心电图avL导联T波变化对老年冠心病病人冠脉狭窄程度的诊断价值

doi:10.3969/j.issn.1003-9198.2024.08.008

摘要/Abstract

摘要： 目的分析心电图avL导联T波变化对老年冠心病(CHD)病人冠脉狭窄程度的诊断价值。方法选择2019年7月至2022年10月就诊于本院的124例老年CHD病人,冠状动脉狭窄程度按照Gensini积分法分为重度组(36例,Gensini评分＞40分)、中度组(40例,Gensini评分为21~40分)、轻度组(48例,Gensini评分为1~20分)。所有病人均接受心电图检测。比较3组病人一般资料、实验室指标、avL导联T波改变与其他心电图特征,采用Logistic回归分析老年CHD病人冠脉狭窄程度的危险因素,绘制ROC曲线分析avL导联T波改变对老年CHD病人冠脉狭窄程度的诊断价值。结果左心室舒张末期内径(LVEDD)和血清N末端脑钠肽前体(NT-proBNP)水平在轻度组、中度组和重度组中逐步升高,且3组间差异有统计学意义(P＜0.01);3组间avL导联T波改变、ST段抬高、ST段压低、病理性Q波比例相比,差异有统计学意义(P＜0.01)。Logistic回归分析显示,NT-proBNP、LVEDD、avL导联T波改变、ST段抬高、ST段压低、病理性Q波是影响老年CHD病人冠脉狭窄程度的独立危险因素; ROC曲线分析表明,avL导联T波改变诊断老年CHD冠脉狭窄程度的AUC为0.701(95%CI:0.603~0.798)。结论心电图avL导联T波改变是老年CHD病人冠脉狭窄程度的独立危险因素,在冠脉狭窄程度诊断中具有一定价值。

关键词: 老年人, 冠心病, 心电图, avL导联T波, 冠脉狭窄程度

Abstract: Objective To analyze the diagnostic value of T wave change of avL lead in electrocardiograph(ECG) for the degree of coronary artery stenosis in the elderly patients with coronary heart disease (CHD). Methods A total of 124 elderly patients with CHD who were treated in our hospital from July 2019 to October 2022 were selected and divided into severe group (Gensini score > 40,36 cases), moderate group (Gensini score 21-40,40 cases) and mild group (Gensini score 1-20,48 cases). All patients received ECG detection. The general data, laboratory indexes, avL lead T wave changes and other ECG characteristics of the three groups were observed and compared. The risk factors of the degree of coronary artery stenosis in the elderly CHD patients were analyzed by Logistic regression analysis. Receiver operating characteristic (ROC) curve was drawn to analyze the value of avL lead T wave changes in the diagnosis of coronary artery stenosis in the elderly CHD patients. Results The levels of left ventricular end-diastolic diameter (LVEDD) and serum N-terminal pro-brain natriuretic peptide (NT-proBNP) were highest in the severe group, followed by the moderate group and the mild group (P<0.05).There were significant differences in the proportions of T wave changes in avL lead, ST-segment elevation, ST-segment depression and pathological Q wave among the three groups (P<0.01). Logistic regression analysis showed that NT-proBNP, LVEDD, T wave changes in avL lead, ST-segment elevation, ST-segment depression and pathological Q wave were the independent risk factors for the degree of coronary artery stenosis in the elderly patients with CHD; ROC curve showed that the area under the curve (AUC)of T wave changes in avL lead in diagnosing coronary artery stenosis in the elderly patients with CHD was 0.701 (95%CI: 0.603-0.798). Conclusions The T wave changes of avL lead in ECG is an independent risk factor for the degree of coronary artery stenosis in the elderly CHD patients, and it has certain value in the diagnosis of coronary artery stenosis.

Key words: aged, coronary heart disease, electrocardiogram, avL lead T wave, degree of coronary artery stenosis

中图分类号:

R541.4

向超, 罗彩东. 心电图avL导联T波变化对老年冠心病病人冠脉狭窄程度的诊断价值[J]. 实用老年医学, 2024, 38(8): 788-791.

XIANG Chao, LUO Caidong. Analysis of the diagnostic value of T wave change of avL lead for the degree of coronary artery stenosis in elderly patients with coronary heart disease[J]. Practical Geriatrics, 2024, 38(8): 788-791.

参考文献

[1] BAI M F, WANG X. Risk factors associated with coronary heart disease in women: a systematic review[J]. Herz, 2020, 45(Suppl 1):52-57.
[2] LIANG F, WANG Y. Coronary heart disease and atrial fibrillation: a vicious cycle[J].Am J Physiol Heart Circ Physiol, 2021, 320(1):H1-H12.
[3] KATTA N, LOETHEN T, LAVIE C J, et al. Obesity and coronary heart disease: epidemiology, pathology, and coronary artery imaging[J].Curr Probl Cardiol, 2021, 46(3):100655.
[4] ZHAO J, FAN H, WANG T, et al. TyG index is positively associated with risk of CHD and coronary atherosclerosis severity among NAFLD patients[J].Cardiovasc Diabetol, 2022, 21(1):123.
[5] CURY R C, LEIPSIC J, ABBARA S, et al. CAD-RADS^TM 2.0 - 2022 coronary artery disease-reporting and data system: an expert consensus document of the Society of Cardiovascular Computed Tomography (SCCT), the American College of Cardiology (ACC), the American College of Radiology (ACR), and the North America Society of Cardiovascular Imaging (NASCI)[J].J Cardiovasc Comput Tomogr, 2022, 16(6):536-557.
[6] ARNETT D K, BLUMENTHAL R S, ALBERT M A, et al. 2019 ACC/AHA guideline on the primary prevention of cardiovascular disease: a report of the American College of Cardiology/American Heart Association Task Force on clinical practice guidelines[J].Circulation, 2019, 140(11):e596-e646.
[7] PESSAH M A, HUHTALA H, KOSONEN P, et al. Early ischemic ST-segment and T-wave changes during balloon angioplasty[J].J Electrocardiol, 2022, 73:87-95.
[8] 中华医学会心血管病学分会.稳定性冠心病诊断与治疗指南[J].中华心血管病杂志, 2018, 46(9): 680-694.
[9] RAMPIDIS G P, BENETOS G, BENZ D C, et al. A guide for Gensini score calculation[J].Atherosclerosis, 2019, 287:181-183.
[10] 中国医药生物技术协会心电学分会,中国老年学会老年医学委员会心电专家委员会.心电图测量技术专家共识[J].临床心电学杂志, 2019, 28(2):81-90.
[11] TAHERINIA A,AHMADI K,BAHRAMIAN M,et al. Diagnostic value of standard electrocardiogram in acute right ven-tricular myocardial infarction[J]. Eur J Transl Myol,2019,29(2):8184.
[12] 金飞燕,沈江英.avL导联T波改变联合中性粒细胞与淋巴细胞比值对急性冠状动脉综合征心血管终点事件的预测价值分析[J].心脑血管病防治, 2022, 22(5):88-90,94.
[13] LIU L, WANG D. A rare transitory change of the De Winter ST/T-wave complex in a patient with cardiac arrest:a case report[J].Medicine:Baltimore, 2020, 99(19):e20133.
[14] CIPRIANI A, D’AMICO G, BRUNELLO G, et al. The electrocardiographic "triangular QRS-ST-T waveform" pattern in patients with ST-segment elevation myocardial infarction: incidence, pathophysiology and clinical implications[J].J Electrocardiol, 2018, 51(1):8-14.
[15] SAWANO M, YUAN Y, KOHSAKA S, et al. Electrocardiographic ST-T abnormities are associated with stroke risk in the REGARDS Study[J].Stroke, 2020, 51(4):1100-1106.