心房颤动患者动态心电图参数Pmax、Pd和Pv的变化及其临床意义

Changes and their clinical significance of Pmax,Pd and Pv of dynamic electrocardiogram in atrial fibrillation patients

目的研究心房颤动患者动态心电图参数P波最大时限(Pmax)、P波离散度(Pd)和P波变异(Pv)的变化及其临床意义。方法回顾性抽取2020年6月至2023年6月于河南省直第三人民医院诊断并进行治疗的86例心房颤动患者作为研究组,根据2016年欧洲心脏病学会心房颤动管理指南,其中低危患者15例,中危患者39例,高危患者32例;另抽取同期在医院进行体检的志愿者86例作为对照组。比较研究组与对照组、研究组中不同严重程度患者的Pmax、Pd和Pv参数差异,比较Pmax、Pd和Pv参数单独检测以及联合检测效能。结果研究组Pmax、Pd和Pv均高于对照组(t=41.85、43.55、26.36,P均<0.001)。研究组中不同严重程度患者的Pmax、Pd和Pv比较差异均有统计学意义(F=21.65、12.92、20.64,P均<0.001),且Pmax、Pd和Pv从高到低分别为高危患者、中危患者以及低危患者。Pmax、Pd和Pv联合检测对心房颤动的诊断灵敏度(94.19%,81/86)高于三者单独检测(70.93%,61/86;75.58%,65/86;87.21%,75/86)。受试者工作特征曲线分析结果显示,Pmax、Pd和Pv联合检测对心房颤动的诊断的曲线下面积(0.873)高于三者单独检测(0.772、0.771、0.776)。针对心房颤动患者,其Pmax、Pd和Pv截断值分别为122.03 ms、44.26 ms以及221.36 ms 2。结论Pmax、Pd和Pv参数变化可作为心房颤动早期诊断评价的重要依据。

ObjectiveTo investigate the changes of P-wave maximum duration(Pmax),P-wave dispersion(Pd)and P-wave variation(Pv)in patients with atrial fibrillation,and to analyze to clinical role of the dynamic electrocardiogram parameters.MethodsEighty-six atrial fibrillation patients who were diagnosed and were treated in the Third People’s Hospital of Henan Province from June 2020 to June 2023 were retrospectively selected as the research group,including 15 low-risk patients,39 moderate-risk patients,and 32 high-risk patients classified by the 2016 European Society of Cardiology Atrial Fibrillation Management Guidelines.Another 86 volunteers who underwent physical examinations in the hospital during the same period were selected as the control group.The differences in Pmax,Pd and Pv parameters were compared between the research group and the control group,as well as among patients with different degrees of disease severity in the research group.The efficacy of each single index detection and combined detection(Pmax,Pd and Pv)were also compared.ResultsThe Pmax,Pd,and Pv of the research group were higher than those of the control group(t=41.85,43.55,26.36;all P<0.001).There were statistically significant differences in Pmax,Pd,and Pv among patients with different degrees of disease severity in the research group(F=21.65,12.92,20.64;all P<0.001);the levels of Pmax,Pd,and Pv showed a down trend in the order of high-risk patients,moderate-risk patients,and low-risk patients.The sensitivity of the combined detection of Pmax,Pd,and Pv for the diagnosis of atrial fibrillation(94.19%,81/86)was higher than that of the three single index tests(70.93%,61/86;75.58%,65/86;87.21%,75/86).The receiver operating characteristic revealed that the area under the curve of the combined detection of Pmax,Pd,and Pv(0.873)for the diagnosis of atrial fibrillation was higher than that of the three single index tests(0.772,0.771,0.776).For atrial fibrillation patients,the cut-off values of Pmax,Pd and Pv were 122.03 ms,44.26 ms and 221.36 ms 2,respectively.ConclusionsChanges in Pmax,Pd and Pv parameters can serve as important basis for early diagnosis and evaluation of atrial fibrillation.