阵发性心房颤动患者心电图P波指数联合心房超声参数预测急性脑梗死的价值

Value of ECG P-wave index combined with atrial ultrasound parameters in predicting acute cerebral infarction in patients with paroxysmal atrial fibrillation

目的分析阵发性心房颤动并发急性脑梗患者心电图P波指数结合心房超声参数变化的临床意义。方法回顾性收集三明市第二医院2022年5月至2023年12月95例阵发性房颤患者的病历资料,并根据患者是否并发急性脑梗死分为合并脑梗死组(58例)和单纯房颤组(37例)。两组患者均接受心电图检测和心房超声检测。观察两组患者基线特征、P波时限、V_(1)导联P波终末电势(PTFV_(1))、左房最大、最小容积及左房主动和被动排空分数。采用logistic回归分析影响阵发性房颤并发急性脑梗死的相关因素,进一步运用受试者工作特征(ROC)曲线分析P波指数和心房超声参数对急性脑梗死的预测效能。结果两组患者P波时限、PTFV_(1)及左房最大容积、最小容积、左房膨胀指数、左房主动排空分数、被动排空分数等比较,差异有统计学意义(P<0.05)。logistic回归分析显示,P波时限、PTFV_(1)、左房最大容积及左房最小容积均为阵发性房颤并发急性脑梗死的独立危险因素(P<0.05),而左房膨胀指数、左房主动排空分数、左房被动排空分数均为评估阵发性房颤并发急性脑梗死的保护因素(P<0.05)。ROC曲线显示P波指数联合心房超声参数对阵发性房颤患者发生急性脑梗死的预测效能最高。结论P波时限、PTFV_(1)升高及心房超声参数异常可提示房颤患者急性脑梗死发生风险较高。

Objective To explore the value of ECG P-wave index combined with atrial ultrasound parameters in predicting acute cerebral infarction in patients with paroxysmal atrial fibrillation(PAF).Methods The data of 95 patients with PAF in Sanming Second Hospital from May 2022 to December 2023 were retrospectively collected.According to whether the patients were complicated with acute cerebral infarction,they were divided into a group with cerebral infarction(58 cases)and a group with simple atrial fibrillation(37 cases).All patients underwent electrocardiography and atrial ultrasonography.Baseline characteristics,P-wave duration,V_(1) lead P-wave terminal potential(PTFV_(1)),left atrial maximum and minimum volume,and left atrial active and passive ejection fraction were observed in both groups.Logistic regression was used to analyze the related factors affecting PAF complicated with acute cerebral infarction,and receiver operating characteristic(ROC)curve was further used to analyze the predictive efficacy of P-wave index and atrial ultrasound parameters in acute cerebral infarction.Results There were statistically significant differences in P-wave duration,PTFV_(1),maximum and minimum volume of left atrial,left atrial dilation index,and left atrial active and passive ejection fraction between the two groups(P<0.05).Logistic regression analysis showed that P-wave duration,PTFV_(1),left atrial maximum and minimum volume were independent risk factors for PAF complicated with acute cerebral infarction(P<0.05).Left atrial dilatation index,left atrial active and passive ejection fraction were protective factors for PAF complicated with acute cerebral infarction(P<0.05).ROC curve showed that P-wave index combined with atrial ultrasound parameters had the highest predictive efficacy for acute cerebral infarction in patients with PAF.Conclusion The increase of P-wave duration,PTFV_(1) and abnormal atrial ultrasound parameters may suggest a higher risk of acute cerebral infarction in patients with PAF.