立体心电向量图T环复极参数在无症状心肌缺血诊断中的价值

Evaluation of 3D-ECG T-loop depolarization date for silent myocardial iischemia

目的探讨立体心电向量图T环复极参数对无症状心肌缺血诊断中的价值。方法对176例住院患者进行12导联心电图、平面心电向量图、立体心电向量图采集T环最大向量振幅、R-T角、ST向量、T环长/宽、RT比值、ST向量仰角、ST向量水平角,进行回顾性分析,并以冠状动脉造影阳性结果为冠心病心肌缺血的"金标准"。结果 (1)立体心电图诊断心肌缺血敏感性特异性均高于常规心电图及平面向量图。立体心电向量图较心电图及平面心电向量图检出无症状心肌缺血的阳性率差异有统计学意义(P<0.01)。(2)无症状心肌缺血中立体心向量图测得T环复极参数中T环最大向量振幅(0.28±0.06)mV、R-T角(80.65±57.32)°、ST向量(0.07±0.04)mV、T环长/宽(0.89±0.18)、RT比值(3.08±1.04)、ST向量仰角(110.04±49.27)°、ST向量水平角(-94.24±62.17)°与平面向量各值比较差异有统计学意义(P<0.05)。结论无症状心肌缺血为冠心病重要类型,心电图及平面心电向量图对心肌缺血诊断并敏感度及特异度不高,立体心电向量图复极指标检测对提高无症状心肌缺血的诊断具有独特的临床意义,且3D-ECG中T环复极各参数更为准确。

Objective To explore the evaluation of 3D-ECG T-loop depolarization date for SMI. Methods 12- lead ECG, VCG, 3D-ECG,were performed for the 176 hospitalized patients and T-loop maximum vector magnitude, angle of R-T,ST vector,L/W of T-loop,R/T,angle of ST vector elevation and angle of ST vector horizontal were collected and retrospectively analyzed using positive coronary angiography as the gold standard for diagnosis of CHD myocardial ischemia. Results （1）Higher specificity was observed in diagnosing SMI with 3D-ECG. Compared with ECG and VCG, the differences of detection rate for SMI,3D-ECG had statistically significant（P 〈： 0.01）. （2）Among the patione of SMI, 3D-ECG mesure T-loop depolarization date of T-loop maximum vector magnitude（0.28 ± 0.06） mV, angle of R-T（80.65 ± 57.32） ° , ST vector （ 0.07 ± 0.04 ） mV, L/W of T-loop （ 0.89 ± 0.18 ）, R/T （ 3.08 ± 1.04 ）, angle of ST vector elevation （ 110.04 ± 49.27 ） °, angle of ST vector horizontal-（94.24 ± 62.17） ° , compared with VCG was statistically significant（P 〈 0.05）. Conclusion SMI is the most common manifestation of coronary heart disease （CHD）. ECG and VCG is not sensitive and specific enough in diagnosing myocardial ischemia. Combing T-VCG to improve the diagnosis for asymptomatic myocardial ischemia is of great clinical significance,and T-loop depolarization date of 3D- ECG are more accurate.