二维超声心动图及心电图对STEMI患者梗死相关冠状动脉的预测价值
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摘要
目的:探讨二维超声心动图(2DE)、心电图(ECG)对急性ST段抬高型心肌梗死(STEMI)患者的梗死相关冠状动脉(IRCA)的预测价值。方法:回顾性分析483例STEMI患者的2DE、ECG及冠状动脉造影(CAG)结果,根据2DE及ECG结果预测IRCA,并与CAG结果对比,分别计算两种方法单独及联合预测的敏感度、特异度、准确度、阳性预测值、阴性预测值。结果:对于左前降支(LAD)病变,2DE的敏感度、特异度、准确度、阳性预测值、阴性预测值分别为88.83%、33.58%、73.50%、77.69%、53.57%,ECG分别为75.65%、86.57%、78.67%、93.62%、57.71%,联合预测分别为94.56%、31.14%、77.02%、78.20%、68.85%。对于左回旋支(LCX)病变,2DE的敏感度、特异度、准确度、阳性预测值、阴性预测值分别为18.67%、88.29%、66.67%、41.79%、70.67%,ECG分别为3.33%、96.40%、67.49%、29.41%、68.88%,联合预测分别为19.33%、86.49%、65.63%、39.19%、70.42%。对于右冠状动脉(RCA)病变,2DE、ECG、CAG间差异均无统计学意义(P>0.05)。结论:2DE、ECG对STEMI患者的IRCA有一定的预测价值。
Objective: To investigate the predictive value of two-dimensional echocardiography(2DE) and electrocardiography(ECG) for infarct-related coronary artery in patients with acute ST segment elevation myocardial infarction. Methods: 2DE, ECG and coronary arteriongraphy(CAG) results of 483 STEMI patients were retrospective analyzed, IRCA was predicted based on 2DE and ECG results and compared with CAG, and calculated the sensitivity, specificity, accuracy, positive predictive value(PPV) and negative predictive value(NPV) of single and combination prediction of the two methods. Results: For LAD, the sensitivity, specificity, accuracy, PPV and NPV of 2DE were 88.83%, 33.58%, 73.50%, 77.69%, 53.57%,while ECG were 75.65%, 86.57%, 78.67%, 93.62%, 57.71%, their combination were 94.56%, 31.14%, 77.02%, 78.20%, 68.85%. For LCX, the sensitivity, specificity, accuracy, PPV and NPV of 2DE were 18.67%, 88.29%, 66.67%, 41.79%, 70.67%, while ECG were 3.33%, 96.40%, 67.49%,29.41%, 68.88%, their combination were 19.33%, 86.49%, 65.63%, 39.19%, 70.42%. For RCA, there was no statistical difference among 2DE, ECG and CAG(P>0.05). Conclusion: 2DE and ECG have certain predictive value for IRCA in STEMI patients.
Objective: To investigate the predictive value of two-dimensional echocardiography(2DE) and electrocardiography(ECG) for infarct-related coronary artery in patients with acute ST segment elevation myocardial infarction. Methods: 2DE, ECG and coronary arteriongraphy(CAG) results of 483 STEMI patients were retrospective analyzed, IRCA was predicted based on 2DE and ECG results and compared with CAG, and calculated the sensitivity, specificity, accuracy, positive predictive value(PPV) and negative predictive value(NPV) of single and combination prediction of the two methods. Results: For LAD, the sensitivity, specificity, accuracy, PPV and NPV of 2DE were 88.83%, 33.58%, 73.50%, 77.69%, 53.57%,while ECG were 75.65%, 86.57%, 78.67%, 93.62%, 57.71%, their combination were 94.56%, 31.14%, 77.02%, 78.20%, 68.85%. For LCX, the sensitivity, specificity, accuracy, PPV and NPV of 2DE were 18.67%, 88.29%, 66.67%, 41.79%, 70.67%, while ECG were 3.33%, 96.40%, 67.49%,29.41%, 68.88%, their combination were 19.33%, 86.49%, 65.63%, 39.19%, 70.42%. For RCA, there was no statistical difference among 2DE, ECG and CAG(P>0.05). Conclusion: 2DE and ECG have certain predictive value for IRCA in STEMI patients.
引文
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[2]刘艳,李志樑.心电图与二维超声心动图联合检测对急性心肌梗死左前降支病变部位的预测作用[J].中西医结合心脑血管病杂志,2016,14(24):2962-2964.
[3]Alpert JS,Thygesen K,Antman E,et al.Myocardial infarction redefined--a consensus document of The Joint European Society of Cardiology/American College of Cardiology Committee for the redefinition of myocardial infarction[J].J Am Coll Cardiol,2000,36(3):959-969.
[4]赵松青,杨俊华.二维超声心动图与心电图推测急性心肌梗死左回旋支与右冠状动脉的对比研究[J].山东医药,2009,49(49):46-47.
[5]陈永洪,杨俊华.二维超声心动图与心电图在急性心肌梗死左前降支病变部位判定的应用比较[J].实用临床医学,2006,7(9):25-26.
[6]姜洋,李兆奇.多普勒彩色超声心动图在急性心肌梗死诊断中的应用分析[J].中国实用医药,2015,(13):120-121.
[7]付建莉,沈亚梅,张小用,等.多普勒彩色超声心动图检测在急性心肌梗死诊断中的应用研究[J].河北医学,2016,22(11):1797-1799.
[8]Zagatina A,Zhuravskaya N,Egom E,et al.A novel method for left anterior coronary artery flow velocity assessment by transthoracic echocardiography at the peak of a supine bicycle test[J].Acta Radiol,2016,57(9):1056-1065.
[9]Chen ZW,Yu ZQ,Yang HB,et al.Rapid predictors for the occurrence of reduced left ventricular ejection fraction between LADand non-LAD related ST-elevation myocardial infarction[J].BMCCardiovasc Disord,2016,16:3.
[10]Pourafkari L,Nader ND,Heydari N,et al.The prognostic value of a prominent Q wave in lead(-)aVR in acute anterior wall myocardial infarction[J].Turk Kardiyol Dern Ars,2015,43(6):520-528.
[11]吴英,林中园,干青晖,等.心电图、心肌标志物与超声心动图在急性心肌梗死早期诊断中的临床应用研究[C].//《中华急诊医学杂志》第十三届组稿会暨第六届急诊医学青年论坛论文集,2014:90-93.
[12]Tamura A,Kataoka H,Mikuriya Y,et al.Inferior ST segment depression as a useful marker for identifying proximal left anterior descending artery occlusion during acute anterior myocardial infarction[J].Eur Heart J,1995,16(12):1795-1799.
[13]Kosuge M,Kimura K,Ishikawa T,et al.Electrocardiographic criteria for predicting total occlusion of the proximal left anterior descending coronary artery in anterior wall acute myocardial infarction[J].Clin Cardiol,2001,24(1):33-38.