aVR T波形态在评估急性冠状动脉综合征三支病变患者左心功能中的意义  

Significance of T wave morphology in lead aVR in evaluating left ventricular function in patients with acute coronary syndrome with three-vessel disease

作　　者：郑晓斌 王瑞英[2] 路申潞 熊上 ZHENG Xiaobin;WANG Ruiying;LU Shenu;XIONG Shang(Shanxi Medical University,Taiyuan,Shanxi 030001,China;Department of Cardiology,the Second Hospital of Shanxi Medical University,Taiyuan,Shanxi 030013,China)

机构地区：[1]山西医科大学,山西省太原市030001 [2]山西医科大学第二医院心血管内科,山西省太原市030013

出　　处：《中国动脉硬化杂志》2021年第1期60-65,共6页Chinese Journal of Arteriosclerosis

基　　金：山西省科技攻关项目(20140313015-9)。

摘　　要：目的研究急性冠状动脉综合征(ACS)三支病变患者心电图aVR导联T波形态预测左心功能变化的意义。方法160名冠状动脉造影明确的ACS三支病变患者按照入院心电图aVR导联T波形态分为T波直立组(72例)和T波倒置组(88例),比较两组一般资料、左心功能、冠状动脉病变及临床结局情况。结果与T波倒置组比较,T波直立组左心室射血分数(LVEF)较低,LVEF<50%占比、血清N末端脑钠肽前体(NT-proBNP)、Gensini评分、Syntax评分及Syntax≥23分占比较高,两组比较均有统计学意义(P<0.05)。T波直立组较倒置组使用升压药患者例数更多、平均住院时间更长(均P<0.05)。Spearman相关分析显示,aVR T波直立与LVEF呈负相关,与Gensini及Syntax评分、NT-proBNP、住院时长呈正相关(均P<0.05)。多元Logistic回归分析示,aVR导联T波直立与LVEF(OR=0.974,95%CI:1.007~1.030,P<0.05)独立相关。结论ACS三支病变患者中,aVR导联T波直立患者较T波倒置患者具有更低的LVEF值与较差的临床结局,aVR T波直立可评估ACS三支病变患者左心功能情况。Aim To study the significance of T wave shape of aVR lead in predicting left ventricular function in patients with acute coronary syndrome(ACS)with three-vessel disease.Methods 160 patients with ACS three-vessel disease confirmed by coronary angiography were enrolled and divided into T-wave upright group(n=72)and T-wave inversion group(n=88)according to the T-wave morphology in lead aVR of electrocardiogram.The general data,left ventricular function,coronary artery lesion and clinical outcome were compared between the two groups.Results Ejection fraction(LVEF)was lower but proportion of LVEF<50%,serum N-terminal pro-brain natriuretic peptide(NT-proBNP),Gensini score,Syntax score and proportion of Syntax≥23 were higher in T-wave upright group than in T-wave inversion group(all P<0.05).Compared with the T-wave inversion group,the upright group had more cases of using vasopressor and longer average hospitalization day(all P<0.05).Spearman correlation analysis showed that upright T wave in lead aVR was negatively correlated with LVEF,and positively correlated with Gensini and Syntax score,NT-proBNP,LVEF and hospitalization day(all P<0.05).Multivariate Logistic regression analysis showed that upright T wave in lead aVR was independently associated with ejection fraction.Conclusions The patients of upright T wave in lead aVR with ACS three-vessel disease had lower LVEF values and worse clinical outcome than that of T wave inversion.Upright T wave in lead aVR can be used to evaluate the left ventricular function in patients with ACS three-vessel disease.

关 键 词：急性冠状动脉综合征 三支病变 aVR导联T波直立 左心功能 

分 类 号：R5[医药卫生—内科学]