心电图测量冠心病患者左房室间期与患者病情、心脏彩超及冠状动脉病变的关系分析

The analysis of the relationship between the atrioventricular interval of patients with coronary heart disease measured by electrocardiogram and the patients'condition,cardiac color Doppler ultrasound and coronary artery lesions

目的分析心电图测量冠心病(CHD)患者左房室(AR)间期与患者病情、心脏彩超及冠状动脉病变的关系。方法将2018年6月至2020年4月山东省烟台市烟台山医院接受食管心电图检查的CHD患者按AR间期分AR间期<100 ms(AR间期缩短组,53例)、AR间期100~150 ms(AR间期正常组64例)、AR间期>150 ms(AR间期延长组,72例);比较三组一般资料、病情、心脏彩超及冠状动脉病变指标,无序多项Logistic回归分析冠心病AR间期与病情、心脏彩超及冠状动脉病变指标的关系。结果三组性别构成、年龄、糖尿病、吸烟史、血脂、血尿酸(UA)、舒张压(DBP)比较差异无统计学意义(P>0.05),但高血压比例(54.72%、31.25%、46.81%,χ^(2)=7.283,P<0.05)、收缩压(SBP)[(138.84±4.97)、(122.47±7.45)、(139.23±7.05)mmHg(1 mmHg=0.133 kPa)]、CHADS2评分[(1.47±0.08)、(1.02±0.15)、(1.67±0.10)分]、CHADS2-VASc评分[(1.49±0.28)、(1.00±0.24)、(1.74±0.22)分]、Gensini评分[(38.27±5.84)、(24.45±6.08)、(39.42±5.71)分]比较差异有统计学意义(F=11.423、4.938、12.597、11.345,P<0.05);三组每搏输出量(SV)比较差异无统计学意义(P>0.05),但病情[心绞痛(AP):41.51%(22/53)、65.62%(42/64)、37.50%(27/72),急性心肌梗死(AMI):58.49%(31/53)、34.38%(22/64)、62.50%(45/72),χ^(2)=3.469,P<0.05]、左心室舒张末期容积(LVEDV)[(150.73±15.09)、(141.49±28.68)、(151.49±14.47)ml]、左心室收缩末期容积(LVESV)[(42.15±10.49)、(39.82±8.37)、(40.94±11.02)ml]、左心室射血分数(LVEF)[(56.27±4.94)%、(62.20±3.69)%、(57.64±4.99)%]、舒张早期二尖瓣血流速度与舒张晚期二尖瓣血流速度比值(E/A)(0.98±0.29、1.22±0.35、0.97±0.34)、冠状动脉病变支数(单支、双支、≥3支分别为14、18、21例,37、13、14例,9、22、41例)比较差异有统计学意义(F=4.377、7.252、4.944、3.424、5.824,P<0.05);无序多项Logistic回归分析显示高血压、AMI、LVEDV、LVESV、LVEF、Gensini评分、冠状动脉双支病变、冠状动脉≥3支病变均与CHD患者AR间期存在显著关联(OR=2.349、1.893、2.754、2.872、0.414、2.201、4.336、3.401,均P<0.05)。结论CHD患者AR间期与病情、心脏彩超及冠状动脉病变指标存在密切关联,值得临床重视。

Objective To analyze the relationship between the left atrioventricular(AR)interval of patients with coronary heart disease(CHD)measured by electrocardiogram and the patients′condition,cardiac color Doppler ultrasound and coronary artery lesions.Methods The CHD patients undergoing esophageal ECG examination in Yantai Mountain Hospital from June 2018 to April 2020 are divided into three groups according to the AR interval:AR interval<100ms,AR interval 100 to 150 ms,and AR interval>150 ms;The general data,condition,cardiac color Doppler ultrasound and coronary artery lesions indicators of the three groups were compared.Disorderly multiple Logistic regression was used to analyze the relationship between coronary heart disease AR interval and condition,cardiac color Doppler ultrasound and coronary artery lesions indicators.Results There were no statistical difference in gender,age,diabetes,smoking history,blood lipids,blood uric acid(UA)and diastolic blood pressure(DBP)among 3 groups(P>0.05);but there were statistical differences in proportion of hypertension,systolic blood pressure(SBP),CHADS2 score,CHADS2-VASc score and Gensini score among 3 groups:54.72%(29/53),31.25%(20/64)and 46.81%(35/72);(138.84±4.97),(122.47±7.45)and(139.23±7.05)mmHg(1 mmHg=0.133 kPa);(1.47±0.08),(1.02±0.15)and(1.67±0.10)scores;(1.49±0.28),(1.00±0.24)and(1.74±0.22)scores;(38.27±5.84),(24.45±6.08)and(39.42±5.71)scores,P<0.05.There was no statistical difference in stroke volume(SV)among 3 groups(P>0.05),but there were statistical differences in the incidence of AP,incidence of AMI,left ventricular end-diastolic volume(LVEDV),left ventricular end-systolic volume(LVESV),left ventricular ejection fraction(LVEF),the ratio of early diastolic mitral valve blood flow velocity to late diastolic mitral valve blood flow velocity(E/A)and single branch/double branches/≥3 branches lesions of coronary artery:41.51%(22/53),65.62%(42/64)and 37.50%(27/72);58.49%(31/53),34.38%(22/64)and 62.50%(45/72);(150.73±15.09),(141.49±28.68)and(151.49±14.47)ml;(42.15±10.49),(39.82±8.37)and(40.94±11.02)ml;(56.27±4.94)%,(62.20±3.69)%and(57.64±4.99)%;0.98±0.29,1.22±0.35 and 0.97±0.34;14/18/21,37/13/14 and 9/22/41,P<0.05.Disorderly multiple Logistic regression analysis showed hypertension,AMI,LVEDV,LVESV,LVEF,Gensini score,coronary artery double branches lesions and≥3 branches lesions of coronary artery were significantly associated with the AR interval of coronary heart lesions(OR=2.349,1.893,2.754,2.872,0.414,2.201,4.336 and 3.401;P<0.05).Conclusions The AR interval of coronary heart disease is closely related to the condition,cardiac color Doppler ultrasound and coronary artery lesions indicators,which deserves clinical attention.