变异型心绞痛ST段改变趋势图及散点图分析

Dynamic electrocardiography analysis of variant angina patients

目的研究动态心电监测中ST段趋势图和散点图对变异型心绞痛(VA)诊断及治疗的临床意义。方法对34例已经确诊的VA患者的动态心电图监测24h散点图及缺血事件ST段趋势图结果进行回顾分析总结。结果34例VA患者动态心电图监测ST段趋势图检测出134次缺血事件,缺血事件ST段趋势图突然呈现"细柱型"改变52次(占38.8%),呈"峰型"改变82次(占61.2%)。24h散点图呈一分布19例,三分布10例及多分布5例。散点图近点可见散在连续短周期7例,散点图远端可见散在或密集长周期4例。结论VA冠状动脉痉挛时ST段趋势图具有典型的动态改变,通过ST段趋势图可直观观察24hVA发作的时间、频率、持续时间及痉挛变化的全过程,间接判断缺血冠状动脉;通过散点图快速观察VA患者伴发的危险性心律失常。因此,ST段趋势图和散点图为临床诊断和治疗VA及预防心性猝死提供了重要的无创价廉的心电学依据,在临床工作中具有重要的意义。

Objective To explore the clinical monitoring value of the ST-segment charts and Lorenz plots(LPs)to diagnose variant angina(VA)and related arrhythmia in the data of 12-lead Dynamic Electrocardiography(DCG)in VA patients.Methods The ST-segment charts and LPs were made from the data of 24 h ambulatory electrocardiograms of 34 VA patients.Then these ST-segment charts and LPs were analyzed respectively.Results In34 patients with VA,there were 134 ST-segment elevation episodes.We found 52 ST-segment changes of"thin column"(38.8%)and 82 ST-segment changes of"peak"(61.2%).There were 19 cases in one distribution pictures,10 cases in three distribution pictures and 5 cases in multiple distribution pictures in PLs.There were 7 cases of continuous short period and 4 cases of diffused and/or continuous long period in PLs.Conclusions ST-segment charts can exactly record the overall process of variant angina attack including the time,frequency and duration in 24 hours,and it also can locate the ischemic coronary.LPs can quickly diagnose the malignant arrhythmia.Therefore,ST-segment charts and PLs provide an important non-invasive and inexpensive tool for clinical diagnose and treatment and prevention of sudden cardiac death in VA patients,which are of great clinical significance.