有关室性心动过速诊断标准的价值评估

目的 评价Brugada标准、Steurer标准、Verecke标准以及这3种标准中各个单项标准对诊断室性心动过速(VT)的价值及其存在的缺陷.方法 对120例VT者发作时常规12导联同步心电图进行分析.计算以上各种标准对诊断VT的敏感性以及上述3种标准对各种器质性心脏病所致的VT及无器质性心脏病的特发性VT(IVT)的敏感性.结果 3种标准中的各个单项标准对诊断VT的敏感性较低,均小于60%;而多项组合上述3种标准对诊断VT的敏感性明显提高,依次分别为:96.7%、74.2%及86.7%.另外,3种标准对器质性心脏病所致VT的敏感性较高,分别为99.1%、81.3%及96.7%,而Brugada标准对右束支传导阻滞(RBBB)型的IVT的敏感性较高(100%),对左束支传导阻滞(LBBB)型的IVT的敏感性较低(40%),而Steurer标准及Verecke标准对IVT的敏感性均较低(0%～12.5%).结论 心电图单项标准对诊断VT敏感性较低,不能依据心电图某单一标准来诊断VT.多项组合的Brugada标准是诊断VT最敏感的方法,但对LBBB型的IVT敏感性较低.诊断时应密切结合临床资料以及其它诊断标准综合考虑.

Assessment of the value of the diagnostic criteria for ventricular tachycardia

Objective To assess three diagnostic criteria, namely Brugada criterion, Steurer criterion and Verecke criterion and to evaluate the value and defects of these three criteria for ventricular tachycardia (VT). Methods we an-alysed 12 lead EKG of 120 cases of VT patients during the period of onset. Calculation was done for the sensitiveness of di-agnosing VT, organic heart disease associated VT and idiopathic VT(IVT) using the criteria of Brugada, Steurer and Ve-recke. Results Every single component of the three criteria for VT diagnosis showed low sensitiveness, all smaller than 60%. Whereas there was a significant increase in the sensitiveness of the multi-step Brugada criterion, Steurer criterion and Verecke criterion for VT (96.7%, 74.2% and 86.7%, respectively). In addition, the three criteria for organic heart disease associated VT showed comparatively higher sensitiveness (99.1%, 81.3% and 96.7%, respectively). Brugada criterion had higher sensitiveness (100%) for the diagnosis of RBBB type of IVT and lower one (40%) for LBBB type of IVT. Both Steurer and Verecke criteria showed lower sensitiveness in the diagnosis of IVT(0%～12.5%). Conclusion The single component of ECG criteria had lower sensitiveness of the dianosis of VT. it cannot diagnose VT with sigle cri-teria. And the multi-step Brugada criterion was considered as one of the most sensitive methods to diagnose VT, but showed lower sensitiveness in diagnosing LBBB type of IVT. Thus, the clinical data and other diagnostic criteria should be comprehensively taken into consideration so as to avoid misdiagnosis.