平板运动试验Tpe、MTWA、ST/HR斜率、ST/HR指数对冠心病PCI术后主要心脏不良事件的预测ROC分析  

ROC analysis of treadmill exercise test Tpe, MTWA, ST/HR slope, ST/HR index for predicting major adverse cardiac events after coronary heart disease PCI

作　　者：王高超 WANG Gaochao(Changzhou Hospital of Traditional Chinese Medicine,Changzhou Jiangsu 213000,China)

机构地区：[1]常州市中医院,江苏常州213000

出　　处：《中国急救复苏与灾害医学杂志》2022年第10期1278-1281,共4页China Journal of Emergency Resuscitation and Disaster Medicine

基　　金：江苏省优势学科建设工程项目(编号:YSHL0813-19)。

摘　　要：目的探究平板运动试验T波峰末间期(Tpe)、微伏级T波电交替(MTWA)、ST/心率(HR)斜率、ST/HR指数对冠心病经皮冠状动脉介入(PCI)术后主要心脏不良事件(MACE)的预测价值。方法选取常州市中医院2017年1月—2020年12月冠心病患者134例作为研究对象,入院后均行平板运动试验,并采取PCI术治疗,根据术后6个月是否发生MACE分为发生心脏不良事件组(25例)与未发生心脏不良事件组(109例)。结果发生心脏不良事件组Tpe、MTWA、ST/HR斜率、ST/HR指数高于未发生心脏不良事件组(P<0.05);Tpe、MTWA、ST/HR斜率、ST/HR指数随心功能分级、冠脉狭窄程度增加呈不断升高趋势(P<0.05);Tpe、MTWA、ST/HR斜率、ST/HR指数与心功能分级、冠脉狭窄程度呈正相关(P<0.05);Logistic回归分析,Tpe、MTWA、ST/HR斜率、ST/HR指数与冠心病PCI术后MACE独立相关(P<0.05);将Tpe、MTWA、ST/HR斜率、ST/HR指数进行Logistic二元回归拟合,返回预测概率logit(p)作为独立检验变量,绘制受试者工作特征(ROC)曲线,获取联合预测的曲线下面积AUC为0.930,95%CI为0.876~0.983,敏感度为88.00%,特异度为85.32%,明显高于各指标单独预测。结论平板运动试验Tpe、MTWA、ST/HR斜率、ST/HR指数与冠心病心功能分级、冠脉狭窄程度显著相关,联合预测PCI术后MACE价值较为可靠,可作为临床及早预测MACE的潜在途径。ObjectiveTo explore the effects of treadmill exercise test T wave end interval(Tpe),microvolt T wave electrical alternation(MTWA),ST/heart rate(HR)slope,ST/HR index on percutaneous coronary intervention(PCI)in coronary heart disease,the predictive value of postoperative major adverse cardiac events(MACE).MethodsA total of134 patients with coronary heart disease in our hospital from January 2017 to December 2020 were selected as the research subjects.After admission,they all underwent treadmill exercise test and PCI.Event group(25 cases)and no adverse cardiac event group(109 cases).ResultsTpe,MTWA,ST/HR slope and ST/HR index in the group with adverse cardiac events were higher than those in the group without adverse cardiac events(P<0.05).The degree of coronary stenosis increased continuously(P<0.05);Tpe,MTWA,ST/HR slope,ST/HR index were positively correlated with cardiac function classification and coronary stenosis degree(P<0.05);Logistic regression analysis,Tpe,MTWA,ST/HR slope and ST/HR index were independently correlated with MACE after PCI for coronary heart disease(P<0.05).Return the predicted probability logit(p)as an independent test variable,draw the receiver operating characteristic(ROC)curve,and obtain the joint prediction area under the curve AUC of 0.930,95%CI of 0.876 to0.983,sensitivity of 88.00%,and specificity of 85.32%,which was significantly higher than the individual forecasts of each indicator.ConclusionTpe,MTWA,ST/HR slope,ST/HR index of treadmill exercise test are significantly correlated with coronary heart disease classification and coronary stenosis.The combined prediction of MACE after PCI is more reliable and can be used as a potential approach for early clinical prediction of MACE.

关 键 词：冠心病 平板运动试验 经皮冠状动脉介入术 主要心脏不良事件 预测价值 

分 类 号：R541.4[医药卫生—心血管疾病]