冠状动脉慢性完全闭塞病变血运重建前后患者心电指标及心功能变化研究

Study on the changes of ecg and cardiac function in patients with chronic total occlusion before and after percutaneous coronary intervention

目的探讨单支冠状动脉慢性完全闭塞病变患者(CTO),经皮冠状动脉介入术(PCI)前后T波振幅、Tpeak-Tend(Tp-Te)等十二导联心电指标以及随访6个月比较纽约心功能(NYHA)分级的改善情况。方法纳入成功行CTO-PCI的单支血管CTO患者192例,按有无合并陈旧性心肌梗死分为合并陈旧性心肌梗死的CTO组(MI CTO组,106例)、不合并陈旧性心肌梗死的CTO组(non-MI CTO组,86例),比较两组心电指标术前术后变化情况以及6个月后NYHA分级。结果两组患者心电指标中,术前下壁导联的T波振幅,下壁、前壁导联Tp-Te指标差异有统计学意义(P<0.05);术后仅有Ⅰ、Ⅲ导联的Tp-Te差异有统计学意义(P<0.05)。MI CTO组术后心电复极指标T波振幅、Tp-Te均有导联,较术前差异有统计学意义(P<0.05)。non-MI CTO组血运重建后,7个导联(Ⅰ导联、Ⅲ导联、AVR导联、AVF导联、V4导联、V5导联、V6导联)的Tp-Te差异有统计学意义(P<0.05),随访6个月,组间比较NYHA分级差异无统计学意义,而组内比较NYHA分级差异有统计学意义(P<0.05)。结论CTO患者血运重建后心电复极指标和心功能分级均会改善,non-MI CTO患者,由Tp-Te改善引起,而MI CTO患者是因为T波振幅和Tp-Te的双重改善引起。

Objective To investigate the improvement of 12-lead ecg indexes such as T-wave amplitude,Tpeak-Tend(Tp-Te)in patients with chronic coronary total occlusion(CTO)of single-branch before and after percutaneous coronary intervention(PCI),and to compare the improvement of cardiac function(NYHA)grading in six months of follow-up.Methods 192 consecutive patients with single vessel CTO who underwent PCI were divided into two groups according to with or without old myocardial:CTO group with old myocardial infarction(MI CTO group,106 cases)and CTO group without old myocardial infarction(non MI CTO group,86 cases).The repolarization indexes before and after revascularization and NYHA grading after six months were compared.Results Among the ecg indexes of the two groups,the preoperative T-wave amplitude of the inferior wall leads,and the TpTe indexes of the inferior wall leads and the anterior wall leads were significantly different(P<0.05).There was statistically significant difference in Tp-Te of leadⅠandⅢafter revascularization(P<0.05).In the MI CTO group,both the T-wave amplitude and Tp-Te,indexs of postoperative repolarization,showed statistically significant difference compared with the preoperation(P<0.05).After revascultation in the non-MI CTO group,there were statistically significant differences in Tp-Te of the seven leads(Ⅰlead,Ⅲlead,AVR lead,AVF lead,V4 lead,V5 lead and V6 lead)(P<0.05).Follow-up for 6 months showed no statistically significant difference in NYHA grading between the groups,but there was statistically significant difference in NYHA grading within the groups(P<0.05).Conclusion Both repolarization index and cardiac function are improved after revascularization.CTO patients without old myocardial infarction are caused by Tp-Te improvement,while CTO patients with old myocardial infarction are caused by improvement of T wave amplitude and Tp-Te.