U波异常有助诊断缺血性心脏病—冠脉造影与心电图对照

目的 探讨U波异常在诊断缺血性心脏病中的价值。方法 选择临床拟为冠心病的男性患者52例，排除电解质紊乱，应用常规心电图、运动负荷心电图及冠脉造影，分析ST段缺血性改变、U波异常在诊断缺血性心脏病中的敏感性和特异性。结果 52例临床拟诊冠心病患者，冠脉造影阳性者38例。冠脉造影阳性者中，常规心电图ST段呈缺血性改变者16例，U波异常者8例，其诊断缺血性心脏病的灵敏度分别为42．11％、21．11％(16/38、8/38)；运动试验阳性者26例，运动诱发U波异常者15例，其诊断缺血性心脏病的灵敏度分别为68．42％、39．47％(26/38、15／38)。冠脉造影阴性者(n＝14)中，常规心电图ST段无缺血性改变6例，U波正常13例，特异度分别为42．86％、92．86％(6／14、13／14)5运动负荷时，结果 阴性9例，U波正常14例，特异度分别为64．29％、100％(9／14、14／14)。运动负荷时尚见2例单独U波异常，其冠脉造影证实有病理性狭窄。结论 U波异常在诊断缺血性心脏病中敏感性虽不如ST段下移的高，但U波异常的特异性高，尤其是运动诱发的U波异常更具诊断价值；缺血性U波异常有助诊断冠心病。     

心电图U波及U波倒置的临床意义

U波为Einthoven于1906年首次描述。直立的U波在心电图12个标准导联中均可正常地出现,U波振幅正常平均为0.3mm或为T波振幅的5～25％。U波的方向通常与T波一致,但有两种例外,即在右侧胸前导联或Ⅲ导联中当T波倒置时U波可以直立。在心率缓慢时,U波一般在V_(2～3)导联中最高,其高度可达     

心电图U波的新视野

U波是心电图T波后宽而低平的小波,于1903年由Einthoven命名。现将近年来从基础到临床对U波研究的若干进展叙述如下.     

体验中心电图U波倒置的分析

心电图U波倒置与某些心血管疾病的诊断,特别是冠心病、高血压有关,本文在对离退休干部体检中,发现教师与其他职业相比,发生U波倒置的比例更高,有鉴于此,本文对912例离退休干部健康体检者心电图U波倒置与职业及其相关因素作了分析统计,现报道如下:     

U波在心肌缺血中的诊断价值

Ｕ波是心电图中波形最小,最不明确的波形,常常不受注意。然而,Ｕ波可能是心电图诸波中最重要的波形之一,其形态和(或)向量方向的改变常常伴随晚期的心脏病。作者试图对Ｕ波在缺血性心脏病诊断上的意义作一综述。1　正常Ｕ波:正常Ｕ波是一个小而圆的波,出现在Ｔ波之后,方向与Ｔ波相同,即在Ｔ波直立的导联中Ｕ波也是直立,Ｕ波的向量在额面为 60°,在横面呈向前及轻度向左,反映在心电图上,Ⅱ、Ｖ3、Ｖ4导联Ｕ波幅度最大,在ａＶＬ导联最不明显。因此,Ｑ-Ｔ间期应在受Ｕ波影响最小的ａＶＬ导联上测量。关于Ｕ波的产生机理,曾经提出很多学说,较为…     

老年人异常U波发生率的分析

目的探讨U波的临床意义。方法随机观察某一时间段410例患者常规心电图中U波形态与其年龄的关系。异常U波的发生率与年龄应用散点图初步观察，再进行Spearman等级相关分析。结果异常U波发生率和年龄间存在正相关。结论异常U波的发生率随着年龄的增长而增加，异常U波的发生以老年人为主，异常U波提示心脏形成U波的一部分心肌组织功能的减退。     

心电图U波（综述）

U 波是心电图中较小的波,近来越来越受到临床的重视,但对 U 波的正常形态、波幅大小和方向的变化及 U 波产生的机理仍无统一认识,现综述如下。正常 U 波 U 波是在 T 波后0.02—0.04s 出现的四钝状的低平波,其方向与 T 波相同,时限0.10—0.30s,V_2、V_3导联 U 波可高达0.2—0.3mV,肢体导联波幅低,一般在0.10—0.15mV,额面电轴+60。鲁端等报道正常组U 波幅在-0.02—0.12mV,(3)U 波时限0.     

U波在心电图诊断中的意义

U形波自1906年由Einthoven确认并命名后,关于其形成的原因虽曾有过许多解释,但至今仍无定论。有后电位说、浦肯野纤维说,还有人认为是动脉圆锥的复极波。目前,越来越多的学者认为U波代表着心室浦肯野纤维的复极变化。     

Coronary Physiology Assessment for the Diagnosis and Treatment of Stable Ischemic Heart Disease

Coronary artery disease is the most prevalent cardiovascular disease in the USA. In the majority of settings, percutaneous coronary intervention (PCI) for stable coronary artery disease (CAD) reduces angina and improves quality of life; however, it does not improve survival and is associated with infrequent but serious complications. Selection of appropriate patients and coronary lesions for revascularization with PCI is crucial to maximize the benefit-to-risk ratio. The assessment of the hemodynamic significance of intermediate coronary lesions has been shown to improve outcomes and reduce healthcare costs. The current review summarizes the existing evidence regarding the physiological assessment of coronary lesions, with emphasis on fractional flow reserve, the most common invasive hemodynamic assessment modality.     

245例冠状动脉造影在冠心病诊断中的价值

为了探讨冠状动脉造影在冠心病诊断中的价值，将245例选择性冠状动脉造形分为心肌梗塞组（101例）、心绞痛组（76例）、不典型心绞痛组（45例）和非冠心病组（23例）进行分析观察，其中224例有满意的左室造影可供分析。结果发现164树冠状动脉造影显示阳性改变，其利心肌梗塞组阳性率96．1%，心绞痛组71．1％，不典型心绞痛组28.9％，非冠心病组无一例阳性．共查出病变冠状动脉血管290支，依次分布于前降支130支、左回旋支80支、右冠状动脉67支、左冠状动脉主干13支．224例在室造影阳性表现为节段运动异常或室壁瘤，心肌梗塞组阳性率86．5％、心绞痛组55．2％、不典型心绞痛组34．1％、非冠心病组5％．结果提示冠状动脉造影仍是显示冠状动脉病变的最直接、有效的方法．     

女性冠心病患者动态心电图与冠脉造影对比研究

目的：探讨动态心电图与冠脉造影对女性冠心病的诊断价值。方法将150例女性患者动态心电图与冠脉造影结果进行对比分析。结果动态心电图ST T改变诊断女性冠心病的灵敏度为74.2%,特异度为75.5%,Kappa检验结果显示K值=0.4727,提示动态心电图和冠脉造影结果具有一致性。动态心电图对冠心病单支、双支和三支血管病变的灵敏度为60%,75%,91%。结论动态心电图对于女性冠心病的心肌缺血诊断有重要参考价值。     

血管生长素与超声心动图对冠心病心衰患者诊断的一致性研究

目的探索冠心病患者进展为心力衰竭过程中,血浆血管生长素（ANG）水平与超声心动图表现的变化情况,以及二者对冠心病合并心衰的诊断效能。方法选取2013年10月到2014年10月在复旦大学附属中山医院诊断为冠心病患者56例,其中25例合并慢性心力衰竭,其余31例为非心衰患者。对其进行血浆ANG浓度测定。并对这些患者心超报告进行分析,计算根据美国心脏超声协会即推荐16节段左心室室壁运动指数（LVWMI）积分。分析二者的相关性,并用受试者工作特征曲线（ROC）曲线评价二者对心衰诊断的作用。结果单纯冠心病组与冠心病合并心衰组相比,N末端B型利钠肽（NT-pro BNP）、ANG、LVWMI具有显著差异,两组ANG分别为（2905.0±741.6）pg/ml与（3977.6±963.2）pg/ml,LVWMI积分分别为1.989±0.383与1.361±0.274,二者与NT-pro BNP均具有显著相关性（P〈0.01,Pearson相关检验）。ANG与LVWMI对冠心病慢性心衰诊断的ROC曲线下面积分别为0.7935（95%可信区间0.66780~0.91930）、0.9168（95%可信区间0.84835~0.98520）,二者合并后对冠心病心衰诊断的ROC曲线下面积为0.9200（0.84890~0.99110）。结论冠心病合并心衰患者血浆ANG水平较未合并心衰组显著升高,左心室节段收缩功能显著下降,二者是诊断冠心病合并心衰的良好指标。     

Radiation Exposure to Angiographer During Coronary Arteriography Using the U arm Image Amplifier

Radiation exposure to the angiographer was measured using thermoluminescent dosimeters (TLD), commercial film badges, and appropriate ionization survey meters. Data were collected during 47 coronary artery examinations with the lead overleaf. During a single coronary examination, the angiographer receives 0.9 mR to the lens and 2.8 mR to the hand. The calculated yearly exposure to the angiographer performing 10 examinations per week is 450 mR to the lens, 9% of the maximum permissible dose (MPD), and 1400 mR to the hand, 2% of the MPD. Exposure rates for the left anterior oblique (LAO) and right anterior oblique (RAO) projections during cine and fluoroscopy were taken at the position occupied by the angiographer. Scatter radiation is 5-10 times greater in the LAO projection. The second trial was monitored during 18 coronary artery examinations minus the lead overleaf. A significant decrease in radiation exposure was accomplished through the use of the lead overleaf.     

同型半胱氨酸代谢异常与冠心病的关系

目的：探讨同型半胱氨酸代谢异常与冠心病的关系。方法：选择245例健康对照者和入住我院冠心病房的439例经冠状动脉造影证实为冠心病者作为研究对象，监测其血浆同型半胱氨酸（Hcy）、叶酸和VitB12水平，分析亚甲基四氢叶酸还原酶（MTHFR）基因多态性，并根据冠状动脉造影结果，分成单支、双支和三支病变组，分析病变支数与MTHFR基因多态性的关系。结果：冠心病患者血浆Hcy水平（17．61＋11．62）显著高于对照组（12．92＋8．23）（P〈0．001），叶酸和VitBl2水平低于对照组（P〈0．05）。冠心病组TT基因型明显高于对照组（P〈0．05），冠心病组中三支血管病变组的TT基因频率比单支和双支血管病变组高（P〈0．005），TT型纯合子的血浆Hcy含量与CC型纯合子和CT杂合子比较具统计学差异（P〈0．001），而叶酸和VitB12含量低于后两者（P〈0．05）。结论：血浆Hcy含量和MTHFR基因突变相关，其TT纯合子血浆Hcy水平最高，而在三支血管病变组的TT基因频率最高，提示MTHFR基因突变可导致Hcy水平升高，是冠心病的危险因素。     

Clinical Covariates of Abnormal Heart Rate Turbulence in Coronary Patients

Background: The aim of this study is to evaluate the association between heart rate turbulence (HRT) parameters and clinical characteristics of coronary artery disease (CAD) patients. Methods and Results: In 122 patients (mean age 62 ± 9 years) with angiographically documented CAD, 24‐hour Holter monitoring with HRT analysis was performed to evaluate turbulence onset (TO) and turbulence slope (TS). There was a significant correlation between TO and TS (P =?0.31; P < 0.001) . According to quartile values, TO ≥?0.37% and TS ≤ 4.25 ms/RR were considered as abnormal in this patient population. Average values of TO were higher and TS lower in patients over 60 years, in patients with a past history of myocardial infarction and in those with EF < 40%. Considering pharmacotheraphy, higher (better) values of TS were observed in patients on statins, nitrates, and beta‐blockers while lower TS values were noted in patients on calcium blockers. Patients with abnormal parameters of HRT compared to group with normal HRT values were characterized by features of more advanced CAD: age over 60 years (75% vs 49%), past history of MI (75% vs 64%), and EF < 40% (25% vs 3%). Multivariate analysis revealed age > 60 years (OR 1.27; P = 0.002) and EF < 40% (OR 1.39; P = 0.001) as independent clinical factors associated with abnormal HRT parameters. Conclusions: HRT parameters are influenced by clinical characteristics and pharmacotherapy of studied patients with TS more than abnormal TO depending on clinical characteristics of patients. Advanced age, prior myocardial infarction and left ventricular dysfunction are key factors influencing values of HRT parameters.     

Intensity of Guideline-Directed Medical Therapy for Coronary Heart Disease and Ischemic Heart Failure Outcomes

PurposeThe impact of guideline-directed medical therapy for coronary heart disease in those hospitalized with acute heart failure is unknown.MethodsWe studied guideline-directed medical therapies for coronary disease: angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs), beta-adrenoreceptor antagonists, antiplatelet agents or anticoagulants, and statins. Using inverse probability of treatment weighting the propensity score, we examined associations of guideline-directed medical therapy intensity (categorized as low [0-1], high [2-3], or very high [4] number of drugs) with mortality in 1873 patients with angina, troponin elevation, or prior myocardial infarction.ResultsAt discharge, 0-1, 2-3, and 4 medications were prescribed in 467 (25%), 705 (38%), and 701 (37%) patients, respectively. Relative to those prescribed 0-1 drugs (reference), all-cause mortality was lower with 2-3 (hazard ratio [HR] 0.48, 95% confidence interval [CI] 0.28-0.84, P = 0.009) or all 4 drug classes (HR 0.56, 95% CI 0.33-0.96, P = 0.034) over 181-365 days, with similar reductions present from 0-180 days. In those with heart failure with preserved ejection fraction, mortality trended lower with 2-3 drug classes (HR 0.43, 95% CI 0.18-1.02, P = 0.054) and was significantly reduced with 4 drugs (HR 0.32, 95%CI 0.12-0.84, P = 0.021) during 0-180 day follow-up. In heart failure with reduced ejection fraction, all-cause mortality was reduced during both 0-180 and 181-365 days when discharged on 2-3 (HR 0.30 for 181-365 days, 95%CI 0.14-0.64, P = 0.002) or all 4 drug classes (HR 0.43, 95%CI 0.19-0.95, P = 0.038).ConclusionsIncreasing guideline-directed medical therapy intensity for coronary heart disease resulted in lower mortality in patients with acute ischemic heart failure with both preserved and reduced ejection fractions.