动态心电图在冠心病患者心肌缺血及心律失常中的诊断价值

目的:探讨动态心电图在冠心病(CHD)患者心肌缺血和心律失常中的诊断价值.方法:选择2019年3月至2020年3月在湖南中医药高等专科学校附属第一医院诊治的130例CHD患者,所有患者行常规心电图及动态心电图检测,观察两种方法心肌缺血及心律失常检出情况.结果:常规心电图检查冠心病患者心肌缺血阳性者68例,占52.3％(...     

左心室肥厚并急性心肌梗死患者室性电风暴心电图特征及对预后的影响

目的:研究左心室肥厚并急性心肌梗死患者室性电风暴心电图特征及对预后的影响。方法:选择2018年1月至2019年1月就诊于青海红十字医院的左心室肥厚并急性心肌梗死室性电风暴患者100例作为观察组,另选取无左心室肥厚的急性心肌梗死室性电风暴患者作为对照组,两组患者均进行心电图检查以及持续心电监护,对心电图特征和患者预后进行分析,比较两组患者ST段抬高导联数、QTc间期、对应导联ST段下移发生率、冠脉病变支数及并发症发生率。结果:观察组ST段抬高导联数(4.17±1.07),QTc间期(431.0±13.2)mm、对应导联ST段下移发生率(36.0%)与对照组比较,差异具有统计学意义(P0.05)。观察组冠脉病变支数(1支49例、2支30例、3支21例)与对照组(1支7例、2支13例、3支10例)比较,差异具有统计学意义(P0.01)。观察组并发症发生率高于对照组(7.0%比2.0%,P0.05)。结论:左心室肥厚并急性心肌梗死室性电风暴患者心电图多项指标发生异常,对患者预后具有预测价值。     

心电图平板运动试验对冠心病患者无症状性心肌缺血的诊断价值

目的:探讨心电图平板运动试验(TET)对冠心病(CHD)患者无症状性心肌缺血(SMI)的诊断价值.方法:选取2019年2月至2021年2月于阳江市中医医院进行诊治的CHD患者112例,性别不限,年龄39～70岁,均行TET、动态心电图(DCG)及冠状动脉造影检查.以冠状动脉造影结果 为金标准,分析TET和DCG检查对S...     

动态心电图在无症状性心肌缺血患者中的诊断价值

目的:观察动态心电图在无症状性心肌缺血患者中的诊断价值。方法:收集石河子大学医学院第一附属医院2017年1月至2017年12月无症状性心肌缺血患者88例,性别不限,年龄40~82岁。根据护理人员抽签法分为动态心电图组和常规心电图组,每组44例,两组患者分别采用动态心电图和常规心电图检查,比较两组患者ST段压低幅度、心率和检出率。结果:动态心电图组患者ST段压低幅度和心率明显低于常规心电图组(P<0.05)。动态心电图组检出率为95.5%(42/44例),常规心电图组为79.5%(35/44例),差异有统计学意义(P<0.05)。结论:动态心电图在无症状性心肌缺血患者诊断中检出率高。     

急性心肌梗死患者心电图ST段改变与侧支循环开放、左室功能的关系

目的:探讨急性心肌梗死(AMI)患者心电图ST段改变与侧支循环开放、左室功能的关系.方法:选取2017年9月至2020年9月九江市第一人民医院收治的100例AMI患者为研究对象,根据就诊时心电图ST段的水平分为ST段抬高组35例、ST段压低组32例以及ST段无偏移组33例,所有患者均给予常规心电图、冠状动脉造影和心脏彩...     

动态心电图、常规心电图对原发性高血压患者心肌缺血及心律失常的诊断价值

目的:探讨动态心电图、常规心电图对原发性高血压患者心肌缺血及心律失常的诊断价值,以期为进一步提高原发性高血压心肌缺血及心律失常临床诊断准确率提供参考。方法:选择2016年4月至2018年4月惠州市博罗县人民医院心电图室接收的原发性高血压患者200例,对其临床资料进行回顾性分析,将患者资料按照诊断方法的不同分为常规心电图组(87例)与动态心电图组(113例),常规心电图组采用常规心电图检测,动态心电图组采用24 h动态心电图检测,对两种检测方法下患者心肌缺血及心律失常的发生情况进行对比观察。结果:与常规心电图组相比,动态心电图组患者心肌缺血及心律失常阳性检出率均显著增高(P0.05),房室传导阻滞及ST-T段改变检出率均明显较高(P0.05)。结论:24 h动态心电图可明显提高原发性高血压患者心肌缺血及心律失常的检出率,可实现对患者病情的有效预测与准确评估,为临床治疗方案的开展提供可靠依据。     

基于心电图的心肌缺血非线性分析

心电图是心肌缺血检测的一种方便、经济、无创的工具,其主要的临床表现为ST-T段变化.鉴于心脏是一个混沌系统,本文从非线性角度出发,对心电图特征参数序列进行分形维数和最大Lyapunov指数分析,其中特征参数序列包括：心电图RR间期,瞬时心率HR（heart rate）,ST段的平均幅值STmean,ST段最小幅值STmin,STmean与HR的比值STr,T波峰末间期TpTe,R波峰值Ramp,T波峰值Tamp.利用公共数据库Long-term ST database（LTST）中心肌缺血和非心肌缺血心电数据,通过统计t检验分析,除最大分形维数分析中的TpTe与最大Lyapunov指数分析中的Ramp和Tamp特征参数外,其余参数均有显著性差异.基于心电图的非线性分析为心肌缺血检测与诊断提供另一重要依据.     

动态心电图对冠心病诊治的指导意义

目的探讨动态心电图对冠心病的诊断和治疗的指导意义. 方法分析了176例冠心病动态心电图特征. 结果在冠心病患者缺血性ST段下移中,无症状性心肌缺血占72.5%,发生次数是有症状的2.6倍,缺血性ST段下移有明显的昼夜分布规律,上午6～10时为发作高峰,占全天总次数38.2%.夜间缺血持续时间与ST段下移的程度均比白天为重. 结论提示在冠心病诊断中,DCG是日常生活中发现冠心病和无症状性心肌缺血的方法,要彻底改善冠心病的预后,应重视无症状性心肌缺血在内的总缺血负荷的治疗,并结合缺血的昼夜分布规律调整给药时间.     

CXCL4与非ST段抬高心肌梗死患者冠状动脉病变稳定性的相关性研究

目的:探讨血清血小板趋化因子 4(CXC chemokine ligand 4,CXCL4)水平与非ST段抬高心肌梗死患者冠状动脉病变稳定性的相关性.方法:选取 2021 年 1 月至 2022 年 12 月期间于本院接受治疗的 90 例非ST段抬高心肌梗死伴冠状动脉病变患者作为研究对象,采用冠脉造影检查冠状动脉病变稳定性,并根据冠脉造影检查结果,将患者分为稳定组和不稳定组(n=45).所有入选者均采用酶联免疫吸附法测定血清CXCL4水平,分析血清CXCL4水平与非ST段抬高心肌梗死患者冠状动脉病变稳定性的关系.结果:稳定组血清CXCL4水平显著低于不稳定组(P＜0.05).建立Logistic回归分析模型,结果显示,血清CXCL4 水平高与非ST段抬高心肌梗死患者发生不稳定性冠状动脉病变密切相关(OR＞1,P＜0.05).绘制受试者工作特征(Receiver operator characteristic,ROC)曲线结果显示,血清CXCL4 水平预测不稳定型冠状动脉病变的曲线下面积＞0.8,具有一定预测价值.结论:非ST段抬高心肌梗死患者血清CXCL4 水平与冠状动脉病变稳定性密切相关,在冠状动脉病变稳定性预测中具有较高价值.     

动态心电图ST段分析要注意的几个问题

目前对无症状心肌缺血的诊断,判断冠心病的预后及临床疗效评价,都依赖于对动态心电图ST移位的精确定量分析进行诊断。因此在对HolteryST段分析时,对下列影响ST段记录及分析精确度的一些因素应予特别重视。一、影响ST段记录精确度的因素导联的选择三通道动态心电图记录仪CMv5导联对左室前壁引起的ST段下移较敏感,主要用于检测前壁心肌缺血;CSavf对下壁心肌缺血敏感性高,用于观察下壁心肌缺血。Holter检测对左室下壁的缺血性ST段改变敏感性较低。     

动态与常规心电图诊断冠心病心肌缺血、心律失常、心绞痛的比较分析

目的:研究24 h动态心电图在冠心病心肌缺血、心律失常、心绞痛中的诊断价值。方法:127例临床诊断冠心病的门诊和住院患者,均进行24 h动态心电图及常规心电图检查;比较两组心肌缺血、心律失常、心绞痛的检出情况。结果:动态组心肌缺血阳性检出率（90.55%）显著高于常规组（34.65%）,差异具有统计学意义（P<0.05）。动态组各类心律失常检出率显著高于常规组（P<0.05）。动态组检出变异性心绞痛16例,常规心电图未发现,差异具有统计学意义（P<0.05）。结论:24 h动态心电图诊断冠心病心肌缺血、心律失常、心绞痛具有一定的临床价值。     

Heart rate, magnitude and duration of ST-segment depression in symptomatic and asymptomatic episodes of myocardial ischemia in patients with coronary artery disease recorded by Holter

In the group of 85 patients with coronary artery disease the exercise and 24-hour ambulatory electrocardiograms were recorded in order to analyse the frequency of asymptomatic episodes of myocardial ischemia and to determine differences between symptomatic and asymptomatic episodes of myocardial ischemia. All patients had ischemic ST-segment depression (greater than or equal to 1 mm) on the exercise electrocardiogram. During exercise testing, 23 (27%) patients had ST-segment depression without anginal pain or dyspnea. On the 24-hour ambulatory electrocardiogram transient episodes of myocardial ischemia were found in 50 (58.8%) patients. In 16 patients all episodes were asymptomatic, in 9 all episodes were symptomatic, and in 25 patients some episodes were symptomatic and some asymptomatic. During a 24-hour electrocardiogram in 25 patients with both types of ischemia, 175 transient episodes of myocardial ischemia were recorded. Most of them (125, i.e. 71.4%) were asymptomatic. The heart rate in symptomatic and asymptomatic episodes was similar. The magnitude of ST-segment depression in symptomatic episodes was higher than in asymptomatic episodes (P less than 0.01). There was not significant difference in the duration of the two types of myocardial ischemia. This study suggests: 1. During daily activities, in patients with the positive exercise test, asymptomatic episodes of myocardial ischemia are more frequent than symptomatic episodes. 2. The magnitude of ST-segment depression is the main factor in the determination of the presence of anginal pain.     

参麦注射液对大鼠急性心肌缺血及eNOS mRNA表达的影响

目的：探讨参麦注射液(SMI)预处理可能对 大鼠急性心肌缺血及心肌内皮型一氧化氮合酶(eNOS)mRNA表达的影响。方法:大鼠随机分为对照组、模型组、处理组1和处理组2，应用异丙肾上腺素建立大鼠心肌 缺血模型,以心电图ST段抬高值作为心肌缺血指标，硝酸还原酶法测定血清和心肌的NO^-₂/NO^-₃，RT-PCR检测心肌eNOS mRNA表达。结果：模型组各时点的心 电图ST段均显著高于对照组，缺血20 min时达高峰，血清和心肌NO^-₂/NO^-₃含量及 心肌eNOS mRNA表达均低于对照组；两个处理组于缺血20、30、40 min时的心电图ST段抬高 幅度均显著低于模型组，血清和心肌NO^-₂/NO^-₃含量均显著高于模型组，心肌eNOS mRNA表达强于模型组；处理组1和处理组2比较，心电图ST段抬高幅度、血清和心肌的NO^-₂/NO^-₃含量及心肌eNOS mRNA表达差异均无显著。结论：参麦注 射液可能是通过促进心肌组织eNOS mRNA表达、增强eNOS活性而提高NO水平，达到抗心肌缺 血的作用。     

Short-term ECG recordings for heart rate assessment in patients with chronic atrial fibrillation

Introduction

There is no consensus on the length of ECG tracing that should be recorded to represent adequate rate control in patients with atrial fibrillation (AFib). The purpose of the study was to examine whether heart rate measurements based on short-term ECGs recorded at different periods of the day may correspond to the mean heart rate and rate irregularity analyzed from standard 24-hour Holter monitoring.

Material and methods

The study enrolled 50 consecutive patients with chronic AFib who underwent 24-hour Holter monitoring. Mean heart rate (mHR) and the coefficient of irregularity (CI) were assessed from 5- and 60-minute intervals of Holter recordings in different periods of the day.

Results

The highest correlation in mean heart rate interval within 24 h was found during a 6-hour sample and in the periods 11.00 AM–12.00 PM, 12 PM–1.00 PM, and 1.00 PM–2.00 PM. With respect to irregularity, only the CI measurements based on a 6-hour interval (7.00 AM–1.00 AM) show a correlation > 0.08 compared to data from the 24-hour recording.

Conclusions

Only long-term (6-hour) recordings provide a high correlation within 24 h in mean heart rate interval and coefficient of irregularity. It seems that the mean heart rate interval in 1-hour periods between 11 AM and 2 PM might be predictive for 24-hour data. Short time recordings of the coefficient of irregularity of heart rate in AFib patients at this moment are not useful in clinical practice for long-term prognosis of ventricular irregularity.     

The sensitivity of the symptom angina pectoris as a marker of transient myocardial ischaemia in chronic stable angina pectoris

Therapeutic decisions in patients with angina pectoris are traditionally based on the history reported by the patient, since objective evidence of myocardial ischaemia during daily life is often not available. In this study, ambulatory ST segment monitoring was performed in 60 patients with a history of chronic stable angina pectoris, positive exercise test and/or positive coronary angiography, and a correlation was made between the episodes of chest pain and ST segment change. The patients were grouped according to the results of exercise testing and coronary arteriography, and one group was studied with and without antianginal medication. Overall, 195 episodes of angina were noted, only 94 of which (48%) were accompanied by ST segment depression. Pain and ST segment changes were best correlated in patients with a positive exercise test, positive angiography and who were not receiving antianginal medication. In 101 episodes of chest pain, ST segment change could not be identified; in 18 (18%) there was sinus tachycardia, in 12 (12%) ventricular premature beats, and in 71 (70%) sinus rhythm solely. Thus, anginal pain appears not to be the reliable indicator of transient myocardial ischaemia as was previously thought, a finding which supports the use of objective methods in identifying episodes of transient myocardial ischaemia in daily life.     

Psychological Correlates of Mental Stress-induced Ischemia in the Laboratory: The Psychophysiological Investigation of Myocardial Ischemia (PIMI) Study

Participants consisted of 184 patients (160 males, 24 females) with positive angiograms or prior myocardial infarctions who displayed at least 1 mm of ST segment depression on a standardized treadmill test. Mean scores on the Reward Dependence subscale of the Tridimensional Personality Questionnaire were higher in patients displaying ischemia during mental stress. Patients who reported higher levels of irritability/anger in response to the Speech stressor were also more likely to display ischemia. However, this result was primarily a result of the females in the sample whose ratings of interest and irritability were associated with ischemia during the Speech task. Psychometric measures previously found in prospective studies to predict acute cardiac events were unrelated to mental stress-induced ischemia in the laboratory.     

Correlation between preoperative ischemia and major cardiac events after peripheral vascular surgery

Patients who undergo peripheral vascular surgery are at increased risk for postoperative cardiac events and are difficult to assess preoperatively because of limitations on their activity. We prospectively studied 176 consecutive eligible patients undergoing elective vascular surgery to determine the value in predicting a postoperative cardiac event of preoperative electrocardiographic monitoring to detect myocardial ischemia. Of the 176 patients, 32 (18 percent) had 75 episodes of monitored ischemic ST-segment depression preoperatively (of which 73 were asymptomatic), and 13 (7 percent) met strict criteria for major postoperative cardiac events, including 1 with a fatal myocardial infarction, 3 with nonfatal infarctions, 4 with unstable angina, and 5 with ischemic pulmonary edema. Of the 32 patients with ischemia before their operations, 12 had postoperative events (univariate relative risk, 54; 95 percent confidence interval, 7.2 to 400). Only 1 postoperative event occurred among 144 patients who did not have preoperative ischemia. The sensitivity of preoperative ischemia was 92 percent, the specificity 88 percent, the predictive value of a positive result 38 percent, and the predictive value of a negative result 99 percent. In multivariate analyses, preoperative ischemia was the most significant correlate of postoperative cardiac events and remained a statistically significant independent correlate even after we had controlled for all other preoperative factors (multivariate relative risk, 24.4; 95 percent confidence interval, 6.8 to 88). These preliminary data suggest that preoperative electrocardiographic monitoring to detect episodes of myocardial ischemia is a useful method for assessing cardiac risk in patients who undergo elective vascular surgery. In particular, the absence of ischemia during monitoring indicates a very low risk.     

Anti-ischemic effect of chronic oestrogen replacement therapy alone or in combination with medroxyprogesterone acetate in different replacement schemes

Background: Oestrogen replacement therapy in postmenopausal women has a protective effect upon the cardiovascular system and improves exercise-induced myocardial ischemia. Although in hormone replacement schemes progestins are required to reduce the likelihood of uterine malignancies, little is known on the cardiovascular effect of progestins. The purpose of this study was to evaluate the effect of oestrogen replacement alone and two different estrogen–progestin replacement therapy schemes upon exercise induced myocardial ischemia. Material and method: The study population included 18 female menopausal patients with coronary artery disease. After a baseline exercise test patients received conjugated equine estrogens (CEE) 0.625 mg alone for 30 days when they underwent a second exercise test and were randomized to receive in a cross-over design medroxyprogesterone acetate (MPA) either in continuous combined therapy (2.5 mg/daily) for 28 days or in cyclical therapy (10 mg o.d. from day 16 to day 28). Results: After CEE alone two patients with a previously positive exercise test showed a negative exercise test. CEE increased time to 1 mm ST compared to baseline (352±185 vs 265±133 s, P<0.01). In the 2 pts in whom the exercise test was negative after CEE the test remained negative during continuous combined MPA therapy while become positive during cyclical MPA. CEE+continuous combined MPA increased both time to 1 mm ST and exercise time compared to baseline (386±165 vs 265±133 s, P<0.01 and 545±198 vs 465±186 s, P<0.05, respectively). No difference was found between baseline and CEE+cyclical MPA in either time to 1 mm ST or exercise time (268±164 vs 265±133 s, P=NS and 455±223 vs 465±186 s, P=NS, respectively). Conclusion: Continuous combined therapy with CEE+MPA improves exercise-induced myocardial ischemia in female patients with coronary artery disease while the beneficial effect of CEE is reduced by cyclical therapy.     

心通胶囊对心肌缺血大鼠心室肌亚硝酸盐和cGMP含量的影响

目的:探讨心通胶囊对实验性大鼠心肌缺血的预防效果及其与一氧化氮形成的相关机制。方法:应用垂体后叶素致大鼠急性心肌缺血模型,以心电图上ST段的抬高作为心肌缺血的指标。测定大鼠心肌缺血心室肌组织一氧化氮(NO)代谢产物(NO₂^-/NO₃^-)和cGMP含量。结果:急性心肌缺血组大鼠的心室肌组织NO₂^-/NO₃^-和cGMP含量分别为(486±59)nmol/gprotein和(0.38±0.08)nmol/gprotein,明显低于正常对照组大鼠的NO₂^-/NO₃^-和cGMP含量,有显著差异(P＜0.01);急性心肌缺血前使用心通胶囊组的心室肌组织NO₂^-/NO₃^-和cGMP含量为(845±105)nmol/gprotein和(0.51±0.10)nmol/gprotein明显高于缺血组(P＜0.01)。与正常组比较,缺血组的心电图ST段抬高明显抬高(P＜0.05);心肌缺血前使用心通胶囊,可使心肌缺血得以改善。结论:心通胶囊提高急性心肌缺血大鼠心室肌组织的NO含量,进而使cGMP含量升高,达到改善心肌缺血的作用。     

Body surface mapping of cardiac activity after partial left ventriculectomy

MECG measurements were performed using 35 electrodes in 10 patients operated with partial left ventriculectomy (PLV). Body surface ECG signals were recorded and five measurements were done: prior to PLV, second, third, fourth and fifth postoperative day. This work was concentrated on the following mapping methods: average isopotential ST segment maps (STM), QRS interval isointegral maps (QRM) and isochronal activation maps (IAM). STMs of the patients show a great positive area (elevation) over the anterior aspect of the heart and a great negative area (depression) over the lateral and posterior aspect of the heart before the operation. After the operation, the ST elevation over the anterior, lateral and posterior aspect of the heart was reduced. A substantial positive value over the excised area of the heart was present also on the end of the postoperative monitoring interval. Minimal and maximal values of the QRMs were smaller and also show some kind of normalisation. The area of the left ventricle, where PLV was performed, was carefully analysed for any changes of activation time for different heart regions. IAMs indicate that the start of the first activation was quite stable and in accordance with the position of the QRMs minimum.