12导联动态心电图ST段压低诊断冠心病的价值

目的探讨24h12导联动态心电图ST段压低诊断冠心病的临床意义。方法将163例12导联动态心电图检查有缺血性ST段压低伴或不伴典型胸痛患者分为两组（A组ST段压低伴典型胸痛者88例，B组ST段压低不伴典型胸痛或无症状者75例），并与冠状动脉造影进行对比分析。结果A组88例冠状动脉造影明显狭窄79例，其中单支病变44例，双支病变25例，3支病变10例，而B组75例冠状动脉造影明显狭窄15例。以冠状动脉造影阳性为标准，A组对冠心病的诊断阳性率为89．77％，特异性为80．00％，准确度为85．28％。而B组阳性率仅为20．00％，两组阳性率差异有非常显著性意义（χ^2=80．75，P〈0．01）。结论12导联动态心电图检查缺血性ST段压低伴有典型胸痛，诊断冠心病的价值要优于仅有ST段改变者，前者阳性率和准确度较高，具有重要的临床应用价值。     

ST段延长对冠心病的诊断价值

<正> 常规心电图诊断冠心病的阳性率较低,很多冠心病患者心电图无ST段水平压低,文献曾指出ST段水平延长≥0.12s,也是心肌缺血的心电图表现之一,为此我们对ST段延长诊断冠心病的价值进行探讨.1、资料与方法选择80例冠状动脉造影(CAG)患者,除外心肌梗塞、房颤、心室肥厚、完全性束支阻滞、预激综合征、洋地黄药物影响及电介质紊乱,且心电图无缺血性改变为观察对象.CAG证实冠脉狭窄1支或1支以上狭窄≥50%确诊为冠心病,两支冠脉狭窄≥50%以上为双支,3支以上狭窄≥50%以上为多支,共51例,为冠心病组,平均年龄53.9±9岁;29例CAG冠脉狭窄<50%或正常者为对照组,平均年龄52.8±8.9岁.ST段测量及阳性标准参照Schamroth的选用基线稳定无ST段偏移的12导联心电图以R波为主的导联、ST段水平延伸≥0.12s为延长改变即ST段阳性,除外过渡型ST—T连接者.统计方法采用X~2检验.     

aVR、V1导联心电图对左主干及前降支近端明显狭窄的诊断价值

目的探讨aVR、V1导联对冠状动脉左主干及前降支近端狭窄诊断的阳性预测价值。方法对比分析120例冠造结果为左主干病变患者典型aVR、V1导联心电图改变的几率，对比分析120例心电图有典型变化患者的冠脉造影结果。结果①有68例（占56．7％，68／120，）的左主干病变患者出现了典型的aVR、V1导联心电图表现，即典型“左主干”心电图对左主干病变诊断的敏感性为56．7％；②有31例（占37.3％，31／83）典型aVR、V1导联心电图患者冠造结果为左主干病变，有81例（占97．6％，81／83）的典型aVR、V1导联心电图患者冠造结果为左主干及前降支病变，37例患者未检查冠造，典型“左主干”心电图对左主干病变的阳性预测价值为37.3％．而对左主干及／或前降支近段狭窄病变的预测价值为97．6％，二者的差异有显著性（p〈0．001）。结论心电图出现aVR、V1导联ST抬高〉1mm，且aVR导联ST段抬高〉V1导联，V4-6导联ST段下移≥2mm，Ⅱ、Ⅲ、aVF导联ST段下移≥1mm对诊断左主干或前降支近段明显狭窄有很好的阳性预测价值。     

综合心电图计分法在诊断冠心病多支病变中的应用

目的探讨静息状态下冠心病患者(非急性心肌梗死、无胸痛发作状态)常规十二导联心电图对冠状动脉多支病变的预测作用。根据冠心病患者静息状态下的十二导联心电图,制定一套简单易行的对冠状动脉多支病变有一定诊断价值的、新的心电图计分系统。方法分析拟诊为不稳定型心绞痛行冠状动脉造影患者(104例)的造影资料及冠状动脉造影前心电图资料。选择性多体位左、右冠状动脉造影,以左主干、前降支、回旋支和右冠状动脉中任一支狭窄≥50%者为阳性,将患者分为阴性组(8例)、多支病变组(30例)和非多支病变组(66例)。计数各组心电图aVR导联ST段抬高病例数、异常导联数、ST段移位绝对值之和、异常导联数 ST段移位绝对值之和及ST段时间,进行统计学分析。选取年龄及以上5项心电图指标,每项指标达到规定记1分,达标项数之和为该患者的心电图积分(自称为综合心电图计分法)。分别计数各组综合心电图计分法积分,并与冠状动脉病变支数进行相关性分析。结果以上5项心电图指标多支病变组与非多支病变组比较差异有显著性。综合心电图计分法积分均值阴性组、非多支病变组和多支病变组分别为0.50±0.53、2.20±1.76和4.20±1.21,三组间差异有显著性(P<0.01)。综合心电图计分法积分与冠状动脉狭窄支数呈正相关(r=0.491,P=0.000)。综合心电图计分法的敏感性为83%,特异性为77%,阳性预测值为60%,阴性预测值为92%。结论综合心电图计分法优于传统的单项心电图评价指标,该法简单易行,对诊断冠心病患者多支病变有较好的敏感性和特异性。综合心电图计分法对非急性心肌梗死、胸痛发作难以及时行心电图检查的冠心病患者多支病变的诊断有重要价值。     

心电图aVR导联变化对严重左主干狭窄病变的诊断意义

【】 目的 探讨冠状动脉左主干慢性严重狭窄病变的心电图特点。方法 单中心前展性连续选取典型心绞痛发作时12导联心电图aVR导联ST段抬高≥1mm,其他导联ST段压低或不抬高者作为研究对象,心绞痛缓解后aVR导联ST段抬高≥1mm恢复到等电位线。符合这一标准者共计76例住院急性冠脉综合症患者。依冠状动脉造影结果,分析左主干病变特点和其他冠状动脉病变特征。目测狭窄程度≥70%,为严重左主干狭窄病变。结果 单纯左主干严重狭窄54例(54/76, 71.1%),左主干病变 前降支近端近开口病变6例(6/76,7.9%);单纯左回旋支狭窄3例(3/76,3.9%); 其他复杂三支血管病变13例(13/76,17.1%)。冠状动脉正常者为零。左主干严重狭窄患者,aVR导联ST段抬高比非左主干患者更明显(0.25±0.10mV vs 0. 20±0.11mV, P<0.001); ST段压低导联多见于II III aVF和V3-V6导联,左主干严重狭窄患者,ST压低导联ST段压低程度比非左主干患者更明显(p<0.001)。这一特点诊断左主干严重狭窄的敏感性为72.7%, 假阳性54.4%,特异性45.4%,符合率61.9%。     

12导联动态心电图与冠状动脉造影对比分析

目的探讨12导联动态心电图对冠心病的诊断价值。方法将150例12导联动态心电图与冠状动脉造影结果进行对比分析。结果150例患者中，12导联动态心电图阳性84例，其中冠脉造影阳性69例，冠脉造影阴性15例。12导联动态心电图阴性66例．其中冠脉造影阴性43例．冠脉造影阳性23例。在不同年龄组中，男性患者冠脉造影阳性率均高于12导联动态心电图阳性率．但差异不显著（p〉0．05）。女性患者中，65岁以上年龄组，12导联动态心电图阳性率与冠脉造影阳性率一致（p〉0．05）。女性45岁以下及56～65岁年龄组，冠脉造影阳性率均低于12导联动态心电图的阳性率，但差异不显著（p〉0．05）。女性45～55岁年龄组，12导联动态心电图阳性率与冠脉造影阳性率相比较，差异有显著性（p〈0．01）。另外，随着冠状动脉病变支数的增多，12导联动态心电图诊断冠心病的阳性率亦增高。结论12导联动态心电图是临床诊断冠心病的重要无创性检查方法之一，它操作简单、经济、实用。适合临床广泛应用。     

变异型心绞痛患者动态心电图ST段抬高与冠状动脉病变的关系

目的观察变异型心绞痛患者12导联24h动态心电图ST段改变与冠状动脉造影提示冠状动脉狭窄的相关性。方法对25例动态心电图显示ST段抬高的变异型心绞痛患者进行冠状动脉造影检查,将两者结果进行对比分析。结果 25例动态心电图发现与症状相关的ST段抬高的患者中,17例患者68%冠状动脉造影证实存在>50%冠状动脉狭窄动态心电图判断的痉挛血管、LAD20例、LCX2例,RCA4例,其中1例LAD及RCA同时发生。其中动态心电图提示LAD痉挛的20例患者,8例未见冠状动脉存在>50%以上狭窄。对于7例双支或多支病变者,仅有1例动态心电图诊断与CAG结果完全符合。结论动态心电图ST段改变对变异性心绞痛诊断有重要价值,此类患者常合并有冠状动脉病变,以LAD最多见。     

临床心电图和外周血管超声对冠状动脉病变预测价值的临床研究

目的 探讨心电图和外周血管超声对冠状动脉病变的预测价值.方法 回顾性分析168例冠心病患者联合心电图和外周血管超声与冠状动脉造影（CAG） 资料.根据CAG确定病变范围,通过分析心电图,多导联ST-T改变,如aVR 导联ST 段抬高＞0.05 mV,且合并≥6个导联ST段压低（幅度越大预测性越高）或aVR导联ST 抬高大于V1导联ST 段抬高,联合颈动脉和股动脉超声检测,提示外周动脉硬化积分与冠状动脉硬化狭窄积分呈正相关.结果 ①多支病变组心电图改变特点与非多支病变组差异有统计学意义（P＜0.05）.②与非冠心病组比较,冠心病组颈股动脉内膜增厚和斑块形成率增高（P＜0.05）.冠状动脉多支病变组颈股动脉斑块形成率高于其他两组（P＜0.05）.③冠状动脉多支病变组颈股动脉粥样硬化IMT与对照组比较差异有统计学意义（P＜0.01）,与单支病变组比较差异亦有统计学意义（P＜0.05）.结论 联合心电图和外周血管超声检测预测冠状动脉多支血管病变、左主干病变准确性高,临床检测方便,适合基层推广.     

潘生丁试验中QT间期离散度增加对冠心病诊断价值的探讨

目的观察冠心病患者潘生丁试验前后心电图ST段、校正QT间期(QTc)及QT间期离散度(QTd)的变化,以探讨潘生丁试验时诊断冠心病的更敏感及特异的指标。方法对30例冠心病患者(冠心病组)及32例正常者(对照组)进行潘生丁试验,记录试验前后12导联同步心电图,测量其ST段,QTc及QTd的改变。根据受试者作业特征曲线(ROC曲线)求出QTc及QTd的阳性分界点,结合传统诊断标准ST段下移≥0．1mV,分别计算其特异性及敏感性。并与“并联诊断”方法进行比较。结果以潘生丁试验诊断冠心病时,如分别以ST段下移≥0．1mv、QTc≥440ms、QTd≥40ms为标准,其特异性分别为100％、68．8％、93．8％;敏感性分别为53．3％、83．3％和87．6％。如采用“并联诊断”方法,分别以ST段下移≥0．1mV和QTc≥440ms、ST段下移≥0．1mV和QTd≥40ms、QTc≥440ms和QTd≥40ms为标准,其特异性分别为68．8％、93．8％、68．8％。敏感性分别为70．0％、96．8％、90．0％。结论在潘生丁试验时,如以传统的诊断标准(ST段下移≥0．1mV),结合QTd≥40ms,可明显提高其诊断的敏感性而不影响其特异性,QTd≥40ms可作为潘生丁试验时诊断冠心病的一项重要参考指标。     

静息状态下心电图指标对冠心病多支病变诊断价值的比较

目的探讨静息状态下常规十二导联心电图对冠心病患者（非急性心肌梗死、无胸痛发作状态）冠状动脉（冠脉）多支病变的诊断价值。方法观察分析1999年11月至2006年1月于济南市第四人民医院心内科入院拟诊不稳定型心绞痛行冠状动脉造影（CAG）患者（104例）的造影资料及CAG前ECG资料。选择性多体位左、右冠状动脉造影,以左主干、前降支、回旋支、右冠状动脉中任一支狭窄≥50%者为阳性,将患者分为阴性组（8例）、多支病变组[30例,LAD+LCX+RCA和（或）左主干病变]和非多支病变组（66例,单支病变+双支病变）。其中,左主干病变14例（可并发单支、双支或3支病变）。计数各组病例心电图aVR导联ST段抬高病例数、异常导联数、ST段移位绝对值之和、异常导联数+ST段移位绝对值之和、ST段时间,进行统计学分析。结果异常导联数+ST移位、异常导联数、ST段时间、aVR导联ST段抬高,多支病变组与非多支病变组比较有显著差异。异常导联数+ST移位、异常导联数和ST移位的敏感性显著高于aVR导联ST抬高,异常导联数+ST移位的敏感性明显高于ST移位。aVR导联ST抬高和ST移位特异性最好,两者之间无明显差异。结论异常导联数+ST移位、异常导联数、ST移位是诊断冠心病多支病变的敏感指标,且均优于aVR导联ST抬高;异常导联数+ST移位的敏感性明显高于ST移位。     

Value of QT dispersion in the interpretation of treadmill exercise electrocardiograms of patients without exercise-induced chest pain or ST-segment depression

It has recently been reported that increased QT dispersion seen on standard 12-lead electrocardiograms (ECGs) reflects transient myocardial ischemia. The present study investigates whether increased QT dispersion induced by exercise is a useful indicator for detecting significant coronary stenosis in patients who do not have chest pain or significant ST-segment depression in response to exercise. We studied 135 consecutive patients (mean age +/- SD, 55 +/- 9 years; 97 men and 38 women) who complained of anginal chest pain and who did not have exercise-induced chest pain or significant ST-segment depression during treadmill exercise electrocardiography. Coronary angiography was performed in all of patients. Of the 135 patients, 97 had no significant coronary stenosis, 25 had 1-vessel coronary artery disease (CAD), and 13 had multivessel CAD. QT dispersion immediately after exercise was significantly greater in the group with significant coronary stenosis than without significant coronary stenosis (62 +/- 13 vs 40 +/- 14 ms, p <0.0001). When QT dispersion >/=60 ms immediately after exercise was considered a positive result, this indicator had a sensitivity of 74%, a specificity of 85%, and an accuracy of 81% for the diagnosis of significant coronary stenosis. In conclusion, we have shown that QT dispersion immediately after exercise is useful for detecting significant CAD in patients who do not have exercise-induced chest pain or significant ST-segment depression.     

Usefulness of QT dispersion immediately after exercise as an indicator of coronary stenosis independent of gender or exercise-induced ST-segment depression

Several recent studies suggest that QT dispersion on a standard 12-lead electrocardiogram is a clinically useful indicator of significant coronary stenosis. In this study, we compared the diagnostic accuracy of QT dispersion immediately after exercise as an indicator of coronary stenosis in men and women, and in the presence or absence of exercise-induced significant ST-segment depression. The subjects were 273 consecutive patients (mean age 56 ± 9 years; 190 men and 83 women) without a history of myocardial infarction who underwent treadmill exercise electrocardiography and coronary angiography for evaluation of angina. Of these, 146 patients had no significant coronary stenosis, 61 had single-vessel disease, 56 had multivessel disease, and 10 had left main coronary artery disease. QT dispersion immediately after exercise was significantly greater in patients with significant coronary stenosis than in those without (64 ± 14 vs 39 ± 14 ms, p <0.01). QT dispersion immediately after exercise was significantly more sensitive in men (sensitivity 75%; specificity 85%) and significantly more specific in women (sensitivity 77%, specificity 88%) than exercise-induced significant ST-segment depression (men: sensitivity 62%, specificity 74%; women: sensitivity 81%, specificity 68%) as an indicator of significant coronary stenosis. The addition of factors such as gender and the presence or absence of exercise-induced significant ST-segment depression did not significantly alter the sensitivity and specificity of QT dispersion immediately after exercise for detecting significant coronary stenosis (patients with significant ST-segment depression: sensitivity 77%, specificity 88%; patients without significant ST-segment depression: sensitivity 72%, specificity 86%). In conclusion, QT dispersion immediately after exercise is a clinically useful indicator of significant coronary stenosis independent of gender or the presence or absence of exercise-induced significant ST-segment depression.     

电话传输远程心电监测对冠心病心肌缺血的诊断价值

目的评价12导联电话传输远程心电监测(TTM)对冠心病(CHD)心肌缺血的诊断价值。方法选择60例疑诊CHD患者,将其普通心电图(ECG)、12导联TTM和冠状动脉造影(CA)结果进行对比分析,以CA为金标准计算灵敏度、特异度等指标,研究ST段压低最佳幅度与冠状动脉病变程度和病变支数的相关关系。结果TTM诊断心肌缺血ST段压低的最佳幅度为0.10mV。ST段下移的程度与冠状动脉供血不足的程度有一定相关性。结论12导联TTM检出ST段压低对诊断心肌缺血可提供有益线索,从而为进一步临床诊断和治疗提供依据。     

Significance of exercise QT dispersion in patients with coronary artery disease who do not have exercise-induced ischemic ST-segment changes.

The poor sensitivity and the poor predictive value of ST-segment depression have limited the usefulness of the exercise electrocardiogram (ECG) in the diagnosis and evaluation of coronary artery disease (CAD). The QT dispersion (QTD), recorded as the difference between maximal and minimal QT intervals on a 12-lead exercise ECG, is sensitive to myocardial ischemia and may improve the accuracy of exercise testing in patients with CAD who do not show an ST-segment depression. Exercise ECGs were analyzed in 50 subjects who had undergone coronary angiography for clinical indications. None of them showed an ST-segment depression during or after exercise: There were 25 patients with significant coronary artery stenosis and 25 without significant stenosis. The QTD measured before, immediately after, and 1 min after exercise was similar in the 2 groups. The QTD at 3 and 5 min after exercise was significantly greater in patients with CAD than in the controls, and the most marked difference in QTD was observed at 3 min after exercise. A QTD at 3 min after exercise of >60 ms had a sensitivity of 80% and specificity of 88% regarding the diagnosis of CAD. When a deltaQTD (post-exercise QTD minus QTD at rest) at 3 min after exercise of >0 ms was added to a QTD of >60 ms as a condition for positivity, the specificity increased to 96%. QTD measured at 3 min after exercise increases the accuracy of exercise testing in patients with CAD who do not show an ST-segment depression.     

运动试验阴性的男性患者QT离散度的变化对冠心病的诊断价值

目的 观测运动试验中QT离散度的改变是否能够增加运动试验对冠心病的检出率。方法分析60例因有明显的临床指征而行冠状动脉造影的男性患者,术前患者运动试验均未诱发ST段压低。其中34例为两年期间连续冠状动脉造影结果未见显著狭窄者(对照组),26例为两年期间连续冠状动脉狭窄者(实验组)。两组分别测量运动试验前及运动试验后1、3、5分钟12导心电图最长和最短的QT间期的差值,即QT离散度(QTd)。结果 运动停止即刻实验组QTd明显较对照组大。以运动停止即刻QTd大于60ms为指标诊断冠心病的敏感性为84.6％,特异性为76.5％,符合率为87.7％。结论 对运动试验未能诱发出ST段压低的人群。以运动停止即刻QTd大于60ms作为诊断冠心病的指标,可以提高诊断的准确性。     

三种内乳动脉造影方法比较(附180例结果分析)

目的 :研究内乳动脉 (IMA)造影三种方法并分析其结果。方法 :180例冠状动脉造影 (CAG)患者接受主动脉弓数字减影血管造影 (AAG) ,其中 4例左锁骨下动脉 (SCA)狭窄 ,选择 176例AAG中IMA显影不满意的 5 6例先行左上肢加压SCA造影 (SCAG)后行IMA直接造影 (IMAG)。结果 :1 IMAG成功率低于AAG和SCAG[88% (49 5 6 )vs 10 0 % (180 180 ) ]和 10 0 % (5 6 5 6 ) ,P <0 0 5 ];IMAG和SCAG造影满意率高于AAG[10 0 % (49 4 9)和 91% (5 1 5 6 )vs 6 8% (12 0 176 ) ,P <0 0 1]。 2 造影结果 :12例IMA近端有较大分支 (6 8% ) ,6例明显迂曲 (3 4 % ) ,10例血管纤细 (5 7% ) ,3例血管狭窄 (1 7% )。结论 :CAG时应常规行AAG、SCAG或IMAG     

非心肌梗死冠心病患者运动致ST段抬高的临床意义

目的 研究运动致ST段抬高在非心肌梗死患者中发生率及其临床意义。方法 2004年6月至2006年6月共有4601例患者接受了运动平板试验,其中有15例非心肌梗死患者出现ST段抬高,对这15例患者的临床特点与冠状动脉造影结果进行分析。结果 15例（3．2‰）运动致ST段抬高患者中,男性13例,女性2例,年龄40-75岁。单支病变者6例（40％）,2支病变者6例（40％）,3支病变者3例（20％）;12例（80％）累及前降支,1例（6．6％）累及左主干,7例累及右冠状动脉,在累及前降支及左主干13例患者中有8例为重度狭窄病变（狭窄程度为90％-100％）,所有ST段抬高的导联均与病变血管的供血部位一致。结论 运动致ST段抬高在非心肌梗死患者中发生率非常低,多因冠状动脉有严重的固定性狭窄,特别是前降支,可根据出现ST段抬高的导联判断缺血心肌的部位。     

Dipyridamole-echocardiography test in patients with exercise-induced ST-segment elevation

Fourteen consecutive patients with exercise-induced ST-segment elevation in the absence of previous infarction and basal left ventricular asynergy at rest performed a dipyridamole test (infusion of dipyridamole, 0.14 mg/kg/min intravenously for 4 minutes) during 12-lead electrocardiographic (ECG) and 2-dimensional echocardiographic monitoring. In 7 of the 14 patients, dipyridamole infusion consistently induced ST-segment elevation in the leads that showed ST elevation on effort; reversible asynergy (occurring in the region corresponding to the ECG leads with diagnostic changes) could always be documented by echocardiography. In 2 patients dipyridamole induced reversible asynergy in presence of ST-segment depression. In these 9 patients angiography invariably revealed a severe organic stenosis in the coronary artery feeding the region that became transiently asynergic after dipyridamole. In the other 5 patients (all of whom had either spontaneous or ergonovine-induced ST-segment elevation), the dipyridamole test yielded no significant echocardiographic or ECG change; coronary angiography showed absent (2 patients) or significant (3 patients) coronary artery disease. In conclusion, dipyridamole may induce transmural ischemia in humans, as detected by the electrical hallmark of ST elevation; this ECG pattern, in contrast to ST depression, reliably predicts the presence and site of transient regional asynergy. When dipyridamole induces ST-segment elevation, severe basal stenosis is invariably present in the coronary artery supplying the transiently asynergic myocardial region.