心电图联合心脏彩超诊断冠心病心力衰竭病情严重程度的价值研究

Value of electrocardiogram combined with cardiac color Doppler ultrasound in diagnosis of severity of coronary heart disease with heart failure

目的探讨心电图联合心脏彩超诊断冠心病心力衰竭病情严重程度的价值研究。方法选取2017年1月一2018年12月在徐州医科大学附属医院接受检查的100例冠心病心力衰竭患者为研究对象,根据纽约心功能分级(NYHA)进行分组,其中心功能Ⅱ级组37例、心功能Ⅲ级组35例、心功能Ⅳ级组28例。所有患者行心电图检査以及心脏彩超检查。比较3组心电图指标差异,包括QRS电压、QRS时限、QTc间期;比较3组心脏彩超检査指标差异,包括左心室收缩末期内径(LVESD)、左心室舒张末期内径(LVEDD)、左房内径(LA)、心功能射血分数(LVEF)、二尖瓣舒张早期与舒张晚期血流峰值速度比值(E/A);分析心电图和心脏彩超检査指标与心功能的相关性。结果三组患者的QRS电压值、QRS时限值、QTc间期比较,差异有统计学意义(P<0.05)。心功能Ⅲ级组、心功能Ⅳ级组的QRS电压值均低于心功能Ⅱ级组、QRS时限值及QTc间期均高于心功能D级组(均P<0.05)。心功能Ⅳ级组的QRS电压值均低于心功能Ⅲ级组、QRS时限值及QTc间期均高于心功能Ⅲ级组(均P<O.05)。心功能Ⅲ级组、心功能Ⅳ级组的LVESD、LVEDD、LA及E/A均高于心功能Ⅱ级组、LVEF均低于心功能Ⅱ级组(均P<O.05)。心功能Ⅳ级组与心功能Ⅲ级组的LVESD、LVEDD、LA、LVEF、E/A比较,差异无统计学意义(P>0.05)。Spearman等级相关分析显示:QRS时限、QTc间期、LVESD、LVEDD、LA及E/A均与心功能呈正相关(r分别为0.453>0.625,0.421、0.456、0.411.0.592,均P<0.05);QRS电压及LVEF均与心功能呈负相关(r分别为-0.617.-0.459,均P<0.05)。结论心电图联合心脏彩超可用于诊断冠心病心力衰竭病情严重程度,可提高评估准确性。

Objective To investigate the value of electrocardiogram(ECG)combined with cardiac color Doppler ultrasound in the diagnosis of severity of coronary heart disease.Methods One hundred patients with coronary heart disease who were examined at the affiliated hospital of Xuzhou medical university in between January 2017 and February 2018 were selected for this study.37 cases of cardiac function level Ⅱ group,35 cases of cardiac function level Ⅲ group,and 28 cases of cardiac function levelⅣgroup were based on the New York Heart Association(NYHA)heart function classification Ⅱ-Ⅳ.All patients underwent ECG and cardiac color Doppler ultrasound.QRS voltage,QRS time limit,QTc interval of ECG,and left ventricular end-systolic diameter(LVESD),left ventricular end-diastolic diameter(LVEDD),left atrial diameter(LA),cardiac function ejection fraction(LVEF),and ratio of peak velocity of early mitral valve diastolic to late diastolic blood flow(E/A)of Doppler ultrasound were compared within three groups.Results The difference of QRS voltage value,QRS time limit and QTc interval between the three groups was statistically significant(P<0.05).The QRS voltage values of cardiac function Ⅲ group and cardiac function Ⅳ group were lower than cardiac function Ⅱ group,QRS time limit and QTc interval were higher than cardiac function Ⅱ group(P<0.05).The QRS voltage values of the cardiac function IV group were lower than the cardiac function Ⅲ group,the QRS time limit and the QTc interval of the cardiac functionⅣgroup were higher than that of the cardiac function Ⅲ group(P<0.05).LVESD,LVEDD,LA and E/A in cardiac function Ⅲ and IV group were higher than cardiac function Ⅱ group and LVEF were lower than cardiac function Ⅱ group(P<0.05).There were no significant differences between the cardiac function Ⅳ group and the cardiac function Ⅲ group in LVESD,LVEDD,LA,LVEF and E/A(P>0.05).Spearman rank correlation analysis showed that QRS time limit,QTc interval,LVESD,LVEDD,LA and E/A were positively correlated with cardiac function(r=0.453,0.625,0.421,0.456,0.411,0.592,respectively.0.05);QRS voltage and LVEF were negatively correlated with cardiac function(r=-0.617,-0.459,P<0.05).Conclusion ECG combined with cardiac color Doppler ultrasound could be used to diagnose the severity of heart failure in coronary heart disease,which can improve the accuracy of assessment.