心电图T波峰末间期及左心房面积指数对不稳定型心绞痛患者发生主要不良心血管事件的预测价值

Predictive value of Tp-e combined with left atrium area index in major adverse cardiovascular events in patients with unstable angina

目的探讨心电图T波峰末间期(T peak-end-interval,Tp-e)联合左心房面积指数(left atrium area index,LAAI)对不稳定型心绞痛(unstable angina,UA)患者发生主要不良心血管事件(major adverse cardiovascular event,MACE)的预测价值。方法选取2014年1月至2016年5月荆门市第二人民医院200例UA患者为研究对象,入院后对患者进行超声心动图及心电图检查,进行为期2年的前瞻性随访,根据是否发生MACE,分为研究组54例(发生组)及对照组146例(未发生组),统计分析相关指标与MACE发生的关系。结果(1)与对照组相比,研究组患者的左心房面积(left atrium area,LAA)、LAAI明显更高,差异有统计学意义(t=2.571,P<0.05;t=2.771,P<0.05)。但两组患者的左心房内径指数(left atrial diameter index,LADI)、左心室舒张末期内径(left ventricular end diastolic dimension,LVEDD)、左心室重量指数(left ventricular mass index,LVMI)等比较,差异无统计学意义(P>0.05)。与对照组相比,研究组患者Tp-e、cTp-e、Tp-ed、cTp-ed时间均显著较长,差异有统计学意义(P<0.001);两组患者QT、cQT、Tp-emin、Tp-ed/QT时间等比较,差异无统计学意义(P>0.05)。(2)Cox多因素分析结果显示,Tp-e、cTp-e、Tp-e/QT、Tp-ed、cTp-ed、LAAI是影响MACE发生的独立危险因素(P<0.05)。(3)受试者工作特征曲线(receiver operating characteristic curve,ROC)分析结果显示,LAAI、Tp-e、cTp-e、Tp-e/QT、Tp-ed、cTp-ed对MACE诊断的截断值分别为10.6 cm2/m2、115 ms、117 ms、0.283、42.5 ms、42.6 ms,相应的曲线下面积分别为0.653、0.847、0.752、0.736、0.893、0.886。结论LAAI及Tp-e、cTp-e、Tp-e/QT、Tp-ed、cTp-ed在发生MACE的UA患者中明显增高,对MACE均有一定的预测价值。

Objectives To explore the predictive value of T peak-end-interval(Tp-e)combined with left atrium area index(LAAI)for major adverse cardiovascular events(MACE)in patients with unstable angina(UA).Methods Totally 200 patients from January 2014 to May 2016 in The Second People's Hospital of Jingmen City were selected for the study.They were examined by echocardiography and electrocardiogram.They were followed up for 2 years.According to the occurrence of MACE,patients were divided into study group(54 cases)and control group(146 cases).The rela⁃tionship between related indicators and MACE was analyzed.Results(1)Compared with control group,left atrium ar⁃ea(LAA)and LAAI in study group were significantly higher(t=2.571,t=2.771,all P<0.05).However,there were no significant differences in left atrial diameter index(LADI)and left ventricular end diastolic dimension(LVEDD),left ventricular mass index(LVMI)between the two groups.The durations of Tp-e,cTp-e,Tp-ed,cTp-ed were signifi⁃cantly longer in study group than those in control group(P<0.001),but there were no significant differences in dura⁃tions of QT,cQT,Tp-emin,Tp-ed/QT between the two groups(P>0.001).(2)The results of Cox multivariate analysis show that Tp-e,cTp-e,Tp-e/QT,Tp-ed,cTp-ed and LAAI were independent risk factors affecting the occurrence of MACE(P<0.05).(3)Receiver operating characteristic curve(ROC)showed that the cut-off values of LAAI,Tp-e,cTp-e,Tp-e/QT,Tp-ed and cTp-ed were 10.6 cm2/m2,115 ms,117 ms,0.283,42.5 ms and 42.6 ms respectively.The corresponding areas under the curve were 0.653,0.847,0.752,0.736,0.893 and 0.886,respectively.Conclu⁃sions LAAI and Tp-e,cTp-e,Tp-e/QT,Tp-ed,cTp-ed significantly increase in UA patients with MACE,which have certain predictive value for MACE.