增加阳性标准的室性心动过速积分法对宽QRS波心动过速的诊断价值

Diagnostic value of ventricular tachycardia integral method with increased positive criteria in wide QRS complex tachycardia

目的探讨室性心动过速积分法(室速积分法)与增加阳性标准的室速积分法在宽QRS波心动过速(WCT)的诊断价值。方法回顾性分析2013年1月至2018年7月山东省聊城市人民医院146例WCT患者的心电图特征,分析室速积分法、Brugada四步法、Vereckei四步法及增加阳性标准"V1~V6导联RS波谷时间≥100 ms"和"起始激动速度(Vi)/终末激动速度(Vt)≤1"的室速积分法诊断价值。结果室速积分法第1~5和7项阳性标准敏感度较低,特异度均较高,符合室速积分法的原则。室速积分法准确率、敏感度、阴性预测值明显低于Brugada四步法和Vereckei四步法(51.4%比83.6%和80.8%、34.6%比92.5%和93.5%、35.2%比74.2%和72.0%),特异度明显高于Brugada四步法和Vereckei四步法(97.4%比59.0%和46.2%),差异有统计学意义(P<0.05)。室速积分法增加阳性标准V1~V6导联RS波谷时间≥100 ms和Vi/Vt≤1后敏感度明显高于室速积分法(61.7%和65.4%比34.6%),差异有统计学意义(P<0.05),特异度未降低。结论室速积分法对WCT诊断特异度较高,敏感度较低,应用室速积分法仍不能确诊时,可以增加V1~V6导联RS波谷时间≥100 ms和Vi/Vt≤1阳性标准,能提高室速诊断准确率。

Objective To investigate the diagnostic value of ventricular tachycardia(VT)integral and VT integral with increased positive criteria in wide QRS wave tachycardia(WCT).Methods The electrocardiogram characteristics of 146 patients with WCT from January 2013 to July 2018 in Liaocheng People′s Hospital of Shandong Province were retrospectively analyzed.The diagnostic value of VT integral,Brugada four-step,Vereckei four-step and increased positive criteria"V1 to V6 lead RS valley time≥100 ms"and"initial excite velocity(Vi)/terminal excite velocity(Vt)≤1"were studied.Results The positive criteria from first to fifth and seventh of the VT integral had lower sensitivity but higher specificity,which was consistent with the principle.The accuracy,sensitivity and negative predictive value of VT integral were significantly lower than Brugada four-step and Vereckei four-step(51.4%vs.83.6%and 80.8%,34.6%vs.92.5%and 93.5%,35.2%vs.74.2%and 72.0%),the specificity was significantly higher than Brugada four-step and Vereckei four-step(97.4%vs.59.0%and 46.2%),and there were statistical differences(P<0.05).The sensitivity of the VT integral with increased positive criteria"V1 to V6 lead RS valley time≥100 ms"and"Vi/Vt≤1"was significantly higher than that of VT integral(61.7%and 65.4%vs.34.6%),and there was statistical difference(P<0.05);additionally,the specificity did not decrease.Conclusions The VT integral has higher specificity but lower sensitivity for WCT.When the VT integral fails to diagnosis,V1 to V6 lead RS valley time≥100 ms and Vi/Vt≤1 can increase the positive standard,and improve the accuracy of VT further.