老年和老年前期心电图P波终末向量界限值探讨

Critical Value of P Wave Terminal Force of Electrocardiogram in Elderly and Pre elderly

目的 探讨老年和老年前期心电图P波终末向量 (PTFV1)正常界限值及临床机理。方法 住院老年和老年前期170例 ,分为正常组、高血压病组及冠心病组。常规体表心电图测定PTFV1值等 ,并进行多变量分析。结果 根据本文正常组PTFV1的均数和标准差计算 90 %、95 %、99%水平的界限值分别为 -0 .0 2 2、-0 .0 2 5、-0 .0 3 0mm·s。异常PT FV1按不同界限值在冠心病组的敏感性、特异性、阴性和阳性预期值 :<-0 .0 2 2mm·s时为 80 .5 %、92 .5 %、91.7%和82 .2 % ;<-0 .0 2 5mm·s时为 5 3 .7%、92 .5 %、88.0 %和 66.1% ;<-0 .0 3 0mm·s时为 14 .6%、10 0 .0 %、10 0 .0 %和 5 3 .3 %。将PTFV1与下列 16项变量 :即年龄、身高、体重、病程、病史中最高的收缩压和舒张压、近期检查 3次血压的平均收缩压和舒张压、Tv1、Tv5、Sv1+Rv5(振幅 )、RaVL +Sv3 、左心房内径、左室舒张末径、同射血分数有定量关系的QRS计分以及二尖瓣多普勒A波峰速 ,进行相关分析 ,仅与A波峰速 (r =0 .3 97,P <0 .0 1)相关。各组PTFV1异常发生率 :正常组为 7.5 %、高血压Ⅰ期组为 6.9%、高血压Ⅱ期组为 3 .3 %、高血压Ⅲ期组为 2 6.7%、冠心病组为 80 .5 %。结论 老年和老年前期PTFV1的界限值以 -0 .0 2 2mm·s为宜。

Objective To study the critical value of P wave terminal force (PTFV 1) in elderly and pre elderly and its clinical mechanism.Methods 170 cases of elderly and pre elderly in patients were divided into the normal group included 40 subjects(aged 66±4 years),the hypertension(HT) group included 89 patients(aged 67±5 years),the coronary heart disease(CAD) group included 41 patients with age of 74±7 years.Value of PTFV 1 and so on was detected by routine body surpace electrocardiogram,and we carried out a multivariate analysis for it.Results According to the mean and standard error of PTFV 1 in normal group,the critical value was -0.022,-0.025 and -0.030 mm·s for 90%,95% and 99% levels respectively.The sensitivity,specificity,positive and negative predictory values for abnormal PTFV 1 in CAD group were 80.5%,92.5%,91.7% and 82.2% at critical value of <-0.022mm·s respectively,and were 53.7%,92.5%,88.0% and 66.1% at critical of <-0.025mm·s respectively,and were 14.6%,100.0%,100.0% and 53.3% at critical value of <-0.030mm·s respectively.Only the A wave peak velocity(APV) of 16 variables(age,height,weight,disease course,the highest SBP and DBP in history,average SBP and DBP in recent three measures,Tv 1,Tv 5,Sv 1+Rv 5,RaVL+Rv 3,dimension of left atrium and left ventricle,QRS score and APV) was correlated with PTFV 1(r=0.397,P<0.01).The prevalence of abnormal PTFV 1 was 7.5% in normal group,6.9% in HT first phase group,3.3% in HT second phase group,26.7% in HT third phase group and 80.5% in CAD group.Conclusions The critical value for PTFV 1,-0.022mm·s is properly for elderly and pre elderly stage.PTFV 1 merely has a weak correlation with diastolic function.