Ventricular activation and recovery measured in electrocardiographic limb leads correlate with measurements from specific areas in body surface mapping.

AIMS: Dispersion of ventricular depolarization-repolarization in 12-lead electrocardiograms (ECGs) has been reported to provide noninvasive information on arrhythmogenicity. However, there are two methods to calculate the dispersion from ECGs including and excluding limb leads. The aim of this study was to examine whether temporal parameters from limb leads represent activation and repolarization of a particular part of the body surface. METHODS AND RESULTS: We compared the temporal parameters of activation time (AT), activation-recovery interval (ARI), and recovery time (RT) from limb leads of ECGs with those from an 87-lead body surface maps. The study population consisted of 50 normal subjects (25 men and 25 women, 19.4 +/- 1.6 years). The temporal parameters in leads I, II, and III were highly (r > 0.9) correlated with those in unipolar leads over the left lateral, left lower, and right lower chest, respectively. The temporal parameters in leads aVR, aVL, and aVF showed a significant correlation (r > 0.8) with those in unipolar leads over the right upper, left upper, and lower anterior chest, respectively. The mean AT, ARI, and RT from each limb lead of ECG were almost the same as those of unipolar leads over the corresponding areas of the body surface. CONCLUSIONS: These findings suggest that ATs, ARIs, and RTs from limb leads may represent those from unipolar leads of particular areas over the body surface in normal subjects. The temporal parameters from limb leads of ECGs may provide information on activation and repolarization as well as the precordial leads of ECGs.     

老年亚临床甲状腺功能减退症患者心电图改变及血清Hcy、25-(OH)D变化的临床价值

目的 探讨老年甲状腺功能减退症(SH)患者心电图改变及血清同型半胱氨酸(Hcy)、25-羟维生素D[25-(OH)D]变化的临床意义。方法 选取2019年6月—2021年6月核工业四一六医院收治的158例老年SH患者为研究对象,根据冠脉造影结果将患者分为动脉粥样硬化组(n=72)和动脉正常组(n=86),比较两组受试者心电图变化及Hcy、25-(OH)D水平,并分析血清Hcy、血清25-(OH)D及心电图变化与SH患者冠状动脉粥样硬化的关系。结果 动脉粥样硬化组患者的高脂血症构成率、BMI、TC、TG、Hcy、促甲状腺激素(TSH)水平高于动脉正常组(P<0.05),HDL-C、25-(OH)D水平低于动脉正常组(P<0.05);动脉粥样硬化组中窦性心动过缓、QRS低电压、矫正QT间期延长、ST-T改变、不完全性右束支阻滞构成比高于动脉正常组(P<0.05);多因素Logistic回归分析结果显示,Hcy≥12.16μmol/L、25-(OH)D<21.28 mg/L、心电图异常等均是SH患者冠状动脉粥样硬化的独立危险因素;血清Hcy、25-(OH)D评估患者动...     

心电图超声心动图及冠脉造影对诊断心梗的对比

目的 对比研究心电图(ECG)、超声心动图(UCG)、冠状动脉造影(CAG)对心肌梗死(MI)的诊断价值.方法 对疑诊86例心肌梗死患者进行ECG、UCG、CAG检查比较.结果 以CAG结果为标准,在86例疑诊心肌梗死患者中ECG异常者占62.8%,诊断率为79.4%.UCG异常者占60.5%,诊断率为76.5%.CAG异常者占81.4%(确诊MI患者68例).结论 研究证实ECG、UCG、CAG对MI均具有较高的诊断率,且各有特点,对诊断各具有互补性.     

心电图在川崎病急性期的应用研究进展

川崎病是一种急性血管炎症性疾病,冠状动脉损伤及心肌炎是其常见的并发症,尤其在急性期可表现出不同程度的心肌损伤,在心电图上可表现出多种异常。心电图作为一种无创的电生理检查手段,对川崎病的早期诊断及治疗预后评估均有重要意义。随着研究的深入,川崎病早期的心电图表现及电生理意义逐渐被认识,现对近年来国内外研究川崎病急性期心电改变及临床意义进行回顾及总结,就心电图在川崎病诊治的应用进展进行综述。     

2010—2012年山西省克山病病情调查结果分析

目的掌握山西省克山病病情,为防治工作提供科学依据。方法2010年选择石楼、交口县,2011年上半年选择吉县、永和县,2011年下半年选择蒲县、隰县,2012年选择吉县、永和、交口县为调查县;每县选择2个病区乡,每乡选择一个病区村为调查点,每村选择500人左右,开展临床查体和心电图描记。结果共检查7080人,检出克山病180例,总检出率2．54％;其中慢型克山病14例,检出率0．20％,潜在型克山病166例,检出率2．34％;检出异常心电图777例,异常率10．97％,克山病患者心电网异常改变以完全性右束支传导阻滞和ST-T改变为主;克山病病例男女性别比为1：0．84。结论调查期间无新发急型、亚急型克山病患者,慢型、潜在型克山病总体检出率在国家控制标准之内;2010年潜在型克山病检出率以及2011年下半年和2012年慢型克山病检出率超过国家控制标准;应继续开展监测,及时掌握病情动态,同时加强有效防治措施的落实力度。     

Predictive value of Q waves on the 12-lead electrocardiogram after reperfusion therapy for ST elevation myocardial infarction

Design

The data used for the present study were obtained as part of a clinical trial evaluating the effect of thrombus aspiration after primary percutaneous coronary intervention (PCI).

Setting

The study was conducted at a tertiary referral facility for primary PCI at a University Medical Center Groningen in The Netherlands.

Background

Prognosis after ST elevation myocardial infarction (STEMI) is strongly related to infarct size.

Methods

As part of a randomized clinical trial, the first electrocardiogram (ECG) after primary PCI for STEMI was analyzed for the incidence of Q waves (>0.1 mV) on the 12-lead ECG. Infarct size was measured as area under curve (AUC) of creatine kinase (CK) and CK-myocardial band (CK-MB).

Results and Conclusion

Nine hundred thirty-three patients were included, the median number of Q waves on the postprocedural ECG was 3 (interquartile range, 1-4). The number of Q waves on the postprocedural ECG was an independent predictor of infarct size measured either as AUC of CK (P < .001) or AUC of CK-MB (P < .001) and was a significant predictor of mortality during follow-up of 14 months. In conclusion, the number of Q waves on the postprocedural 12-lead ECG after primary PCI for STEMI is a strong predictor of infarct size and long-term mortality.     

肺动脉高压患者心率校正QT间期和QT离散度的研究

目的:检测肺动脉高压(pulmonary hypertension,PH)患者的心率校正的QT间期(heartrate-corrected QT interval,QTc)和QTc离散度(QTc dispersion,QTcd),并评价其与肺动脉压力的关系。方法:入选2003年12月至2008年7月因初步诊断为PH而进行右心导管术的患者。记录静息12导联心电图,手工测量QT间期并用Bazett公式进行校正。根据平均肺动脉压,将患者分为对照组,轻-中度PH组和重度PH组。结果:共入选201例患者。男性患者的QTc和QTcd在3组间差异无统计学意义。女性患者中,重度PH组的QTc比对照组高〔(436.1±39.4)msvs.(407.6±24.8)ms,P=0.037〕,重度PH组的QTcd(68.5±20.9)ms高于对照组(45.1±12.6)ms和轻-中度组(58.6±14.7)ms(P=0.002;P=0.003)。此外,女性患者的QTc和QTcd与平均肺动脉压正相关(r=0.207,P=0.03;r=0.236,P=0.012)。结论:本组资料中女性PH患者的QTc和QTcd与平均肺动脉压正相关,且在重度PH患者中显著增高,有待于进一步探讨。     

Brugada-type patterns are easily observed in high precordial lead ECGs in collegiate athletes

Background

Displacement of ECG leads can result in unwarranted findings. We assessed the frequency of Brugada-type patterns in athletes when precordial leads were purposely placed upward.

Methods

Four hundred ninety-one collegiate athletes underwent two ECGs: one with standard leads, one with V1 and V2 along the 2nd intercostal space. A positive Brugada-type pattern was defined as ST elevation in V1 or V2 consistent with a Type 1, 2, or 3 pattern in the high-lead ECG. A control group was comprised of 181 outpatients.

Results

No Type 1 patterns were seen. In 58 athletes (11.8%), a Brugada-type 2 or 3 pattern was observed. Those with Brugada-type 2 or 3 patterns were more likely male, taller, and heavier. In the control group, 18 (9.9%) had Brugada-type 2 or 3 patterns and were more likely male.

Conclusions

Proper lead positioning is essential to avoid unwarranted diagnosis of a Brugada-type ECG, especially in taller, heavier male athletes.     

冠状动脉影像学与心电图检查诊断老年冠心病价值的对比研究

目的：比较冠状动脉CT血管造影（CTA）与心电图对老年冠心病（CHD）患者的诊断价值。方法选择拟诊冠心病的老年住院患者148例,分别行冠状动脉CTA和心电图检查。其中有96例同时行冠状动脉造影检查。按冠状动脉造影结果分析冠状动脉CTA及心电图诊断冠心病的敏感度（阳性率）、特异度（阴性率）。结果冠状动脉CTA的敏感度为90.1%、特异度为88.1%、符合率为88.8%。心电图诊断CHD的敏感度为72.0%、特异度为57.1%、符合率为68.8%。冠状动脉造影狭窄程度≥90%的病变,心电图的敏感度最高,假阴性率最低;狭窄程度＜90%者与≥90%者比较,心电图敏感度较低,差异显著（均P＜0.01）。结论冠状动脉CTA发现有意义血管狭窄的敏感度、特异度较高,可作为老年冠心病诊断的有效方法;心电图对老年患者严重冠脉狭窄有一定的诊断价值。     

酷似AMI的恙虫病感染致急性心肌炎一例

急性心肌炎是由各种原因引起的心肌急性炎症性病变。部分急性心肌炎可引起胸痛、心肌酶及心电图的动态改变,与AMI临床症状类似。恙虫病是由恙虫病立克次体引起的一种急性疫源性传染病,恙虫病感染可引起心肌弥漫间质性炎症病变。恙虫病感染致病的临床表现多样,易出现漏诊误诊。该文报道了1例酷似AMI的恙虫病感染致急性心肌炎患者的诊治过...