12导联动态心电图QTc间期诊断冠心病心肌缺血的临床价值

Clinical value of 12-lead ambulatory electrocardiogram QTc interval in diagnosis of myocardial ischemia in coronary heart disease

目的探讨12导联动态心电图(12-lead AECG)QTc间期诊断冠心病心肌缺血的临床价值。方法选取2017年11月至2019年12月本院收治的80例冠心病患者作为研究对象,均行12-lead AECG检测,以冠状动脉造影(CAG)检查结果为标准,分析12-lead AECG中QTc间期诊断冠心病心肌缺血的一致性、灵敏度、特异度、准确度、阳性预测值及阴性预测值,并分析患者QTc间期图像特征。结果CAG检查结果显示:80例冠心病患者中,心肌缺血31例,非心肌缺血49例;12-lead AECG诊断冠心病心肌缺血结果与CAG检查结果的一致性较好(Kappa=0.792,P=0.000)。12-lead AECG诊断冠心病心肌缺血的灵敏度为90.32%,准确度为90.00%,特异度为89.80%,阳性预测值为84.85%,阴性预测值为93.62%。ST段严重压低时,冠心病心肌缺血患者12-lead AECG中的QTc间期、QT间期均高于非心肌缺血患者,差异有统计学意义(P<0.05)。结论12-lead AECG中QTc间期诊断冠心病心肌缺血的效果显著,与CAG检查结果的一致性较好,更易发现无症状冠心病心肌缺血患者潜在病变和风险,故临床应根据12-lead AECG中QTc间期特征制定相应的干预措施。

Objective To explore the value of 12-lead ambulatory electrocardiogram(12-lead AECG)QTc interval in the diagnosis of myocardial ischemia in coronary heart disease.Methods A total of 80 patients with coronary heart disease treated in our hospital from November 2017 to December 2019 were selected as the research subjects,and all underwent 12-lead AECG detected.The consistency,diagnostic sensitivity,specificity,accuracy,positive predictive value and negative predictive value of 12-lead AECG QTc interval in the diagnosis of myocardial ischemia of coronary heart disease was analyzed based on the results of coronary angiography(CAG),and the image characteristics of QTc interval were analyzed.Results The results of CAG showed that there were 31 cases of central myocardial ischemia and 49 cases of non myocardial ischemia in 80 patients with coronary heart disease;the results of 12-lead AECG in the diagnosis of myocardial ischemia of coronary heart disease were consistent with those of CAG(Kappa=0.792,P=0.000).The sensitivity,accuracy,specificity,positive predictive value and negative predictive value of 12-lead AECG in the diagnosis of myocardial ischemia of coronary heart disease were 90.32%,90.00%,89.80%,84.85%and 93.62%,respectively.When ST segment was severely depressed,the QTc interval and QT interval of 12-lead AECG in patients with myocardial ischemia of coronary heart disease were higher than those in patients with non-myocardial ischemia,and the difference was statistically significant(P<0.05).Conclusion The effect of QTc interval in 12-lead AECG in the diagnosis of myocardial ischemia in coronary heart disease is significant effective,which is consistent with CAG results.Especially,it is easier to find potential lesions and risks in patients with myocardial ischemia of asymptomatic coronary heart disease.Therefore,clinical intervention measures should be formulated according to the characteristics of QTc interval in 12-lead AECG.