信号平均心电图频谱时间标测检测冠心病及持续性室性心动过速／心室颤动患者结果的分析

目的：本研究观察了频谱时间标测检测心室晚电位心室对冠状动脉粥样硬化性心脏病（冠心病）患者持续性室性心动过速（室速）／心室颤动（室颤）发生的预测价值，并观察了心肌梗死、缺血及心肌梗死部位对心室晚电位的影响。方法：用频谱时间标测法，对２１０例健康人（Ⅰ组）、２０２例冠心病心绞痛患者（Ⅱ组）、１００例陈旧性心肌梗死患者（Ⅲ组）及３９例心肌梗死并持续性室速／室颤患者（Ⅳ组）的信号平均心电图进行分析，根据健康人的正常因子值确定心室晚电位诊断标准，并用Ｘ２检验对各组患者心室晚电位阳性率进行比较。结果：心室晚电位阳性率Ⅰ组与Ⅱ组无显著差异（Ｐ＞０．０５）；Ⅲ组与Ⅳ组显著高于Ⅰ组（Ｐ均＜０．００５）及Ⅱ组（Ｐ均＜０．００５）；Ⅳ组显著高于Ⅲ组（Ｐ＜０．００５）。不同心肌梗死部位无显著差异（Ｐ＞０．０５）；多部位与单部位心肌梗死无显著差异（Ｐ＞０．０５）。预测的敏感性为５１．３％、特异性为９１．０％、阳性预告值为３５．１％、阴性预告值为９５．２％。结论：频谱时间标测检测心室晚电位对预测持续性室速／室颤的发生有重要价值，心肌梗死部位、心肌缺血对心室晚电位的发生无影响。

Spectrotemporal Mapping Analysis of Signal-averaged Electrocardiogram of Coronary Artery Disease Patients

Objective :This paper was aimed to study the value of spectrotemporal mapping analysis of signalaveraged electrocardiogram (SAECG) of coronary aretry disease in predicting patients prone to have sustained VT/VF, and the influence of myocardial infarction, ischemia and infarct site on ventricular late potentials(VLP).Methods: The SAECGs of four groups of subjects were analyzed by spectrotemporal mapping. Group 1 consisted of 210 healthy subjects, group 2202 angina pectoris patients, group 3100 postinfarction patients and group 439 postinfarction with sustained VT/VF patients. The positive criterion of VLP was made according to the distribution of factor of normality value in healthy subjects. The incidence of VLP in each group was compared by X2 test. Results: There was no significant difference in the incidence of VLP between group 1 and group 2 (p>0.05); The incidences of VLP in group 3 and 4 were significantly higher than those in group 1 (both p< 0.005) and 2(both p<0.005); The incidence of VLP in group 4 was significantly higher than that in group 3(p<0.05); There was no significant difference in the incidence of VLP between patients with MI at different sites(p>0. 05), and also between multisites and single site of MI patients(p>0.05); The sensitivity, specificity, positive preditive and negative predictive values of the SAECG for sustained VT/VF were 51.3%,91.0%,35.1% and 95.2%,respectively. Conclusion:Spectrotemporal mapping analysis of SAECG for VLP has important prognostic significance of sustained VT/VF in postinfarction patients while infarct site and myocardial ischemia has no influence on VLP.