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。

Abnormal U Waves in the Diagnosis of the Ischemic Heart Disease-Comparison between Coronary Arteriography and EKG

Objective To study the diagnostic significance of abnormal U waves in the ischemic heart disease. Methods Fifty-two male patients with suspected coronary heart disease were subjected to routine electrocardiography, treadmill test and coronary arteriography. ECG ischemic ST segment and abnormal U waves were compared to the findings of the coronary arteriography . Results There were 38 patients with pathological coronary stenosis in coronary arteriography. Ischemic ST segments were found in 16, and abnormal U waves were 8 in resting ECG. Their sensitivity for diagnosing the ischemic heart disease were 42.1%, 21.1%, respectively. 26 patients showed ischemic ST segment depression and 15 with abnormal U waves in treadmill testing. The sensitivity for diagnosing the ischemic heart disease were 68.4%, 39.5%, respectively. Of 14 subjects with normal coronary arteriography, 6 cases had normal ST segments and 13 with normal U waves in resting ECG test were found. The specificity for the diagnosing of the ischemic heart disease were 42.9%, 92.9%, respectively. During treadmill testing, nine patients had normal ST sogment changes, and 14 normal U waves. Their specificity were 64.3%, 100%(9/14?14/14),respectively. There were 2 other cases with exercise-induced U waves as the only abnormal finding, who had pathological coronary stenosis in coronary arteriography. Conclusion Abnormal U waves is of high specificity for the diagnosis of ischemic heart disease, though its sensitivity is not as high as that of the depression of ST segment. Exercise-induced U waves is especially of significance in the diagnosis. The U wave criteria are helpful in the diagnosis of the coronary heart disease.