急性心肌梗死患者心电图平面QRS-T夹角变化及其与恶性心律失常相关性分析

Changes of flat QRS-T angle on ECG in patients with acute myocardial infarction and its correlation with malignant arrhythmia

目的观察急性心肌梗死(AMI)患者心电图平面QRS-T夹角变化,并分析其与恶性心律失常(MA)相关性。方法选取2017年10月至2020年10月医院AMI患者160例,设为AMI组,另选取健康受试者160例,设为健康组。根据AMI患者是否发生MA分为MA组、NMA组。比较AMI组、健康组平面QRS-T夹角;比较MA组、NMA组平面QRS-T夹角及其他可能影响因素差异;Logistic回归分析法分析AMI患者发生MA的危险因素;绘制受试者工作特征曲线(ROC),分析QRS-T夹角对MA发生的预测价值。结果 160例AMI患者中31例发生MA(19.38%)。AMI组QRS-T夹角大于健康组(P<0.05)。MA组白细胞计数、中性粒细胞计数、血清肌酸激酶同工酶(CK-MB)、血清心肌肌钙蛋白I(cTnI)、血清氨基末端-B型脑钠肽前体(NT-proBNP)、罪犯血管为右冠状动脉构成比、碎裂QRS波构成比均高于NMA组,平面QRS-T夹角大于NMA组(P<0.05)。经Logistic回归分析校正混杂因素后,中性粒细胞计数高、右冠状动脉病变、碎裂QRS波、平面QRS-T夹角大均是AMI患者发生MA的危险因素(P<0.05)。ROC结果显示,QRS-T夹角预测MA发生的最佳截断点为91.38°,灵敏度、特异度、准确度分别为80.65%、79.07%、79.38%,AUC为0.803。结论 AMI患者心电图平面QRS-T夹角增大,是AMI患者发生MA的独立危险因素,同时对MA的发生有较高预测效能。

Objective To observe the changes of the flat QRS-T angle on ECG of patients with acute myocardial infarction(AMI),and to analyze its correlation with malignant arrhythmia(MA).Methods A total of 160 AMI patients in our hospital from October 2017 to October 2020 were selected as the AMI group,and 160 healthy subjects were selected as the healthy group.AMI patients according to whether the occurrence of MA were divided into MA group,NMA group.The flat QRS-T angle between AMI group and healthy group was compared.The difference between the plane QRS-T angle and other possible influencing factors between MA group and NMA group were compared.Logistic regression analysis was used to analyze the risk factors of MA in AMI patients.Draw receiver operating characteristic curve(ROC)and analyze the predictive value of QRS-T angle on the occurrence of MA.Results 31 of 160 AMI patients developed MA(19.38%).The QRS-T angle in the AMI group was larger than that in the healthy group(P<0.05).The white blood cell count,neutrophil count,serum creatine kinase isoenzyme(CK-MB),serum cardiac troponin I(cTnI),serum N-terminal pro-brain natriuretic peptide(NT-proBNP),the composition ratio of the criminal vessel was the right coronary artery,fragmented QRS wave in the MA group were higher than those of the NMA group,of which the QRS-T angle was greater than that of the NMA group(P<0.05).After adjusting for confounding factors by Logistic regression analysis,high neutrophil count,right coronary artery disease,fragmented QRS complex,and large planar QRS-T angle were all risk factors for MA in AMI patients(P<0.05).ROC results showed that the best cut-off point for the QRS-T angle to predict the occurrence of MA was 91.38°,the sensitivity,specificity,and accuracy were80.65%,79.07%,79.38%,and AUC was 0.803.Conclusion The increased QRS-T angle of the ECG plane in AMI patients is an independent risk factor for the occurrence of MA in AMI patients.At the same time,it has a higher predictive power for the occurrence of MA.