肢体导联心电图对冠状动脉回旋支病变的预测价值

Value of electrocardiogram limb lead in predicting coronary artery cyclotron branch lesion

目的观察肢体导联心电图对冠状动脉回旋支病变的预测价值。方法选取615例冠状动脉粥样硬化性心脏病(冠心病)不稳定型心绞痛患者,行冠状动脉造影术,其中单纯回旋支病变患者300例,记录其静息时与心绞痛发作时心电图,根据冠状动脉造影结果分析肢体导联心电图异常改变时回旋支病变的特征。结果静息状态下回旋支病变肢体导联心电图对回旋支狭窄的敏感度为36.00%,特异度为84.76%,准确度为60.98%。心绞痛发作时,肢体导联心电图改变以Ⅰ导联ST段压低最多见,约占发作心电图的90.22%。Ⅱ、aVF导联ST段压低约占发作心电图的67.39%、67.39%;Ⅲ导联很少出现ST段压低,多为正常或略抬高,约占发作心电图的90.22%;aVR多无异常改变,约占发作心电图的70.65%。结论静息状态下肢体导联心电图对回旋支病变的特异度高,但敏感度低;心绞痛发作时肢体导联心电图Ⅰ、Ⅲ导联对回旋支病变有预测价值。

Objective To evaluate the clinical value of electrocardiogram（ECG）limb lead in predicting coronary artery cyclotron branch lesion. Methods Coronary angiography was conducted for a total of 615 patients diagnosed as coronary heart disease,unstable angina pectoris including 300 cyclotron branch lesion patients,recording their electrocardiogram of the resting and angina attack,and predicting the cyclotron branch lesion through analysis of results of coronary angiography and the characteristic of ECG limb lead.Results The sensitivity,specificity and accuracy of limb lead ECG of the resting were 36.00%,84.76% and 60.98%respectively for cyclotron branch lesion.ST segment depression in lead Ⅰ was the most prevalent in the change of limb lead ECG,accounting for about 90.22% of ECG episodes;ST segment depression in lead Ⅱ and lead aVF were about 67.39% and 67.39% of ECG episodes respectively;ST segment depression in lead Ⅲ occurred rarely,mostly normal or slightly elevated,accounting for about 90.22% of ECG episodes;lead aVR had no abnormal change mostly,accounting for about 70.65%in angina attack.Conclusion The specificity of limb lead ECG of the resting is high,but the sensitivity is low for cyclotron branch lesion.It is valuable for predicting cyclotron branch lesion by lead Ⅰ,Ⅲ of limb lead ECG mainly in angina attack.