心电图Defective T波对成人继发孔型房间隔缺损的诊断价值和形成因素分析  

Diagnostic value and influencing factors of defective T wave in secundum atrial septal defect in adults

作　　者：施念 孙茜 闫书妹 刘桂芝[1] SHI Nian;SUN Qian;YAN Shumei;LIU Guizhi(Department of Physical Diagnosis,the First Affiliated Hospital,Zhengzhou University,Zhengzhou 450052)

机构地区：[1]郑州大学第一附属医院物理诊断科,郑州450052

出　　处：《郑州大学学报（医学版）》2022年第5期649-654,共6页Journal of Zhengzhou University(Medical Sciences)

基　　金：河南省医学适宜技术推广项目(SYJS2020095)。

摘　　要：目的:探讨心电图Defective T波(DTW)诊断成人继发孔型房间隔缺损(ASD)的价值及主要形成因素。方法:选取经心脏超声心动图确诊的继发孔型ASD成人患者243例(ASD组)和心脏超声未见明显异常者247例(非ASD组),均描记标准十二导联心电图,观察DTW、不完全性右束支传导阻滞(IRBBB)检出情况,分析DTW对继发孔型ASD的诊断价值和形成因素,观察不同术式前后心电图的变化。结果:ASD组、非ASD组DTW检出率分别为58.02%(141/243)、5.67%(14/247),DTW合并IRBBB检出率分别为51.85%(126/243)、0.81%(2/247),ASD组均高于非ASD组(χ^(2)=155.263、165.363,P<0.001)。DTW诊断继发孔型ASD的敏感度、特异度和准确度分别为58.02%、94.33%和76.33%,DTW合并IRBBB诊断继发孔型ASD的敏感度、特异度和准确度分别为51.85%、99.19%和75.71%。右心室增大、肺动脉收缩压增高是ASD患者DTW形成的主要影响因素[OR(95%CI)分别为1.095(1.020~1.176)、1.040(1.006~1.075)];术前DTW、IRBBB和DTW合并IRBBB阳性的ASD患者经过外科手术或介入手术治疗6个月后均缓解,缓解程度在两种术式组间的差异无统计学意义(P>0.05)。结论:心电图DTW对成人继发孔型ASD的诊断具有较大指导意义,右心室增大、肺动脉收缩压增高是ASD患者DTW的主要形成因素。Aim:To investigate the diagnostic value of defective T wave(DTW)in secundum atrial septal defect(ASD)in adults and its main influencing factors.Methods:A total of 243 adult secundum ASD patients diagnosed by echocardiogram and 247 adults with normal cardiac structure were involved in the study,and 12-lead electrocardiogram(ECG)was performed on all subjects.The detection rate of DTW and incomplete right bundle branch block(IRBBB)was recorded,and the diagnostic value was analysed;the changes of pre-and post-operative ECG were observed in ASD patients undergoing intervention or surgery.Results:DTW was detected in 141 subjects(58.02%)with ASD and 14 subjects(5.67%)without ASD,and the detection rate of ASD patients was significantly higher than that of non-ASD patients(P<0.001).The detection rate of DTW with IRBBB in ASD patients was significantly higher than that in non-ASD patients(51.85%vs.0.81%,P<0.001).The sensitivity,specificity,and accuracy of DTW for diagnosing secundum ASD were 58.02%,94.33%,and 76.33%,respectively;and those of DTW with IRBBB were 51.85%,99.19%,and 75.71%,respectively.Increased right ventricular diameter and increased pulmonary artery systolic pressure were correlated with the formation of DTW in ASD patients[OR(95%CI):1.095(1.020-1.176),1.040(1.006-1.075)].The follow-up ECG data were recorded in ASD patients with operative treatment at the end of 6 months,and it was found that the improvement had no difference between intervention and surgery subgroups before and after operation(P>0.05).Conclusion:DTW contributes to the diagnosis of secundum ASD in adults;increased right ventricular diameter and pulmonary artery systolic pressure may be the influencing factors for the formation of DTW.

关 键 词：继发孔型房间隔缺损 心电图 Defective T波 诊断试验 

分 类 号：R541.1[医药卫生—心血管疾病]