冠心病患者经皮冠状动脉介入治疗术前后心电图缺血性J波的观察

目的 探讨经皮冠状动脉(冠脉)介入治疗(PCI)对冠心病患者心电图缺血性J波的影响及临床意义,为临床提供无创检查指标起到预警作用.方法 选择经皮冠状动脉造影确诊并行PCI治疗的冠心病患者(冠心病组)162例,其中不稳定性心绞痛(心绞痛组)108例,急性心肌梗死(心梗组)54例.记录PCI术前、术后24h内的12导联体表心电图,分别测量各导联J波的振幅和时限,分析PCI术前、术后J波的发生率及参数变化.根据狭窄的冠脉分为2个冠脉狭窄组(前降支狭窄组和右冠脉或回旋支狭窄组),观察体表12导联心电图J波的形态比较及发生率.结果 (1)PCI 术前、术后J波发生率最高为Ⅱ、Ⅲ、aVF导联,冠心病组发生率分别为33.95％、22.84％、26.54％和30.86％、19.75％、23.46％,心绞痛组发生率分别为37.04％、27.78％、31.48％和35.19％、25.00％、27.78％;而心梗组PCI术前为V5、Ⅱ、aVF、Ⅲ、V3导联J波发生率较高,术后J波发生率为V5、Ⅱ、aVF、aVL、Ⅲ导联J波发生率较高(分别为33.33％、27.78％、16.67％、12.96％、11.11％和22.22％、22.22％、14.81％、12.96％、9.26％).(2)前降支狭窄组PCI术前J波在V5、V6导联为25.78％,右冠脉或回旋支狭窄组PCI术前J波在Ⅱ、Ⅲ、aVF导联为35.37％;术后两组均在Ⅱ、Ⅲ、aVF组发生率最高,分别为21.09％和35.37％.(3)全部冠心病组在PCI术前的J波以振幅0.08 mV和时限0.02s的例数最多,PCI术后J波振幅为0.02 mV和时限0.02s例数最多.(4)全部冠心病组PCI术前J波振幅和时限在Ⅱ、Ⅲ、aVF、V3、V4导联上均大于PCI术后,差异有统计学意义[中位数(四分位数间距P25,P75)为:Ⅱ导联振幅0.05(0.05,0.10) mV比0.02(0.02,0.05) mY,P=0.00,时限0.03(0.02,0.04)s比0.02(0.02,0.03)s,P=0.00;Ⅲ导联振幅0.05(0.05,0.10) mV比0.02(0.02,0.05) mV,P=0.00,时限0.02(0.02,0.03)s比0.02(0.01,0.02)s,P=0.00;aVF导联振幅0.05(0.05,0.10)mV比0.02(0.00,0.08)mV,P=0.00,时限0.02(0.02,0.03)s比0.02(0.00,0.02)s,P=0.00;V3导联振幅0.05(0.05,0.16)mV比0.05(0.00,0.05)mV,P=0.03,时限0.02(0.02,0.04)s比0.02(0.00,0.02)s,P=0.01;V4导联振幅0.06(0.04,0.12)mV比0.01 (0.00,0.07) mV,P=0.01,时限0.04(0.04,0.05)s比0.01(0.00,0.02)s,P=0.00].结论 冠心病组和心绞痛组PCI术前、术后J波在Ⅱ、Ⅲ、aVF导联的发生率最高,而心梗组在V5、Ⅱ、Ⅲ、aVF导联较高;前降支狭窄与右冠脉或回旋支狭窄组J波分别在V5、V6与Ⅱ、Ⅲ、aVF导联的发生率最高;PCI术后,J波振幅和时限均降低,说明PCI对冠心病缺血性J波有相对较好的影响.

Ischemic J wave before and post percutaneous coronary intervention in patients with coronary artery disease

Objective To explore the change of electrocardiographic ischemic J wave in patients with coronary heart disease (CHD) underwent percutaneous coronary intervention (PCI).Methods CHD patients (CHD,n = 162) underwent PCI in the hospital were divided into unstable angina pectoris (angina pectoris group,n = 108 ) and acute myocardial infarction group ( AMI group,n = 54 ),12-lead electrocardiogram was recorded within 24 hours before and after PCI.Patients were further grouped into left anterior descending artery group and right or circumflex coronary artery stenosis group.The incidence,amplitude and time course of J waves were measured and analyzed.Results ( 1 ) The highest incidence of J wave appeared in Ⅱ,Ⅲ,aVF leads pre- and post-PCI in CHD groups (33.95％,22.84％,26.54％ and 30.86％,19.75 ％,23.46％ ).Higher incidence of J wave in AMI group was evidenced in V5,Ⅱ,aVF,Ⅲ,V3 leads before PCI(33.33％,27.78％,16.67％,12.96％,11.11％ ) and in V5,Ⅱ,aVF,aVL,Ⅲ leads after PCI (22.22％,22.22％,14.81％,12.96％,9.26％ ).(2) Before PCI,higher incidence of J wave was found in V5,V6 leads (25.78％) in left anterior descending artery group and in Ⅱ,Ⅲ,aVF leads (35.37％) in right or circumflex coronary artery stenosis group.After PCI,the higher incidence of J wave in left anterior descending artery group and right or circumflex coronary artery stenosis group was evidenced in Ⅱ,m,aVF leads (21.09％ and 35.37％,respectively).(3) The ischemic J wave' amplitude and time course in Ⅱ,Ⅲ,aVF,V3,V4 leads were significantly reduced post PCI in CHD patients.Conclusions Higher incidence of J wave was found in Ⅱ,Ⅲ,aVF in CHD patients.PCI is associated with reduced amplitude and time course of J wave suggesting PCI could improve ischemic J waves in CHD patients.