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目的:探讨抬高的ST段(STE)和增大的Tp-e间期在变异型心绞痛(VA)患者中对恶性室性心律失常(MVAE)的预测价值。方法:60例单纯VA患者(无MVAE组)和18例VA合并MVAE的患者(MVAE组)入选本研究。使用t检验、logistic回归分析和受试者工作曲线(ROC)分析ST段抬高时期心电图参数和MVAE(室性心动过速/心室颤动、晕厥和成功复苏的心源性猝死)发生的关系。结果:MVAE组较无MVAE组有更加抬高的STE[(0.72±0.23)mV︰(0.41±0.10)mV,P<0.001],更长的校正的QT间期离散度[cQTd,(49.55±15.40)ms︰(39.98±7.40)ms,P=0.017]、校正的Tp-e间期[cTp-e,(162.07±24.80)ms︰(127.69±12.90)ms,P<0.001],和更大的Tp-e/QT比值[(0.355±0.050)︰(0.297±0.030),P<0.001]。单因素回归分析显示,cQTd(OR=1.117,95%CI:1.013~1.230,P=0.026)、cTp-e间期(OR=1.149,95%CI:1.057~1.248,P=0.001)、Tp-e/QT比值(OR=1.361,95%CI:1.136~1.630,P=0.002)和STE(OR=5.665,95%CI:1.830~17.539,P<0.001)均与MVAE的发作有关。多因素逐步回归分析显示,STE和cTp-ed均可以作为MVAE发生的预测因子。ROC曲线下面积(AUC)cQTd为0.724,cTp-e间期为0.841,Tp-e/QT比值为0.924,STE为0.918。Z检验显示,Tp-e/QT比值的AUC和STE的AUC无显著差异,两者均与cQTd、cTp-e间期的AUC有显著差异(均P<0.05)。相关分析显示,STE分别和cTp-e间期(r=0.658,95%CI:0.527~0.754,P<0.001)、Tp-e/QT比值(r=0.763,95%CI:0.576~0.862,P<0.001)有显著相关性。结论:抬高的ST段和增加的Tp-e间期有关联的电生理机制,并对VA患者的MVAE有独立的预测价值。
Objective: To investigate the predictive value of elevated ventricular ejection fraction (STE) and increased Tp-e interval in patients with variant angina (VA) for malignant ventricular arrhythmia (MVAE). Methods: Sixty patients with simple VA (without MVAE) and 18 with VA combined with MVAE (MVAE) were enrolled in this study. T-test, logistic regression analysis and receiver operating characteristic curve (ROC) were used to analyze the relationship between electrocardiogram parameters of ST segment elevation and occurrence of MVAE (ventricular tachycardia / ventricular fibrillation, syncope and successful sudden cardiac death). Results: Compared with no MVAE group, the MVAE group had more elevated STE [(0.72 ± 0.23) mV: (0.41 ± 0.10) mV, P <0.001] and longer corrected QT interval dispersion [cQTd, (49.55 ± 15.40) ms: (39.98 ± 7.40) ms, P = 0.017], corrected Tp-e interval [cTp-e, (162.07 ± 24.80) ms: (127.69 ± 12.90) ms, P <0.001] Tp-e / QT ratio [(0.355 ± 0.050) :( 0.297 ± 0.030), P <0.001]. Univariate regression analysis showed that there was no significant difference between the cTp-e interval (OR = 1.149, 95% CI: 1.057-1.248, P = 0.001) E / QT ratio (OR = 1.361, 95% CI: 1.136-1.630, P = 0.002) and STE (OR = 5.665,95% CI: 1.830-17.539, P <0.001) were all associated with episodes of MVAE. Multi-factor stepwise regression analysis showed that both STE and cTp-ed could be used as predictors of MVAE. The area under the ROC curve (AUC) cQTd was 0.724, the cTp-e interval was 0.841, the Tp-e / QT ratio was 0.924, and STE was 0.918. The Z test showed that AUC of Tp-e / QT ratio and AUC of STE were not significantly different, both of which were significantly different from that of cQTd and cTp-e AUC (all P <0.05). Correlation analysis showed that the Tp-e / QT ratios (r = 0.763, 95% CI: 0.576-0.862, P <0.05) were significantly different between STE and cTp- <0.001) were significantly correlated. CONCLUSIONS: Elevated ST-segment and increased Tp-e interval have associated electrophysiological mechanisms and are independently predictive of MVAE in VA patients.