信号平均心电图预测冠心病患者心律失常事件的前瞻性研究  

Prospective study on value of signal-averaged electrocardiogram predicting arrhythmic events in patients with coronary artery disease

作　　者：王崇慧[1] 陈柯萍[1] 尹彦琳[1] 路黎明[1] 王莉[1] 李晶[1] 秦学文[1] 徐义枢[1] 姚康宝[1] 张奎俊[1] 王方正[1] 陈新[1] 

机构地区：[1]中国医学科学院阜外心血管病医院

出　　处：《临床心电学杂志》1997年第3期111-114,共4页Journal of Clinical Electrocardiology

摘　　要：目的：评价心室晚电位（ＶＬＰ）预测心律失常事件（ＡＥ）的价值。方法：对２６１例冠心病患者进行２４小时Ｈｏｌｔｅｒ和信号平均心电图（ＳＡ－ＥＣＧ）检测，其中ＡＭＩ患者于发病后２～４周行ＳＡ－ＥＣＧ检测。所有患者均进行临床随访。结果：２６１例冠心病患者中ＶＬＰ阳性率１４９％，随访１３６±６９（４～３６）月，发生ＡＥ１８例。ＶＬＰ阳性组ＡＥ发生率２９７％，明显高于ＶＬＰ阴性组ＡＥ发生率３６％（Ｐ＜００００１）。发生ＡＥ组ＶＬＰ阳性率６１１％，明显高于未发生ＡＥ组ＶＬＰ阳性率１２３％（Ｐ＜０００１）。ＶＬＰ时域分析预测冠心病患者发生ＡＥ的敏感性６１１％、特异性８７７％、阳性预测值２９７％、阴性预测值９６４％、准确性８５６％。结论：ＶＬＰ预测ＡＥ有较高的敏感性、特异性和准确性。ＶＬＰ有助于冠心病（尤其心肌梗死）患者的危险性分层。OBJECTIVE The purpose of this study was to assess the value of ventricular late potentials(VLP) in predicting arrhythmic events (AE).Methods:The SA-ECG and 24 hours Holter monitoring were recorded in 261 patients with coronary artery disease.The SA-ECG was recorded during the 2nd～4th weeks after acute myocardiol infarction(AMI).The clinical follow-up was carried out on all patients.Results:(1)The prevalence of VLP was 14.9% in 261 patients with coronary artery disease.Arrhythmic events occurred in 18 patients during 13.6±6.9(4～36) months follow-up period.29.7% of VLP positive group had arrhythmic events compared with 3.6% in VLP negative group (P<0 0001).Incidence of arrhythmic events was 61.1% and 12.3% respectively in patients with and without VLP (P<0 001).The sensitivity of VLP predicting arrhythmic events in time domain analysis in 261 patients with coronary artery disease was 61.1%,specificity 87.7%,positive predictive value 29.7%,negative predictive value 96.4% and accuracy 85.6%.Conclusions:VLP has a close relation to arrhythmic events.The value of VLP predicting arrhythmic events is relatively high (sensitivity 61.1%,specificity 87.7% and accuracy 85.6%) and VLP may be helpful to risk stratification of patients with coronary artery disease (myocardiol infarction).

关 键 词：心室晚电位 心律失常 预后 冠心病 

分 类 号：R541.402[医药卫生—心血管疾病]