体表信号叠加心电图对急性心肌梗塞的临床意义探讨

Clinical Significance of Signal-averaged Electrocardiogram in Patients With Acute Myocardial Infarction

应用体表信号叠加心电图(SAECG)对60例急性心肌梗塞症状出现后第1,3,7,14,30天系列检测心室晚电位(LP)。检出LP阳性17例(28.3％),80％LP在梗塞后1周内开始出现,40％LP呈间歇出现。阳性组频发室性早搏和室性心动过速检出率(35.7％和21.4％)约为阴性组(17.1％和11.4％)之2倍,但无统计学意义。住院期发生心律失常事件8例(13.3％),7例为LP阳性患者。LP预测事件发生的敏感性87.5％(7/8),特异性80.8％(42/52),阳性准确率41.2％(7/17),阴性准确率97.7(42/43)。

Signal-averaged electrocardiograms (SAECGs) were perfomed in 60 patients with acute myocardial infarction (AMI) in series. Positive late potentials (LPs) were recorded in 17 patients (28.3％). In most of them (80％), the first appearence of LPs was in the 1st week after AMI, and 40％ of LPs appered transiently. There were no significant differences between LPs positive and negative group with respect to age, sex, peak creatine kinase activity, Killip classification on admission, left ventricular ejection fraction, left ventricular internal dimension, and infarct site, There were 2 patients with ventricular aneurysm in the positive but none in the negative (P=0.035). During hospital stay, arrhythmic events (AEs) developed in 7 patients with LPs positive and 1 with LPs negative. The detection of LPs in SAECG predicted AEs with a sensitivity of 87.5％(7/8), specificity of 80.8％ (42/52),positive accuracy of 41.2％ (7/17) and negative accuracy of 97.7％ (42/43).