T波电交替筛查冠心病的研究

The Study of Using Microvolt T Wave Alternans Screening Cornary Heart Disease

目的探讨时域法微伏级T波电交替(MTWA)筛查冠心病的价值.方法经冠脉造影确诊的冠心病(CHD)患者152例为冠心病组.对照组为非冠心病者共140例.采用GE Marquette Case800系统MTWA分析程序以时域法连续分析MTWA及最大MTWA时的心率(HR)为频率阈值.以接收者操作特征曲线(ROC)分析MTWA筛查冠心病的价值.结果 CHD组时域法MTWA(22.04±7.22)μV明显高于对照组(10.63±6.71)μV,P<0.01;频率阈值[(107.61±12.06)次/min]低于对照组[(126.23±9.42)次/min,P<0.01].MTWA筛查CHD的ROC曲线下面积(AUC)为0.908(95%CI0.87～0.946,P<0.01),最佳切点为11.5μV(敏感性为97.66%,特异性为71.43%).结论冠心病患者时域法MTWA的频率阈值明显降低,MTWA幅度明显高于非冠心病患者,可在运动试验中作为冠心病的筛查指标.

Objective To investigate the value of using microvolt T wave alternans（MTWA）to screen coronary heart disease.Methods 152 patients with coronary heart disease（CHD）were selected in CHD group,and 140 patients without coronary artery disease served as control group.MTWA was assessed by MTWA analyzed system with GE Marquette Case 800,the amplitude of MTWA and heart rate of maxim amplitude of MTWA were recorded.The value of MTWA in screening CHD was analyzed by ROC.Results MTWA（22.04±7.22 μV）was higher in CHD group than in control group（10.63±6.71 μV,P0.01）.Threshold of heart rate（107.61±12.06 bpm）was lower in CHD group than in control group（126.23±9.42 bpm,P〈0.01）.Area under curve（AUC）of MTWA was 0.908（95%CI 0.87-0.946,P〈0.01）.The optimal cut-of point was 11.5 μV for screening CAD with a sensitivity of 97.66% and a specificity of 71.43%.Conclusion The threshold of heart rate in CHD patients decreases significantly,and the amplitude of MTWA is higher in CHD patients than in patients without CHD,MTWA maybe a new tool for screening for CHD.