明显大于HATCH评分1分组,差异有统计学意义（P＜0.01）;③平均随访1年,由阵发性房颤进展的持续性房颤患者（进展组）HATCH评分及PTFV1明显大于仍为阵发性房颤患者（阵发组）,差异有统计学意义（分别为P＜0.05,P＜0.01）;④PTFV1为0.07mm·s是ROC曲线上的最佳临界点,其预测房颤进展风险的敏感性为70％、特异性为81.8％,曲线下面积为0.876.结论 PTFV1作为一种无创检查指标对预测阵发性房颤向持续性房颤进展有重要的临床指导意义.     

V1导联P波终末电势与老年高血压病人左室舒张功能的关系

目的：探讨V1导联P波终末电势（PtfV1）与老年高血压病人左室舒张功能的关系。方法：测量135例老年高血压病人的心电图PtfV1,以及心脏超声的E／A比值,E波减速时间（EDT）。左室等容舒张时间（IVRT）．左房内径指数（LADI）．左房射血力（LAEF）,左室质量指数（LVMI）等。心电图PtfV1≥-0．02的84例病人被定为甲组,PtfV1％-0．02mm／s的51例病人被定为乙组,比较两组间心超左室舒张功能指标的差异,并以PtfV1为自变量进行Pearson相关分析和多元逐步回归分析。结果：与甲组比较,乙组的E／A显著下降,EDT、IVRT、LADI、LAEF显著增加（P〈0．05～〈0．01）;Pearson相关分析PtfV1与EDT（r=0．225,P=0．004）、1VRT（r=-0．185,P=0．016）、LADI（r=-0．178,P=0．019）呈显著负相关。多元逐步回归分析示EDT进入方程（R^2=0．051,df=134,P=0．009）,与PtfV1呈线性关系。结论：PtfV1与老年高血压病人左室舒张功能密切相关,是预测老年高血压病人左室舒张功能简便、有效的可靠方法。     

Electrocardiographic P terminal force in lead V1, its components,and the association with stroke and atrial fibrillation or flutter

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心电图V1导联P波终末电势水平对急性冠脉综合征患者预后的影响

目的探讨心电图V1导联P波终末电势(PtfV1)对急性冠脉综合征(ACS)患者预后的影响。方法收集2017年5月至2018年6月期间在北京航天总医院干部医疗科及心血管内科住院治疗的ACS患者308例。根据PtfV1值分为3组:PtfV120 mm·ms组(n=106),20 mm·ms≤PtfV1≤40 mm·ms组(n=100)和PtfV140 mm·ms组(n=102)。比较各组患者临床资料。随访时间不少于6个月,比较3组患者主要不良心血管事件(MACEs)发生率。采用SPSS 20.0软件进行数据处理。无MACEs生存时间采用Kaplan-Meier生存曲线分析。结果随访时间6～30(12.5±7.2)个月。截止随访结束,PtfV120 mm·ms组发生MACEs 2例(占1.89%),20 mm·ms≤PtfV1≤40 mm·ms组发生MACEs 7例(占7.00%),PtfV140 mm·ms组发生MACEs 12例(占11.76%)。Kaplan-Meier分析表明,3组患者的MACEs发生率间差异具有统计学意义(χ~2=8.152,P=0.017),其中PtfV120 mm·ms组患者MACEs发生率显著低于PtfV140 mm·ms组(χ~2=8.079,P=0.004)。结论 PtfV1水平与ACS患者心血管事件发生率有关,可以作为ACS患者远期心血管事件发生率及预后的预测指标。     

P-wave terminal force in lead V1 is a predictive indicator for the diagnosis of tuberculous constrictive pericarditis

Objectives

The purpose of this study is to explore the value of P-wave terminal force in lead V1 (PTFV1) in the clinical diagnosis of tuberculous constrictive pericarditis (TCP).

Electrocardiographic diagnosis of left atrial enlargement: Role of the P terminal force in lead V1

The ability of the electrocardiographic criterion, P terminal force in lead V₁ (PTF-V₁), to diagnosis left atrial enlargement (LAE) is evaluated in a group of 317 men. A left atrial index >2.2 cm/m², determined by echocardiography, is used as the standard for LAE. The value for this criterion of 0.04 mm-sec performs best, although there is no significant difference in percent correct diagnosis for values of PTF-V₁ ranging from 0.03 to 0.09 mm-sec.     

Abnormal P-wave terminal force in lead V1 is associated with cardiac death or hospitalization for heart failure in prior myocardial infarction

The aim of this study was to clarify the prognostic significance of P-wave terminal force in lead V₁ (PTFV₁) in patients with prior myocardial infarction (MI). We retrospectively examined 185 patients with prior MI. The primary end point was cardiac death or hospitalization for heart failure. Abnormal PTFV₁ was defined as PTFV₁ ≥ 40 mm × ms. During a follow-up period of 6.4 ± 2.9 years, 39 patients developed the primary end point. A Kaplan–Meier analysis showed a lower primary event-free rate in 79 patients with abnormal PTFV₁ than in 106 patients with normal PTFV₁ (P < 0.001). When we classified 79 patients with abnormal PTFV₁ into 31 with a purely negative P wave in lead V₁ and 48 with a biphasic negative P wave in lead V₁, the primary event-free rate did not differ between the two groups of patients. A multivariate Cox regression analysis selected age (hazard ratio (HR) 1.09, 95 % confidence interval (CI) 1.04–1.14, P < 0.001), multivessel coronary disease (HR 2.33, 95 % CI 1.02–5.28, P = 0.04), and abnormal PTFV₁ (HR 2.72, 95 % CI 1.24–5.99, P = 0.01) as independent predictors of the primary end point. In conclusion, abnormal PTFV₁ is an independent predictor of cardiac death or hospitalization for heart failure in patients with prior MI. The analysis of P waves in lead V₁ should provide useful prognostic information in patients with prior MI.     

Significance of a terminal R wave in lead V1 of the electrocardiogram.

A terminal r wave in Lead V1 lower than 0.6 mV. was studied in the ECGs of four groups: (1) 104 healthy children, (2) 207 healthy young adults, (3) 171 patients with no autopsy evidence of a cardiopulmonary disease, and (4) 1,078 autopsy patients with a cardiopulmonary disease. Cases with a complete right bundle branch block were excluded. A terminal r wave occurred in 2.9 per cent healthy children, 1.4 per cent of healthy young adults, 0.6 per cent of patients without and in 5.9 per cent of patients with autopsy evidence of a cardiopulmonary disease. The occurrence of a terminal r wave was most common in pulmonary patients (10 per cent). But it was also found in patients with an anterior or a posterior myocardial infarction and in some cases of left ventricular hypertrophy. In the autopsy series RVH occurred in 57 per cent of patients with a Qr pattern, in 30 per cent of patients with a terminal r wave higher than the initial one, and in none of the patients with a terminal r wave lower than the initial one. It is concluded that the height of the terminal r wave has clinical significance. A terminal r wave higher than the initial one in Lead V1 is associated with a cardiopulmonary disease in subjects over 30 years of age, while an r wave lower than the initial one seems to be an innocent finding.     

Significance of P wave terminal force in presumably healthy middle-aged men

In a material comprising 695 males aged 40 to 60 years without cardiovascular disease, the prevalence of abnormal P wave terminal force in V₁ (V₁Ptf) (≤ ? 0.03 mm. second) at rest was 7.1 per cent, whereas the prevalence five minutes after a near-maximal exercise test was 25.4 per cent. Abnormal V₁Ptf was associated with a slightly higher systolic and diastolic blood pressure, maximal rise of systolic blood pressure, and maximal rate-pressure product during the exercise test. The prevalence of abnormal V₁Ptf was not significantly higher in another group of 95 individuals who were angiographied because of strong suspicion of latent coronary heart disease (CHD) according to exercise electrocardiogram.An abnormal V₁Ptf may be considered as a possibly clinically unimportant anomaly in other-wise healthy middle-aged men. V₁Ptf is not suitable as a tool for the diagnosis of latent CHD.     

The P terminal vector in lead V1 of the electrocardiogram in cor pulmonale

The P wave terminal victor in lead V₁ of the ECG (V₁PTV) was abnormal in 55 (80%) of 69 cases of cor pulmonale, but in none of 11 cases of isolated pulmonary valve stenosis. V₁PTV is commonly abnormal in cor pulmonale and this is not likely to be due to pressure overload of the right heart. The commonly held association of an abnormal V₁PTV with left atrial enlargement may also be spurious in these cases.     

老年急性脑卒中患者V1导联P波终末负电势的变化

目的旨在探讨老年人急性脑卒中时心电图Ｖ１导联Ｐ波终末负电势增大（异常ＰｔｆＶ１）的发生机理、发生率及其临床意义，为临床治疗提供指导。方法回顾性分析２７６例老年卒中患者的心电图改变。结果老年急性脑卒中患者的心电图改变以异常ＰｔｆＶ１最常见，发生率为４６４％（１２８例）。其中脑出血组为５７４％（８５例），明显高于缺血性卒中组的３３６％（４３例）（Ｕ＝３９５３，Ｐ＜００１）。结论在处理急性脑卒中时，若心电图上出现异常ＰｔｆＶ１，应注意心功能情况，进行心电监护。     

ST-segment elevation in lead aVR greater than that in lead V(1) secondary to diffuse myocardial ischemia from prolonged hypotension

The prediction of significant left main or diffuse three-vessel coronary artery disease is crucial in patients presenting with an acute coronary syndrome. ST-segment elevation in aVR has been reported to be associated with left main coronary artery obstruction or severe diffuse coronary artery disease in acute coronary syndrome. Herein we report another cause for this ECG finding, that is diffuse ischemia not due to left main coronary artery obstruction or diffuse coronary artery disease but secondary to prolonged hypotension.