微伏级T波电交替和窦性心率震荡在冠心病患者中的诊断价值

Diagnostic value of microvolt T wave alternans and heart rate turbulence in patients with coronary heart disease

目的探讨微伏级T波电交替(MTWA)及窦性心率震荡(HRT)在冠心病诊断中的应用价值。方法选择2013年10月—2014年12月疑诊冠心病并行冠状动脉造影及24小时动态心电图检查的住院患者共76例。采用Beneware动态心电图分析软件记录24 h动态心电图。经冠状动脉造影正常或者冠状动脉狭窄<50%者为对照组(30例),经冠状动脉造影证实相关冠状动脉狭窄>75%且血流分级≤3级为病变组(46例),其中病变组分心绞痛亚组(24例)及心肌梗死亚组(22例)。同时根据冠状动脉病变累及程度分为单支亚组(10例)、双支亚组(15例)和三支亚组(21例),分析24 h动态心电图,比较MTWA和HRT阳性率的变化。结果(1)病变组MTWA阳性率为41.3%,高于对照组的6.7%(P<0.05);病变组HRT阳性率为63.0%,高于对照组的16.7%(P<0.05);病变组MTWA联合HRT阳性率为23.9%,高于对照组的6.7%(P<0.05)。(2)心绞痛亚组MTWA阳性率为75.0%高于心肌梗死亚组的4.5%(P<0.05);心绞痛亚组HRT阳性率为91.7%,高于心肌梗死亚组的31.8%(P<0.05);心绞痛亚组MTWA联合HRT阳性率为41.7%,高于心肌梗死亚组的4.5%(P<0.05)。(3)单支亚组、双支亚组、三支亚组MTWA阳性率分别为30.0%、40.0%、47.6%,HRT阳性率分别为40.0%、40.0%、90.5%,MTWA联合HRT阳性率分别为10.0%、26.7%、28.6%,3个亚组间比较差异均有统计学意义(P<0.05)。(4)MTWA、HRT以及MTWA联合HRT在冠心病患者中检测恶性室性心律失常的灵敏度分别为50.0%、70.0%、75.0%;特异度分别为61.1%,38.9%,68.0%。结论 MTWA、HRT指标均是评估冠心病危险程度较好的无创电生理指标,二者联合运用可提高24小时动态心电图对冠心病的诊断价值;对于冠心病患者发生恶性室性心律失常的预测,联合指标的敏感度及特异度高于单一指标。

Objective To investigate the diagnosis value of microvolt T wave alternans（MTWA） and heart rate turbulence（HRT） in the coronary heart disease.Methods From October 2013 to December 2014,76 patients who were suspected coronary heart disease and underwent coronary angiography,24 hour dynamic electrocardiogram examination were enrolled.Using Baihui dynamic ECG analysis software,24 h dynamic electrocardiograms were recorded.The normal coronary angiography or coronary artery stenosis 50%were enrolled as control group（30 cases）,coronary angiography revealed coronary artery stenosis 75%were enrolled as disease group（46 cases）,and further divided into angina subgroup（24 cases）and myocardial infarction subgroup（22 cases）.At the same time,according to the degree of coronary artery lesions involvement,these patients were divided into single vessel subgroup（16 cases）,two vessel subgroup（18 cases） and three vessel subgroup（12 cases）,24 h dynamic electrocardiogram changes,the positive rate of MTWA and HRT were analyzed and compared between groups.Results（1） The positive rale of MTWA was 41.3%in disease group,which was higher than control group ＇ s 6.7%（P〈0.05）;the positive rale of HRT was 50.0%in disease group,which was higher than that of the control group＇ s 36.7%（P〈0.05）;the positive rate of MTWA combined with HRT was 26.1%in disease group,which was higher than that of control group 3.3%（P〈0.05）.（2） The positive rate of MTWA was 75.0%in angina subgroup,which was higher than myocardial infarction subgroup＇ s4.5%（P〈0.05）;the positive rate of HRT was 91.6%in angina subgroup,which was higher than the 4.5%of myocardial infarction subgroup（P〈0.05）;the positive rate of MTWA combined with HRT was 45.8%in angina subgroup,which was higher than 4.5%of myocardial infarction subgroup（P〈0.05）.（3） Single vessel subgroup,two vessel subgroup,three vessel sub group＇ s MTWA positive rates were 18.8%,33.3%,83.3%,respectively;HRT positive rates were 25.0%,44.4%,91.7%,respectively,the positive rate of MTWA combined with HRT were 6.2%,22.2%,58.3%,respectively,the differences in the 3 subgroups showed significant differences（P〈0.05）.（4） MTWA,HRT and MTWA combined with HRT＇ s sensitivity in detection of malignant ventricular arrhythmias in patients with coronary artery disease were respectively 50.0%,70.0%,75.0%respectively;specificity was 61.1%,55.6%,64.0%respectively.Conclusion It showed that the MTWA,HRT were good noninvasive electrophysiological indexes for evaluation of risk degree in coronary heart disease,combined use of the two indexes can improve the diagnostic value of 24 hour dynamic electrocardiogram for coronary heart disease;to predict the occurrence of malignant ventricular arrhythmia,the sensitivity and specificity of combined indexes are better than single index.