动态心电图MTWA在慢性心力衰竭患者MACE预测中的应用价值

The Application Value of Dynamic Electrocardiogram MTWA in Predicting MACE in Patients with Chronic Heart Failure

【目的】探讨动态心电图微伏级T波电交替(MTWA)预测慢性心力衰竭患者发生主要心血管不良事件(MACE)的临床价值。【方法】选取2019年12月至2021年12月西安医学院附属宝鸡医院收治的100例慢性心力衰竭患者,根据是否发生MACE将其分为MACE组(n=28)及非MACE组(n=72)。所有患者均接受动态心电图检查,采用单因素、多因素Logistic回归分析慢性心力衰竭患者发生MACE的危险因素,采用受试者工作特征(ROC)曲线评估MTWA预测慢性心力衰竭患者发生MACE的价值。【结果】MACE组患者年龄≥65岁、BMI≥25 kg/m^(2)、心律失常史、吸烟史、NYHA分级Ⅳ级、高血压史、过度劳累史占比,以及V1导联最大MTWA(MTWA_(max))、最高心率(MTWA_(peakhr))、平均MTWA(MTWA_(overall))均高于非MACE组(P<0.05)。ROC曲线分析显示,MTWA_(max)、MTWA_(peakhr)、MTWA_(overall)用于预测慢性心力衰竭患者发生MACE的价值较高,曲线下面积分别为0.903、0.686、0.825(P<0.05)。Logisitic回归分析显示,年龄≥65岁、心律失常病史、吸烟史、美国纽约心脏病学会(NYHA)分级Ⅳ级、高血压病史、过度劳累史、MTWA_(max)≥24.706、MTWA_(peakhr)≥1.586、MTWA_(overall)≥1.489均是导致慢性心力衰竭患者发生MACE的危险因素(P<0.05)。【结论】动态心电图MTWA预测慢性心力衰竭患者发生MACE的应用价值较高,值得临床借鉴。

【Objective】To explore the clinical value of microvolt T wave alternation(MTWA)in predicting major adverse cardiovascular events(MACE)in patients with chronic heart failure.【Methods】A total of 100 patients with CHF admitted to Baoji Hospital affiliated to Xi'an Medical College from December 2019 to December 2021 were selected and divided into MACE group(n=28)and non-MACE group(n=72)according to whether they had MACE.All patients underwent ambulatory electrocardiogram examination,and the risk factors for MACE in patients with CHF were analyzed using univariate and multivariate logistic regression analysis.The receiver operating characteristic(ROC)curve was used to evaluate the value of MTWA in predicting MACE in patients with chronic heart failure.【Results】The age≥65 years old,BMI≥25 kg/m^(2),history of arrhythmia,smoking history,NYHA classificationⅣ,history of hypertension,overwork history,and the proportion of V1 lead maximum MTWA(MTWA_(max)),maximum heart rate(MTWA_(peakhr)),and average MTWA(MTWA_(overall))in the MACE group were higher than those in the non-MACE group(P<0.05).ROC curve analysis showed that MTWA_(max),MTWA_(peakhr),and MTWA_(overall) had higher values for predicting MACE in patients with CHF,with areas under the curve of 0.903,0.686,and 0.825,respectively(P<0.05).Logistic regression analysis showed that age≥65 years old,history of arrhythmia,smoking history,NYHA classificationⅣ,history of hypertension,overwork history,MTWA_(max)≥24.706,MTWA_(peakhr)≥1.586,and MTWA_(overall)≥1.489 were all risk factors for MACE in patients with CHF(P<0.05).【Conclusion】The application value of ambulatory electrocardiogram MTWA in predicting MACE in patients with chronic heart failure is high,and it is worthy of clinical reference.