ACS患者T波峰-末间期在心率减速力和连续心率减速力危险分层的意义

The significance of Tpeak-Tend interval in risk stratification of deceleration capacity of rate and heart rate deceleration runs in patient with acute coronary syndroms

目的探讨急性冠脉综合征(ACS)患者T波峰-末间期(Tpe)在心率减速力(DC)和连续心率减速力(DRs)危险分层的意义。方法选择2021年6月~2021年11月在我院心内科住院的275例ACS患者,其中包括急性心肌梗死(AMI)患者173例(AMI组),不稳定型心绞痛(UAP)患者102例(UAP组),另选取健康对照者100例(健康对照组)进行24 h动态心电图监测和十二导联心电图检查。应用动态心电图分析系统分析得出DC及DR2、DR4、DR8值,常规心电图检查计算出Tpe和校正的T波峰-末间期(Tpe √RR)值。比较AMI组和UAP组β受体阻滞剂治疗前和治疗后与健康对照组DC、DR2、DR4、DR8、Tep、Tpe √RR的差异。比较AMI组和UAP组β受体阻滞剂治疗前后DC、DR2、DR4、DR8、Tep、Tpe √RR的差异。比较AMI组和UAP组中室性心律失常组与非室性心律失常组DC、DR2、DR4、DR8、Tep、Tpe √RR的差异。根据DC和DRs进行危险分层,比较AMI组与UAP组中高危、中危和低危组患者Tpe、Tpe √RR的差异,分析AMI组和UAP组DC与Tep,DR2、DR4、DR8与Tep的相关性。结果β受体阻滞剂治疗前AMI组和UAP组DC、DR4、DR8显著低于健康对照组(P<0.05),Tep、Tpe √RR显著高于健康对照组(P<0.05);β受体阻滞剂治疗前AMI组Tpe、Tpe √RR显著高于UAP组(P<0.05)。β受体阻滞剂治疗后AMI组和UAP组DC、DR4、DR8显著高于治疗前(P<0.05),Tpe、Tpe √RR显著低于治疗前(P<0.05)。AMI组和UAP组中室性心律失常组DC、DR4、DR8显著低于非室性心律失常组对照组(P<0.05),Tpe、Tpe √RR显著高于非室性心律失常组(P<0.05)。根据DC进行危险分层,AMI组和UAP组中高危组Tpe、Tpe √RR均显著高于中危组(均P<0.05);中危组Tpe、Tpe √RR均显著高于低危组(均P<0.01)。根据DRs进行危险分层,AMI组和UAP组中高危组Tpe、Tpe √RR均显著高于中危组(P<0.05),中危组Tpe、Tpe √RR均显著高于低危组(P<0.01)。AMI组和UAP组DC与Tpe,DR2、DR4、DR8与Tpe均呈显著负相关(均P<0.01)。结论ACS患者DC、DRs与Tpe呈负相关,DC、DRs和Tpe是ACS高危患者的预测因子。

Objective To investigatethe significance of Tpeak-Tend interval(Tpe)in risk stratification of deceleration capacity of rate(DC)and heart rate deceleration runs(DRs)in patient with acute cononary syndroms(ACS).Methods In 275 patients with ACS,induding 173 patients with acute myocardial infarction(AMI),102 patients with unstable angina pectoris(UAP)and 100 healthy controls were selected in this study.All case were measured with 24h dynamic electrocardiogram and 12 lead electrocardiograms,the value of DC,DR2,DR4 and DR8 were analyzed with dynamic electrocardiogram system.Tpe and the corrected Tpe(Tpe √RR)were calculated by elcctrocardiogram.The differece DC,DR2,DR4,DR8,Tpe and Tpe √RR between the AMI group,the UAP group and the control group were campared before the treatment with theβreceptor blockers and after the treatment with theβreceptor blockers,the differece DC,DR2,DR4,DR8,Tpe and Tpe √RR between the AMI group and the UAP group were campared before the treatment with theβreceptor blockers and after the treatment with theβreceptor blockers,the differece DC,DR2,DR4,DR8,Tpe and Tpe √RR between the AMI group and the UAP group were campared the ventricular arrhythmia group and non-the ventricular arrhythmia group.The risk stratification according to DC and DRs,the differece Tpe、Tpe √RR between the AMI group and the UAP group were campared the high risk group、medium risk group and low risk group,the correlation of DC with Tpe and DR2、DR4、DR8 with Tpe were analyzed in the AMI group and the UAP group.Results The value of DC、DR4、DR8 in the AMI group and the UAP group were significantly lower than that of healthy control group before the treatment with theβreceptor blockers(P<0.01-0.001),and the value of Tpe,Tpe √RR in the AMI group and the UAP group were significantly higher than that of healthy control group before the treatment with theβreceptor blockers(P<0.01).The value of Tpe,Tpe √RR in the AMI group were significantly higher than that of the UAP group before the treatment with theβreceptor blockers(P<0.05).The value of DC,DR4 and DR8 after the treatment with theβreceptor blockers were significantly higher than that before the treatment with theβreceptor blockers in the AMI group and the UAP group(P<0.01-0.001).The value of Tpe and Tpe √RR were significantly lower than that before the treatment with theβreceptor blockers(P<0.001).The value of DC,DR4 and DR8 in the ventricular arrhythmia group were significantly lower than that of the non-ventricular arrhythmia group in the AMI group and the UAP group(P<0.01-0.001),and the value of Tpe、Tpe √RR were significantly higher than that of non-ventricular arrhythmia group in the AMI group and the UAP group(P<0.01).The risk stratification according to DC,the value of the Tpe and Tpe √RR in the high risk group were significantly higher than that of the medium risk group in the AMI group and the UAP group(P<0.05),and its in the medium risk group were significantly higher than that of the low risk group in the AMI group and the UAP group(P<0.01).The risk stratification according to DRs,the value of the Tpe and Tpe √RR in the high risk group were significantly higher than that of the medium risk group in the AMI group and the UAP group(P<0.05),and its in the medium risk group were significantly higher than that of the low risk group in the AMI group and the UAP group(P<0.01).DC,DR2,DR4 and DR8 with Tpe were significantly notable negatively correlated in the AMI group and the UAP group(P<0.01).Conclusion DC、DRs and Tpe had notable negative correlation among the patient of ACS.DC,DRs and Tpe are a predictors in patient with ACS at high risk.