摘要
目的:分析无陈旧性心肌梗死患者运动诱发的ST段抬高现象,比较ST段抬高和继发室性心动过速、心肌梗死的关系,找出预警指标。方法:对9 900例疑似冠心病者行平板运动试验检查,阳性人数3 002例。同时检出ST段抬高者29例,并对其行冠状动脉造影检查,比较ST抬高程度、冠状动脉狭窄、T波顶峰后宽度(TaTe)、T波顶峰后宽度/QT间期(TaTe/QT)、QT离散度(QTd)、修正的QT离散度(QTcd)、室性期前收缩(RONT,室早)和症状之间存在的内在联系。结果:发现9 900例检查者中阳性率30.32%;ST段抬高发生率为0.29%。4例并发心肌梗死,5例并发室性心动过速。同时发现,ST段抬高程度、形态、冠状动脉狭窄、伴发的室性心动过速、心肌梗死、TaTe、TaTe/QT、QTd、QTcd、RONT及症状之间存在正向关系,室性心动过速时TaTe/QT与无心律失常组比较差异有统计学意义(P<0.001)。结论:无心肌梗死者运动诱发心电图ST段抬高,提示冠状动脉存在严重固定狭窄或/并痉挛,并与心肌梗死、室性心动过速有并行关系,尤其TaTe/QT比值,是最有预警可能发生室速的重要价值。
Objective：To analyze the correlation between exercise-induced ST-segment elevation,secondary ventricular arrhythmia and myocardial infarction（MI） in patients with no previous MI history,and to further identify early warning indicators.Methods： Nine thousand nine hundred suspected coronary heart disease（CHD） patients who were examined with exercise treadmill test（ETT） in our hospital between January 2002 and October 2010 were reviewed.ETT was carried out in Bruce protocol with submaximal exercise,and ST-segment depression of at least 0.1mV for 0.08 second after the J point（ST-segment standard） was set positive.positive rate is 30.32%.Among all the patients,twenty nine cases were found with positive exercise-induced ST elevation.The features of elevated ST-segment were analyzed in relation to the extent of coronary artery stenosis.Coronary angiography（CAG） was examined in all the twenty nine cases of exercise-induced ST-segment elevated patients,and intrinsic correlations between coronary artery stenosis,secondary ventricular arrhythmia,MI and clinical manifestation were studied.In addition,parameters including T apex-T end interval（TaTe interval）,TaTe/QT,QTd and QTcd were analyzed in association with the complications.Results： The exercise-induced ST elevation incidence is 0.29% for a total of 9,900 people who examined with the exercise treadmill test.Of those twenty nine ST elevated subjects—mostly male,aging between forty and sixty—twenty five cases were identified with 50%-99% coronary artery stenosis in the CAG,twenty three had ST-segment reverted back to normal baseline after immediate termination of the ETT,five cases were concurrent with ventricular tachycardia（VT）,and four with subsequent MI.Patents with either VT or MI all showed 0.20mV or greater horizontal ST elevation in ECG monitoring.The level of ST-segment elevation is positively associated with coronary artery stenosis,and patients with shorter duration of exercise before ST-segment elevation were found with se
出处
《心肺血管病杂志》
CAS
2011年第6期502-505,共4页
Journal of Cardiovascular and Pulmonary Diseases
