aVR导联的直立T波对非ST段抬高型心肌梗死患者的预后评估价值  

Prognostic value of erect T waves in aV R leads in patients with non-ST elevation myocardial infarction

作　　者：屈丽娜[1] 闫生玲 Qu Lina;Yan Shengling(Department of Cardiology, Yan'an People's Hospital, Yan'an 716000, China)

机构地区：[1]延安市人民医院内科

出　　处：《中国心血管杂志》2019年第3期223-226,共4页Chinese Journal of Cardiovascular Medicine

摘　　要：目的探讨aVR导联中的直立T波在预测非ST段抬高型心肌梗死(NSTEMI)患者预后的临床价值。方法回顾性纳入2011年1月至2016年12月期间收治的400例NSTEMI患者,根据心电图aVR导联中的T波>0mV将患者分为直立T波组(124例)和非直立T波组(276例),随访12个月记录主要不良心脑血管事件(MACCE)。单因素及多因素logistic回归分析影响MACCE发生的独立危险因素。结果直立T波组的左室射血分数低于非直立T波组(P<0.05),而年龄、心率、高血压、糖尿病、心力衰竭(Killip3~4级)、左心室肥大和aVR导联ST段抬高比例均显著高于非直立T波组(均为P<0.05)。中位随访14.5(12~27)个月后,直立T波组中的院内死亡、心力衰竭、心原性休克、再发心肌梗死等均明显高于非直立T波组(均为P<0.05)。多因素logistic回归发现,左室射血分数<40%[比值比(OR)=1.432,95%CI:1.204~2.411,P=0.043]、aVR导联直立T波(OR=3.748,95%CI:2.855~5.392,P<0.001)和aVR导联ST段抬高(OR=2.439,95%CI:2.208~3.956,P<0.001)是发生MACCE的独立危险因素。结论aVR导联的直立T波能够有效预测NSTEMI患者冠状动脉介入术后12个月内MACCE发生风险增加。Objective To investigate the predictive value of upright T waves in aVR lead in the prognosis of patients with non-ST elevation myocardial infarction (NSTEMI). Methods A total of 400 NSTEMI patients were enrolled from January 2011 to December 2016, and were divided into upright T wave group ( n =124) and non-upright T wave group ( n =276) according to the T wave direction in the aVR lead. The major adverse cardiac and cerebrovascualr events (MACCE) for 12 months of follow-up were recorded. Univariate and multivariate logistic regression analysis was used to determine the independent risk factors affecting the occurrence of MACCE. Results Left ventricular ejection fraction (LVEF) was lower in the upright T wave group, while age and heart rate (HR) was higher. Compared with non-upright group, the ratio of hypertension, diabetes, heart failure (Killip 3-4 class), left ventricular hypertrophy (LVH) and ST-segment elevation were higher in upright T wave group (all P <0.05). After a median follow-up of 14.5 months (12-27 months), the incidence of MACCE, including in-hospital mortality, heart failure, cardiogenic shock, and myocardial re-infarction were significantly higher in upright T wave group than those in non-upright T wave group (all P <0.05). Multivariate logistic regression analysis showed that LVEF less than 40%( OR=1.432, 95% CI:1.204-2.411, P =0.043), upright T wave in aVR lead (OR=3.748, 95% CI: 2.855-5.392, P <0.001) and ST segment elevation in aVR lead ( OR=2.439, 95% CI: 2.208-3.956, P <0.001) were independent risk factors for MACCE at 12 months after percutaneous coronary intervention (PCI). Conclusions Upright T wave of aVR lead can effectively predict the increased risk of MACCE at 12 months after PCI in NSTEMI patients.

关 键 词：非ST段抬高型心肌梗死 AVR导联 直立T波 主要不良心脑血管事件 

分 类 号：R542.22[医药卫生—心血管疾病]