心向量图结合动态心电图诊断心肌供血不足的价值

Value of Vectorcardiogram Combined with Dynamic Electrocardiogram in the Diagnosis of Myocardial Insufficiency

目的探讨心向量图(VCG)结合动态心电图(DCG)诊断心肌供血不足的价值。方法选择2020年12月至2021年7月我院收治的150例疑似心肌供血不足患者为研究对象,根据有无典型临床症状分为无症状组(无症状性心肌缺血)70例和有症状组(有症状性心肌缺血)80例。所有患者均接受VCG、DCG、核素心肌灌注显像(MPI)检查,以MPI诊断结果为金标准,分析VCG、DCG单独及联合诊断心肌供血不足与MPI诊断结果的一致性。结果无症状组70例患者中经MPI诊断阳性60例(85.71%),阴性10例(14.29%);经DCG诊断阳性45例(64.29%),阴性25例(35.71%);经VCG诊断阳性49例(70.00%),阴性21例(30.00%);经DCG+VCG诊断阳性55例(78.57%),阴性15例(21.43%)。有症状组80例患者中经MPI诊断阳性74例(92.50%),阴性6例(7.50%);经DCG诊断阳性60例(75.00%),阴性20例(25.00%);经VCG诊断阳性64例(80.00%),阴性16例(20.00%);经DCG+VCG诊断阳性70例(87.50%),阴性10例(12.50%)。无症状组DCG、VCG诊断心肌供血不足与MPI诊断一致性检验的Kappa值分别为0.318、0.400(均P<0.05),DCG+VCG诊断心肌供血不足与MPI诊断一致性检验的Kappa值为0.662(P<0.05)。有症状组DCG、VCG诊断心肌供血不足与MPI诊断一致性检验的Kappa值分别为0.217、0.388(均P<0.05),DCG+VCG诊断心肌供血不足与MPI诊断一致性检验的Kappa值为0.586(P<0.05)。结论VCG结合DCG诊断心肌供血不足与MPI诊断结果的一致性较好,值得临床积极推广。

Objective To explore the value of vectorcardiogram(VCG)combined with dynamic electrocardiogram(DCG)in the diagnosis of myocardial insufficiency.Methods 150 patients with suspected myocardial insufficiency treated in our hospital from December 2020 to July 2021 were selected as the research object.According to the presence or absence of typical clinical symptoms,they were divided into 70 cases in the asymptomatic group(asymptomatic myocardial ischemia)and 80 cases in the symptomatic group(symptomatic myocardial ischemia).All patients underwent VCG,DCG and radionuclide myocardial perfusion imaging(MPI).Taking the diagnosis results of MPI as the gold standard,the consistency between the diagnosis of myocardial insufficiency by VCG and DCG alone and combined with MPI was analyzed.Results In the asymptomatic group,60 patients(85.71%)were positive and 10 patients(14.29%)were negative after MPI diagnosis.DCG diagnosis was positive in 45 cases(64.29%)and negative in 25 cases(35.71%).VCG diagnosis was positive in 49 cases(70.00%)and negative in 21 cases(30.00%).DCG+VCG diagnosis was positive in 55 cases(78.57%)and negative in 15 cases(21.43%).Among the 80 patients in symptomatic group,74(92.50%)were positive and 6(7.50%)were negative.DCG diagnosis was positive in 60 cases(75.00%)and negative in 20 cases(25.00%).VCG diagnosis was positive in 64 cases(80.00%)and negative in 16 cases(20.00%).DCG+VCG diagnosis was positive in 70 cases(87.50%)and negative in 10 cases(12.50%).The Kappa values of DCG and VCG diagnosis of myocardial insufficiency and MPI diagnosis consistency test in asymptomatic group were 0.318 and 0.400,respectively(all P<0.05),and the kappa value of the consistency test between DCG+VCG and MPI was 0.662(P<0.05).The Kappa values of DCG and VCG diagnosis of myocardial insufficiency and MPI diagnosis consistency test in symptomatic group were 0.217 and 0.388,respectively(all P<0.05),and the Kappa value of the consistency test between DCG+VCG diagnosis and MPI diagnosis was 0.586(P<0.05).Conclusion The results of VCG combined with DCG in the diagnosis of myocardial insufficiency are consistent with those of MPI,which is worthy of clinical promotion.