动态心电图在冠心病患者心肌缺血和心律失常诊断中的应用价值

Application value of ambulatory electrocardiography in the diagnosis of myocardial ischemia and arrhythmias in patients with coronary artery disease

目的分析动态心电图在冠心病患者心肌缺血和心律失常诊断中的应用价值。方法抽取2020年1月至2022年1月于河南省直第三人民医接受诊治的78例冠心病患者作为研究对象,以冠状动脉造影、心脏电生理检查为心肌缺血和心律失常的金标准,分析动态心电图诊断心肌缺血和心律失常的效能,并分析动态心电图分型诊断心肌缺血和心律失常的符合情况。结果动态心电图诊断心肌缺血的准确率为92.31%(72/78),灵敏度为93.33%(70/75),特异度为66.67%(2/3),误诊率为33.33%(1/3),漏诊率为6.67%(5/75);诊断心律失常的准确率为96.15%(75/78),灵敏度为98.55%(68/69),特异度为77.78%(7/9),误诊率为22.22%(2/9),漏诊率为1.45%(1/69),具有良好的诊断效能。动态心电图检出心内膜下心肌缺血、透壁性心肌缺血为41例、29例,与冠状动脉造影检出结果(43例、32例)比较差异未见统计学意义(P>0.05)。动态心电图与心脏电生理检查检出窦性心律失常、房性心律失常、房室交界性心律失常、室性心律失常的结果比较差异均未见统计学意义(P均>0.05)。结论动态心电图在冠心病患者心肌缺血和心律失常诊断中有良好的应用价值,且分型诊断符合率高。

Objective To analyze the application value of ambulatory electrocardiography in the diagnosis of myocardial ischemia and arrhythmias in patients with coronary artery disease.Methods Seventy-eight patients with coronary heart disease who were treated in Henan Provincial Third People’s Hospital from January 2020 to January 2022 were included as study subjects.With coronary angiography and cardiac electrophysiological examination as the gold standard for diagnosis of myocardial ischemia and arrhythmia,the efficacy of ambulatory electrocardiography in diagnosis of myocardial ischemia and arrhythmia was analyzed,and the coincidence of ambulatory electrocardiography in differentiation diagnosis of myocardial ischemia and arrhythmia was analyzed.Results The accuracy of ambulatory electrocardiography in diagnosing myocardial ischemia was 92.31%(72/78),the sensitivity was 93.33%(70/75),the specificity was 66.67%(2/3),the misdiagnosis rate was 33.33%(1/3),and the missed diagnosis rate was 6.67%(5/75).The accuracy rate of ambulatory electrocardiography in diagnosing arrhythmia was 96.15%(75/78),the sensitivity was 98.55%(68/69),the specificity was 77.78%(7/9),the misdiagnosis rate was 22.22%(2/9),and the missed diagnosis rate was 1.45%(1/69),with good diagnostic efficacy.There was no significant difference in detecting myocardial ischemia under endocardium and transmural myocardial ischemia by ambulatory electrocardiography(41 case,29 case)and coronary angiography(43 cases,32 case),P>0.05.There was no significant difference in the diagnosis of sinus rhythm,atrial arrhythmia,atrioventricular junction arrhythmia and ventricular arrhythmia by ambulatory electrocardiography and cardiac electrophysiological examination(P>0.05).Conclusions Ambulatory electrocardiography has good clinical value in electrophysiologic diagnosis of myocardial ischemia and arrhythmia in patients with coronary heart disease,and the coincidence rate of differentiation diagnosis is high.