动态心电图ST段、QTc间期预测冠心病患者心肌缺血的价值

The value of ST segment and QTc interval of 24-hour Holter monitoring in predicting myocardial ischemia in patients with coronary heart disease

目的:探讨动态心电图ST段、QTc间期对冠心病(CHD)患者心肌缺血的预测价值。方法:选择高度怀疑CHD心肌缺血患者250例,完善24 h动态心电图及冠脉造影检查。分析ST段、QTc间期的诊断效能,同时绘制ROC曲线,计算曲线下面积,评估上述参数的预测价值。结果:250例患者中,冠脉造影显示182例存在心肌缺血,68例无心肌缺血。ST段检出阳性130例,阴性120例,QTc间期检出阳性117例,阴性133例,二者联合检出阳性132例,阴性118例。ST段、QTc间期及两者联合ROC曲线下面积(AUC)分别为0.9235、0.8873和0.9532,其中两者联合诊断的AUC最大,95%CI为0.6844~0.9638,灵敏度为71.98%,特异度为98.53%、准确度为79.20%,均明显高于单独ST段及QTc间期,差异具有统计学意义(P<0.05)。结论:动态心电图ST段、QTc间期联合检查对CHD患者心肌缺血有一定预测价值。

Objective:To explore the value of ST segment and QTc interval of 24-hour Holter monitoring in predicting myocardial ischemia in patients with coronary heart disease(CHD).Methods:A total of 250 patients with suspected myocardial ischemia in patients with CHD were enrolled in the study.24-hour Holter monitoring and coronary angiography were performed in all patients.The diagnostic efficacy of ST segment and QTc interval was analyzed.The ROC curve was drawn and area under curve(AUC)was calculated to evaluate the predictive value of the above parameter.Results:Among the 250 patients,there were 182 cases with myocardial ischemia and 68 cases without myocardial ischemia.130 cases were positive and 120 cases were negative in ST segment detection.The QTc interval showed positive results in 117 cases and negative in 133 cases.The combined examination showed positive results in 132 cases and negative in 118 cases.The AUC of ST segment,QTc interval and their combined diagnosis was 0.9235,0.8873 and 0.9532 respectively.The AUC of their combined diagnosis was the largest,95%CI was 0.6844-0.9638,sensitivity,specificity and accuracy was 71.98%,98.53%and 79.20%respectively,which were significantly higher than those of ST segment and QTc interval alone(P<0.05).Conclusion:The combined detection of ST segment and QTc interval of 24-hour Holter monitoring has certain predictive value for myocardial ischemia in patients with CHD.