T波低平结合冠脉造影在冠心病中的诊断价值

The diagnostic value of coronary angiography combined with lower T wave on coronary heart disease

目的 结合患者心电图T波低平和冠状动脉造影(Coronary Angiography, CAG)结果,分析其在冠心病(Coronary Heart Disease)诊断中的临床价值。方法 连续收集2020年7月至2021年6月于我院心内科行冠状动脉造影检查且心电图显示T波低平患者的资料。心电图采用以R波为主的导联,T波振幅小于同导联1/10R诊断为T波低平。冠脉狭窄程度≤50%为冠脉造影正常,狭窄程度≥50%为冠脉造影异常。如果患者同时存在冠脉狭窄程度≥50%和≤50%的病变部位,则按≥50%病例统计。冠脉造影异常者行血管直径狭窄率的判断,狭窄率≥70%为需要介入治疗的病例。计算T波低平与冠脉造影异常符合率和检治比(需要介入治疗病例数/冠脉造影患者总例数)。结果 共54例患者心电图均为T波低平,其中单导联T波低平者10例,两个以上导联T波低平者44例。冠脉造影结果显示,54例患者中冠脉造影正常19例,异常35例。异常患者中狭窄部位共计72处:完全闭塞2例,2处;极重度狭窄12例,23处;重度狭窄15例,26处;中度狭窄6例,21处。重度以上狭窄共计29例,51处,需要介入治疗。T波低平与冠脉造影异常符合率为64.8%(35/54),检治比为53.7%(29/54)。结论 心电图T波低平对冠心病的诊断具有重要的临床价值。

Objective To evaluate the united diagnostic effect of the lower T wave and coronary angiography(CAG) on coronary vascular disease. Methods From July 2020 to June 2021, the data of patients who showed lower T wave and underwent CAG in the Department of Cardiology of our hospital were collected continuously. R wave was the mainly lead of electrocardiogram, and the amplitude that lower than 1/10 R was diagnosed as lower T wave. The degree of coronary artery stenosis ≤50% was considered normal, while stenosis ≥50% was considered abnormal by coronary angiography. If the same patient had both ≥50% and ≤50% coronary stenosis sites, he/she was classified into ≥50%group. Patients with abnormal coronary angiography were further under the assessment of vascular diameter stenosis rate,and the cases with the stenosis rate >70% were considered requiring interventional treatment. The coincidence rate between lower T wave and abnormal CAG, and the treatment/examination ratio(the cases requiring intervention/the cases enrolled in this study) were calculated. Results The electrocardiogram of the 54 patients all showed lower T wave,including 10 cases had single lead with lower T wave, 44 cases had more than two leads. CAG results showed 19 patients have normal and 35 have abnormal coronary artery. Among the abnormal patients, revealed 72 stenosis sites, including totally occlusion(2 sites, n=2), extremely severe stenosis(23 sites, n=12), severe stenosis(26 sites, n=15), moderate stenosis(21 sites, n=6). A total of 29 cases showed more than severe stenosis(51 sites) requiring interventional treatment.The coincidence rate of lower T wave and abnormal CAG was 64.8%(35/54), and the treatment/examination ratio was53.7%(29/54). Conclusions Lower T wave has important clinical value in the diagnosis of coronary vascular disease.