心电图aVR导联中直立T波对非ST段抬高型心肌梗死冠状动脉病变的预测

Effect of upright T wave in aVR lead on non ST segment elevation myocardial infarction Prediction of coronary artery disease

目的分析心电图aVR导联中的直立T波对非ST段抬高型心肌梗死(NSTEMI)患者冠脉狭窄病变程度的预测作用。方法回顾性分析2019年1月-2020年12月浙江省诸暨市人民医院收治的NSTEMI患者155例,按aVR导联的T波形态分为T波直立组(T≥0mV)65例和T波倒置组(T<0mV)90例,观察两组冠状动脉造影中病变的狭窄程度和狭窄血管支数,心脏彩超检测中左心室射血分数(LVEF)、左心室舒张末期内径(LVEDD),实验室心功能指标:血清肌酐(S-Cr)、脑钠肽(BNP)及肌钙蛋白I(cTnI)水平,以及随访的不良预后情况。结果与T波倒置组比较,T波直立组重度狭窄者及多支血管病变者占比较高(P<0.01),T波直立组LVEF下降,BNP、cTnI升高(P<0.01),心衰发生率也较高(P<0.05)。结论心电图aVR T波形态变化能够作为辅佐分析NSTEMI患者冠状动脉病变程度的重要指标,T波直立可提示心肌缺血和心功能损伤,应引起临床足够的重视。

Objective To analyze the predictive effect of upright T wave in aVR lead on the degree of coronary stenosis in patients with non ST segment elevation myocardial infarction(NSTEMI).Methods 155 patients with NSTEMI treated in Zhuji people's Hospital of Zhejiang Province from January 2019 to December 2020 were analyzed retrospectively.According to the T wave shape of AVR lead,they were divided into 65 cases in T wave upright group(t≥0mV)and 65 cases in T wave inversion group The degree of stenosis and the number of stenotic vessels in coronary angiography,left ventricular ejection fraction(LVEF),left ventricular end diastolic diameter(LVEDd),and laboratory cardiac function indexes:serum creatinine(Scr),brain natriuretic peptide(BNP)and troponin I were observed.Results Compared with T wave inversion group,the proportion of severe stenosis and multi vessel disease in T wave upright group was higher(P<0.01),LVEF decreased,BNP and cTnI increased(P<0.05),and the incidence of heart failure was also higher in T wave upright group(P<0.05).Conclusion The morphological changes of AVR T wave in ECG can be used as an important index to assist in the analysis of the degree of coronary artery disease in patients with NSTEMI.The upright T wave can indicate myocardial ischemia and cardiac function injury,which should be paid enough attention in clinic.