运动诱发心肌缺血后Tpe间期改变对冠脉临界病变患者风险评价  

Risk evaluation of Tpeak-Tend interval changes for patients with coronary borderline lesion after exercise-induced myocardial ischemia

作　　者：王野[1] 范树良 冯星[1] 张树龙[2] 

机构地区：[1]吉林市人民医院心内科,吉林吉林132000 [2]大连大学附属中山医院心脏中心,辽宁大连116001

出　　处：《实用心电学杂志》2017年第1期32-35,共4页Journal of Practical Electrocardiology

基　　金：辽宁省自然科学基金资助项目(2013023032)

摘　　要：目的评价运动试验诱发心肌缺血后T波峰末间期(简称Tpe)改变对冠脉临界病变患者主要心脏不良事件的预测价值。方法 1入选我院2014年1月至2015年1月通过冠状动脉造影诊断为临界病变并进行平板运动负荷试验的患者50例,设健康对照者50例。2测量运动试验开始前及运动后最大Tpe、平均Tpe、单导联Tpe。3比较运动前后最大Tpe、平均Tpe、单导联Tpe。4平均随访1年,分析主要心血管事件(心源性死亡、急性冠脉综合征或心肌缺血导致靶病变血运重建等临床事件)发生与Tpe间的关系。结果 1冠脉临界病变组运动后最大Tpe较运动前明显延长(P<0.05),平均Tpe明显延长(P<0.05);2静息状态下冠脉临界病变组与对照组Tpe比较,差异无统计学意义(P>0.05);3对照组运动前与运动后Tpe比较,差异无统计学意义(P>0.05);4通过1年随访,发现50例冠脉临界病变患者中发生急性冠脉综合征病例6例,心肌缺血导致靶器官重建2例,无心源性死亡。Tpe延长较明显者易发生主要心血管事件,而对照组则无上述不良事件。结论运动试验后Tpe在冠脉临界病变患者中明显延长,Tpe延长明显者1年中发生主要心血管事件概率增大,但是否具有独立预测价值尚需进一步研究。Objective To observe if there is significant change in the length of Tpeak-Tend in-terval（Tpe）in patients with coronary borderline lesion before and after exercise-induced myocardial ischemia,and to evaluate its predictive value on major adverse cardiovascular events（MACE）a-mong the population with coronary borderline lesion by follow-up.Methods （i）Fifty cases were randomly selected as observation group who were diagnosed with coronary borderline lesion by coro-nary angiography from January 201 4 to January 201 5 in our hospital and underwent treadmill exer-cise test（TET）.Fifty healthy people were taken as control group.（ii）The maximal Tpe（Tpe-Max）,the average Tpe（Tpe-ave）and Tpe of single lead were measured before and after TET re-spectively.（iii）Tpe-Max,Tpe-ave and Tpe of single lead before and after TET were compared. （iv）The relationship between the incidence of MACE（cardiac death,acute coronary syndrome or reascularization of target lesions by ischemia and other clinical events）and Tpe was analyzed during an average of one year.Results （i）Tpe-max and Tpe-ave in the observation group significantly lengthened after TET（P 〈0.05）.（ii）There was no significant difference in Tpe between the two groups at resting state（P 〉0.05）.（iii）No significant difference of Tpe was found before and after TET in the control group（P 〉0.05）.（iv）Among the 50 cases with coronary borderline lesion,6 cases suffered acute coronary syndrome,2 underwent target organ reascularization by ischemia and no cardiac death was reported during a one-year follow-up.The patients with significantly lengthened Tpe were prone to be attacked by MACE while the cases in the control group were not haunted by the above MACE.Conclusion Tpe of patients with coronary borderline lesion significantly length-ens after TET.For the ones with significantly lengthened Tpe,the incidence of MACE increases during one year.However,it still waits for verification that if Tpe can be regarded as an in

关 键 词：T波峰末间期 冠脉临界病变 心肌缺血 心源性死亡 急性冠脉综合征 

分 类 号：R541.75[医药卫生—心血管疾病]