心电图P波离散度及左心房大小预测阵发性心房颤动的研究

目的 探讨P波离散度(Pd)、最大P波时限(Pmax)及左心房大小对阵发性心房颤动(PAF)的预测价值.方法 采用12导联同步心电图机记录160例PAF患者(PAF组)的Pd及Pmax,超声心动图仪测量左心房舒张末期内径(LAD),并与160例非PAF患者(对照组)比较.结果 与对照组比较,PAF组的Pd(47±9)ms比(33±4)ms]增大、Pmax(123±14) ms比(104±11)ms]明显延长,LAD (4.2±0.6)cm比(3.5±0.4)cm]明显增大(P＜0.05).Pd、Pmax与LAD在不同病因PAF患者中差异无统计学意义(P＞0.05).直线相关分析显示Pd及Pmax与LAD呈显著正相关(r分别为0.426、0.558,P＜0.05).Pmax≥110 ms时,预测PAF的敏感性、特异性和阳性预测值分别为81.9％、73.8％和75.7％；Pd≥40 ms时,其敏感性、特异性和阳性预测值分别为81.3％、82.5％和82.3％；当联合Pmax≥110 ms且Pd≥40 ms时,敏感性为74.4％,特异性为91.3％,阳性预测值为89.5％.以LAD≥4.0 cm为左心房扩大诊断标准,则其预测PAF的灵敏度、特异性和阳性预测值分别为68.1％、65.6％和66.5％.结论 Pd、Pmax与PAF患者左心房大小显著相关,均可作为预测PAF的体表心电图指标,联合应用可提高特异性和阳性预测值.

Predictive value of P wave dispersion and left atrial size of paroxysmal atrial fibrillation

Objective To explore the predictive value of P wave dispersion （Pd）, the maximum P wave duration （Pmax） and left atrial size of paroxysmal atrial fibrillation （PAF）. Methods 12-lead synchronous ECG and ultrasonic cardiograph were used to measure the Pd, Pmax and left atrial diameter（LAD） of 160 PAF patients （PAF group）, and 160 patients without PAF were analyzed as control group. Results Compared with the control group, Pd（47±9）msvs （33± 4）ms], Pmax（123± 14）msvs （104±11）ms ], and LAD （4.2± 0.6）cm vs （3.5 ± 0.4） cm ] of PAF group were significantly prolonged （ P 〈 0.05 ）. Pd, Pmax and LAD were similar in patients with PAF result form with a different etiology （ P 〉 0.05 ）. Linear correlation analysis showed that Pd and Pmax had significant positive correlation with LAD （r = 0. 426 ,0. 558 , P 〈 0. 05）. The sensitivity, specificity, ac- curacy, positive predictive value of Pmax≥110 ms for PAF were 81.9% ,73.8% and 75.7% ;those of Pd≥40 ms were 81.3%, 82.5% and 82.3%. When combined with Pmax≥ 110 ms and Pd ≥40 ms, the sensitivity was 74.4%, the specificity was 91.3% and the positive predictive value was 89.5%. The prediction of PAF sensitivi- ty, specificity and positive predictive value were 68.1% , 65.6% and 66.5%, respectively,according to LAD acui- ty 4.0 em for left atrium enlarge diagnostic criteria. Conclusion Pd and Pmax are significantly correlated with left atrial size of PAF patients, regardless of different etiology. Both of Pd and Pmax are predictive index of PAF and combined application can improve the specificity and positive predictive value.