心电图肢体导联反Δ波对二尖瓣脱垂的诊断价值  

Value of reverse Δ-wave in limb leads for diagnosing mitral valve prolapse

作　　者：郭纪群[1] 潘文志[2] 

机构地区：[1]扬中市人民医院心内科,江苏省212200 [2]复旦大学附属中山医院心内科

出　　处：《中华临床医师杂志（电子版）》2012年第14期3868-3870,共3页Chinese Journal of Clinicians(Electronic Edition)

摘　　要：目的评价心电图中出现反Δ波对二尖瓣脱垂(MVP)的诊断价值。方法选择2008年1月至2009年9月就诊于复旦大学附属中山医院的MVP患者108例,入选同期住院的非MVP150例为对照组,其中正常人(无器质性心脏病)60例,陈旧性心肌梗死30例,非心肌梗死的稳定性冠心病30例,收缩功能不全者(LVEF≤45%)30例。将肢体导联QRS波群下降支中出现Δ波定义为反Δ波。结果病例组共有59例(54.6%)患者出现反Δ波。其中,23例(21.3%)反Δ波在侧壁(Ⅰ,AVL)导联,32例(29.6%)出现在下壁(Ⅱ,Ⅲ,AVF)导联,4例(3.7%)患者下壁、侧壁导联均有反Δ波。脱垂瓣叶的位置(前或后叶)与反Δ波出现的位置(下壁或侧壁)无关联性(P=0.732)。对照组150例中心电图出现Δ波的共25例(16.7%),其中正常人7例(11.7%),陈旧性心肌梗死5例(16.7%),非心肌梗死的稳定性冠心病5例(16.7%),收缩功能不全者8例(26.7%)。病例组与对照组反Δ波出现的频率具有统计学差异(54.6%vs.16.7%,P<0.001)。反Δ波诊断MVP的总体敏感度为54.6%、特异度83.3%、准确度71.3%。结论心电图肢体导联反Δ波对MVP的诊断具有一定价值。Objective To evaluate the diagnostic value of reverse Δ-wave in patients with mitral valve prolapse(MVP).Methods A total of 108 patients with MVP who were hospitalized in Zhongshan Hospital of Fudan University were enrolled,while 150 patients without MVP hospitalized in the same period were included as control group,of whom 60 were health(without structural heart disease)cases,30 were old myocardial infarction(MI)cases,30 were stable coronary heart disease and 30 were systolic dysfunction(LVEF≤45%)cases.Reverse Δ-wave was defined as presence of Δ-wave in descending branch of QRS complex in the limb leads.Results Reverse Δ-wave was presented in 59(54.6%)patients in case group.Among them,23 cases(21.3%)appeared in lateral(Ⅰ,AVL)leads,32(29.6%)in inferior leads(Ⅱ,Ⅲ,AVF),and 4(3.7%)appears in both lateral and inferior leads.There was no associations between site of the prolapsing valve leaflet(anterior or posterior leaf)and positions of reverse Δ-wave(inferior wall or lateral wall)(P=0.732).Out of 150 cases in control group,there was 25 patients(16.7%)having reverse Δ-wave in electrocardiography(ECG).Subgroup analysis showed that 7 cases(11.7%)in health patients,5 cases(16.7%)in old MI patients,5 cases(16.7%)in stable coronary heart disease,and 8 cases(26.7%)in systolic dysfunction patients had reverse Δ-wave.There was significant difference of presence of reverse Δ-wave between case group and control group(54.6% vs.16.7%,P<0.001).In all,the sensitivity of reverse Δ-wave in diagnosis of MVP was 54.6%,specificity was 83.3%,and accuracy was 71.3%.Conclusions Reverse Δ-wave in ECG limb leads may indicate MVP.

关 键 词：二尖瓣脱垂 反Δ波 QRS波群 

分 类 号：R542.5[医药卫生—心血管疾病]