无心肌梗死的严重三支血管病变患者心功能不全与其心电图指标的相关性分析  

Analysis on the Correlation Between ECG Parameters and Cardiac Function in Severe Triple Coronary Vessel Disease Patients Without Myocardial Infarction

作　　者：韩霏 禹子清 秦胜梅 方凌燕 李明辉 宿燕岗 葛均波 HAN Fei;YU Zi-qing;QIN Sheng-mei;FANG Ling-yan;LI Ming-hui;SU Yan-gang;GE Jun-bo.(Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University. Shanghai（200032）, Chin)

机构地区：[1]复旦大学附属中山医院心内科上海市心血管病研究所,上海市200032 [2]广东省湛江市第二人民医院

出　　处：《中国循环杂志》2018年第5期441-445,共5页Chinese Circulation Journal

摘　　要：目的:分析无心肌梗死的严重三支血管病变(左前降支、左回旋支及右冠状动脉狭窄均≥70%)患者心功能不全与其心电图指标的相关性。方法:入选2017-03-01至2017-07-05期间入我院且经冠状动脉造影证实无心肌梗死的严重三支血管病变患者96例,根据左心室射血分数(LVEF)分为心功能正常组(LVEF≥50%)78例及心功能不全组(LVEF<50%)18例。比较两组患者心电图指标,受试者工作特征(ROC)曲线确定界值,并通过Logistics回归分析心功能不全与各因素之间的相关性。结果:在96例无心肌梗死的严重三支血管病变患者中,心功能不全组18例(18.8%)。与心功能正常组比,心功能不全组患者心率、QRS波时限、校正的QT间期(QTc)均有明显增加,且差异均有统计学意义(P均<0.05)。ROC曲线分析提示:心率>70.5次/min(敏感度81.3%,特异度58.9%),QRS波时限>97.5 ms(敏感度82.4%,特异度67.5%),QTc>425 ms(敏感度93.8%,特异度41.1%),对心功能不全有较好的预测价值。多因素回归分析提示:在无心肌梗死的严重三支血管病变患者中,心电图指标仅QRS波时限>97.5 ms(OR=7.577,95%CI:1.094~52.490,P=0.030)与心功能不全呈正相关。结论:在未发生心肌梗死的冠状动脉严重三支血管病变的患者中,静息心电图QRS波时限延长提示这些患者存在心功能不全。Objectives：To analyze the correlation between systolic cardiac insufficiency and ECG parameters of patients with triplevessel disease（left anterior descending artery, left circumflex artery and right coronary artery showed ≥ 70% of diameter stenosis）, but without history of myocardial infarction.Methods： A total of 96 triple-vessel disease patients without prior myocardial infarction who underwent coronary angiography examination between 2017-03-01 and 2017-07-05 in Zhongshan hospital were recruited in this study. According to LVEF, patients were divided into the normal cardiac function group（78 patients with LVEF ≥ 50%） and the reduced LVEF group（18 patients with LVEF 50%）. The Receiver Operating Characteristic（ROC） curve was applied to test optimal cut-off value of the ECG parameters and logistics regression analysis was utilized to determine the correlation between ECG indices with cardiac insufficiency.Results： A small percentage（18.8%） triple-vessel disease patients without prior myocardial infarction developed cardiacinsufficiency. QRS duration, QTc duration were all significantly increased in patients with cardiac dysfunction） compared with patients with normal cardiac function（P〈0.05）. ROC curve indicated good predictive efficacy to systolic cardiac insufficiency with HR 70.5 bpm（sensitivity 81.3%, specificity 58.9%）, QRS 97.5 ms（sensitivity 82.4%, specificity 67.5%）, QTc 425 ms（sensitivity 93.8%, specificity 41.1%）. Logistic multivariate regression analysis showed that QRS 97.5 ms（OR=7.577, 95%CI：1.094~52.490,P =0.030） was significantly correlated with systolic cardiac insufficiency.Conclusions： For triple-vessel disease patients without prior myocardial infarction, wider QRS in the resting ECG may indicate cardiac insufficiency.

关 键 词：三支血管病变 心功能 QRS波 

分 类 号：R54[医药卫生—心血管疾病]