探讨心率震荡现象诊断冠心病的价值

The value of heart rate turbulence in the diagnosis of coronary heart disease

目的探讨心率震荡现象（HRT）诊断冠心病的价值。方法将200例拟诊为心绞痛的患者按照冠状动脉造影结果分为冠心病组和对照组，冠心病组100例，对照组100例。每例患者均做24小时动态心电图检查，取得心率震荡（HRT）参数：震荡初始（TO）和震荡斜率（TS）和ST—T改变的情况，比较两组间TO、TS以及ST—T改变对诊断冠心病的各个评价指标。结果TO的各个评价指标与ST—T改变相当，TS对冠心病诊断的特异度（97％）和阳性预测（90％）值明显高于sT—T改变（分别为62％和63．1％）。结论心率震荡现象的指标TO、TS可能成为诊断冠心病的一个新的指标，在诊断价值上甚至有可能高于ST—T改变。

Objective To explore the value of heart rate turbulence in the diagnosis of coronary heart disease （ CHD ）.Methods 200 patients who was clinically diagnosed as angina pectoris were divided into CHD group （ 100 patients ） and control group （ 100 patients ） based on the findings of coronary angiography （ CAG ）. All the patients received 24-hour Holter monitoring. Parameters including turbalence onset （ TO ）, turbalence slope （ TS ）, and ST-T change were noted. The sensitivity, specificity, and positive predictive value of TO, TS, and ST-T change for diagnosis of CHD were compared between the two groups. Results TO was equivalent to ST-T change for diagnosis of CHD, but the specificity and positive predictive value of TS were markedly higher than that of ST-T change （ 97% vs. 62% and 90% vs. 63.1% ）. Conclusions Turbalence onset and turbalence slope can be an new indicator for the diagnosis of coronary heart disease and may even have a higher dignostic value than ST-T change.