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目的探讨心室晚电位对急性冠脉综合征患者预后的预测价值。方法分析2014年6月至2015年12月收治的120例行常规心脏超声检查的ACS患者的临床资料,采用北京麦迪克斯公司生产的MEMRS型心电工作站检测精细状态的患者,经高频平均心电图获取QRS持续时间(f QRSd)、QRS终末40 ms均方根电压值[RMS(40)]、QRS终末低于40μV低振幅波持续时间[LAS(40)]。结果 (1)VLP阳性率:不稳定心绞痛患者为0(0/19),非ST段抬高型心肌梗死患者为5.36%(3/56),ST段抬高型心肌梗死患者为17.78%(8/45),3组的阳性率差异有统计学意义(P<0.05)。(2)VLP预测ACS患者发生MACE的敏感度以及特异度分别为28.1%及92.8%;阳性预测值及阴性预测值分别为39.0%及88.9%,准确度为85.5%。(3)f QRSd、LAS(40)以及RMS(40)阴性预测值均处于较高水平(90%以上),而阳性预测值则相对较低。(4)经多元Logistic回归模型分析,VLP阳性及LAS(40)为预测MACE的独立指标(P均<0.05)。结论心室晚电位对急性冠脉综合征患者的预后具有较高的预测价值。
Objective To investigate the prognostic value of ventricular late potentials in patients with acute coronary syndromes. Methods The clinical data of 120 patients with ACS undergoing routine echocardiography from June 2014 to December 2015 were analyzed. The patients with fine status were detected by the MEMRS-type ECG workstation manufactured by Beijing Medix Co., ECG QRS duration (QRSd), QRS terminal 40 ms root mean square voltage [RMS (40)], QRS terminal below 40 μV low amplitude wave duration [LAS (40)]. Results (1) The positive rate of VLP was 0 (0/19) in patients with unstable angina pectoris, 5.36% (3/56) in patients with non-ST elevation myocardial infarction, and 17.78% in patients with ST segment elevation myocardial infarction 8/45), the positive rate of the three groups was statistically significant (P <0.05). (2) The sensitivity and specificity of VLP predicting MACE in patients with ACS were 28.1% and 92.8% respectively; the positive predictive value and negative predictive value were 39.0% and 88.9%, respectively, with an accuracy of 85.5%. (3) Both f QRSd, LAS (40), and RMS (40) negative predictive values were at a high level (over 90%), while the positive predictive values were relatively low. (4) By multivariate Logistic regression model, VLP positive and LAS (40) were independent predictors of MACE (all P <0.05). Conclusion The ventricular late potential has a high predictive value in the prognosis of patients with acute coronary syndrome.