QTpd及QRS宽度和QRS额面电轴在冠心病患者运动试验中的意义

The significance of QTpd, QRS duration and frontal plane QRS axis during treadmill exercise test in patients with coronary artery disease

目的 :探讨平板运动试验中冠心病 (CHD)患者与非CHD患者QTpd、QRS宽度和QRS额面电轴变化的意义。方法 :对 6 6例经冠状动脉造影和活动平板检查的患者 ,根据冠状动脉病变程度分为非CHD组和CHD组 ,观察运动试验前后QTpd和QRS宽度的变化 ;CHD组根据病变所累及的血管分为 3个亚组 ,CHD组 1为左前降支病变有或无左回旋支病变 ,CHD组 2为右冠病变有或无左回旋支病变 ,CHD组 3为 3支病变或左前降支病变有或无右冠病变 ,观察运动试验前后QRS额面电轴的改变。结果 :①运动前CHD组与非CHD组QTpd、QRS宽度差异无显著性意义 (P >0 .0 5 )。②运动后非CHD组QTpd无明显改变 (P >0 .0 5 )、QRS宽度变窄 (P <0 .0 1) ,CHD组QTpd增大、QRS宽度延长 (P <0 .0 1)。③运动后 ,非CHD组QRS额面电轴无明显改变 (P >0 .0 5 ) ,CHD组 1QRS额面电轴向左偏 (P <0 .0 1) ,CHD组 2QRS额面电轴向右偏 (P <0 .0 1) ,CHD组 3QRS额面电轴改变无统计学意义 (P >0 .0 5 )。结论 :运动导致的QTpd增大。

Objective:To investigate the clinical significance of QTpd?QRS duration and frontal plane QRS axis during treadmill exercise test in patients with or without coronary artery disease.Methods:Sixty six patients who underwent coronary angiography and treadmill exercise test were divided into two groups: with or without coronary artery disease, QTpd and QRS duration were assessed during treadmill exercise test. The patients with coronary artery disease were subdivided into subgroup 1(with left anterior descending artery lesion±left circumflex artery lesion) subgroup 2(with right coronary artery lesion±left circumflex artery lesion) and subgroup 3(with three vessels lesions or with left anterior descending artery lession±right coronary artery lesion). The frontal plane QRS axis was assessed during treadmill exercise test.Results:1 Before exercise, QTpd and QRS duration were no significant difference between two groups(P> 0.05 ). 2 In patients without CAH, QTpd were no significant difference (P> 0.05 ), and QRS duration were significantly shortened (P< 0.01 ) after exercise. In patients with CAD, Qtpd and QRS duration were significantly prolonged (P< 0.01 ). 3 After exercise, there was no significant axis shift in patients without coronary artery disease(P> 0.05 ); In subgroup 1, the frontal plane QRS axis was shifted to the left (P< 0.01 ); In subgroup 2,the frontal plane QRS axis was shifted to the right(P< 0.01 ); In subgroup 3, no siginificant axis shift was observed(P> 0.05 ).Conclusion:For diagnosis of coronang artery disease, it is useful to exercise induced QTpd, and QRS prologation and frontal plane QRS deviation.