动态心电图对冠心病患者心肌缺血及心律失常的预测价值

Predictive value of dynamic electrocardiography for myocardial ischemia and arrhythmia in patients with coronary heart disease

目的观察动态心电图对冠心病患者心肌缺血及心律失常的预测价值。方法选取2020年1月至2022年1月在温岭市中医院诊治的冠心病患者87例为研究对象,根据检查方法不同分为常规心电图组(A组,n=40,常规心电图检查)、动态心电图组(B组,n=47,动态心电图检查)。观察两组心肌缺血检出率,并根据冠状动脉造影结果,分析两种检查方式对心肌缺血诊断效能。观察两组心律失常类型检出率。比较两组患者满意度。结果两组心肌缺血总检出率差异无统计学意义(P=0.154),B组无症状心肌缺血的检出率[25%(25/47)]明显高于A组[10%(10/40)](χ^(2)=5.24,P=0.020)。根据冠脉造影结果,A组、B组心肌缺血检出率分别为68%(27/40)、87%(41/47)。B组诊断心肌缺血的敏感度、特异度、准确度分别为80%(33/41)、67%(4/6)、74%(35/47),均明显高于A组[74%(20/27)、46%(6/13)、68%(27/40)](χ^(2)=8.03、5.89、5.03,P=0.003、0.012、0.005)。B组二、三联律室性期前收缩,频发、二三联律、成对型房性期前收缩,右束支传导阻滞,房室传导阻滞,室上性心动过速等心律失常类型检出率均明显高于A组(χ^(2)=10.78,P=0.001)。根据冠脉造影结果,A组、B组心律失常检出率分别为65%(26/40)、79%(37/47)。B组诊断冠心病心律失常敏感度、特异度、准确度分别为86%(32/37)、40%(4/10)、81%(38/47),B组诊断冠心病心律失常的敏感度、准确度明显高于A组[58%(15/26)、55%(22/40)](χ^(2)=7.30、4.90,P=0.005、0.010)。B组患者满意度为87%(41/47),高于A组的65%(26/40)(χ^(2)=6.24,P=0.044)。结论与常规心电图检测相比,动态心电图对冠心病患者心肌缺血、心律失常检出率及诊断率均明显升高,尤其对于无症状心肌缺血患者,动态心电图具有更显著优势,且患者满意度较高。

Objective To investigate the predictive value of dynamic electrocardiography(ECG)for myocardial ischemia and arrhythmia in patients with coronary heart disease.Methods A total of 87 patients with coronary heart disease who received treatment in Wenling Hospital of Traditional Chinese Medicine from January 2020 to January 2022 were included in this study.These patients were divided into a conventional ECG group(group A,n=40)and a dynamic ECG group(group B,n=47)according to different examination methods.The detection rate of myocardial ischemia in the two groups was determined.The diagnostic efficacy of routine ECG and dynamic ECG for myocardial ischemia was analyzed according to the results of coronary angiography.The detection rate of arrhythmia was determined in each group.Patient satisfaction was compared between the two groups.Results There was no significant difference in the total detection rate of myocardial ischemia between the two groups(P=0.154).The detection rate of asymptomatic myocardial ischemia in group B[25%(25/47)]was significantly higher than that in group A[10%(10/40),χ^(2)=5.24,P=0.020].According to the results of coronary angiography,the detection rates of myocardial ischemia in group A and group B were 68%(27/40)and 87%(41/47),respectively.The sensitivity,specificity,and accuracy of group B in diagnosing myocardial ischemia were 80%(33/41),[67%(4/6),and 74%(35/47)],respectively,all of which were significantly higher than 74%(20/27),[46%(6/13),68%(27/40)]in group A(χ^(2)=8.03,5.89,5.03,P=0.003,0.012,0.005).The detection rates of premature ventricular contraction in bi-triplet rhythm,frequent paired premature atrial contraction in bi-triplet rhythm,right bundle-branch block,atrioventricular block,supraventricular tachycardia in group B were significantly higher compared with group A(χ^(2)=10.78,P=0.001).According to the results of coronary angiography,the detection rates of arrhythmia in groups A and B were 65%(26/40)and 79%(37/47),respectively.The sensitivity,specificity,and accuracy of diagnosing arrhythmia in coronary heart disease in group B were 86%(32/37),40%(4/10),and 81%(38/47),respectively.The sensitivity and accuracy of diagnosing arrhythmia in coronary heart disease in group B were significantly higher than those in group A[58%(15/26),55%(22/40),χ^(2)=7.30,4.90,P=0.005,0.010].Patient satisfaction in group B[87%(41/47)]was significantly higher than that in group A[65%(26/40),χ^(2)=6.24,P=0.044].Conclusion Compared with conventional ECG detection,dynamic ECG has substantially higher detection and diagnosis rates of myocardial ischemia and arrhythmia,as well as a higher patient satisfaction rate,in patients with coronary heart disease,in particular in those with asymptomatic myocardial ischemia.