aVR导联T波形态在预测三支病变NSTEMI患者冠状动脉病变程度、心功能及预后中的意义  

T-wave morphology in lead aVR in evaluating the degree of coronary artery disease,cardiac function and prognosis in patients with three-vessel disease NSTEMI

作　　者：单和英 王琴 陈国英 SHAN Heying;WANG Qin;CHEN Guoying(Department of Electrocardiogram,Shaoxing Municipal Central Hospital,Shaoxing 312030,China)

机构地区：[1]绍兴市中心医院医共体总院心电图室,312030

出　　处：《浙江医学》2021年第22期2437-2440,共4页Zhejiang Medical Journal

摘　　要：目的探讨aVR导联T波形态在预测三支病变非ST段抬高型心肌梗死(NSTEMI)患者冠状动脉病变程度、心功能及预后中的意义。方法选取2017年6月至2019年12月绍兴市中心医院医共体总院收治的NSTEMI患者395例,根据冠状动脉造影结果将其分为三支病变组(160例)和非三支病变组(235例)。根据心电图aVR导联T波形态将三支病变组分为直立T波亚组(65例)和非直立T波亚组(95例)。比较各组患者冠状动脉病变程度、心功能变化及预后情况,采用Spearman秩相关分析T波形态与冠状动脉病变程度、心功能的相关性。结果三支病变组Gensini评分、N末端脑钠肽前体(NT-proBNP)水平高于非三支病变组,左心室射血分数(LVEF)低于非三支病变组,差异均有统计学意义(均P<0.01);直立T波亚组Gensini评分、NT-proBNP水平高于非直立T波亚组,LVEF低于非直立T波亚组,差异均有统计学意义(均P<0.01)。T波形态与Gensini评分、NT-proBNP均呈正相关(均P<0.01),与LVEF呈负相关(P<0.01)。直立T波亚组院内死亡、心力衰竭、心源性休克、再发心肌梗死发生率均高于非直立T波亚组(均P<0.05),脑卒中发生率差异无统计学意义(P>0.05)。结论aVR导联直立T波是三支病变NSTEMI患者冠状动脉病变程度、心功能及预后的重要预测因素。Objective To investigate the significance of aVR lead T wave morphology in evaluating the degree of coronary artery disease,cardiac function and prognosis in patients with three-vessel disease non-ST segment elevation myocardial infarction(NSTEMI).Methods A total of 395 NSTEMI patients admitted to our hospital from June 2017 to December 2019 were enrolled in the study.The patients were divided into three-vessel disease group(n=160)and non-three-vessel disease group(n=235)according to the results of coronary angiography.The three-vessel disease patients were further divided into the upright T wave group(n=65)and the non-upright T wave group(n=95)according to the T wave shape in the aVR lead of the electrocardiogram.The degree of coronary artery disease,heart function and prognosis of each group were compared,and the Spearman method was used to analyze the correlation of T wave morphology with coronary artery lesions and cardiac function.Results The Gensini score and N-terminal pro-brain natriuretic peptide(NT-proBNP)levels in the three-vessel disease group were significantly higher,the left ventricular ejection fraction(LVEF)value was significantly lower than those of the non-three-vessel disease group(all P<0.01).The Gensini score and NT-proBNP levels in the upright T wave group were significantly higher,and LVEF value was significantly lower than those in the non-upright T wave group(all P<0.01).Spearman analysis showed that T wave shape was positively correlated with Gensini score and NT-proBNP(all P<0.01),and negatively correlated with LVEF value(P<0.01).The incidence of hospital death,heart failure,cardiogenic shock,recurrence of myocardial infarction in the upright T wave group was significantly higher than those of the non-upright T wave group(all P<0.05),while there was no significant difference in the incidence of stroke between the two groups(P>0.05).Conclusion The upright T wave in lead aVR is an important indicator for severity of coronary artery disease,heart function and prognosis in patients with th

关 键 词：AVR导联 T波直立 三支病变 非ST段抬高型心肌梗死 冠状动脉 心功能 预后 

分 类 号：R541.4[医药卫生—心血管疾病]