心电图碎裂QRS波联合超声心动图在老年急性心肌梗死诊断及室性心律失常评估中的应用

Application of ECG fragmentation QRS wave combined with echocardiography in diagnosis of AMI and assessment of ventric-ular arrhythmia in the elderly

中文关键词: 老年  急性心肌梗死  室性心律失常  心电图碎裂QRS波  超声心动图  预测价值

英文关键词: elderly  acute myocardial infarction  ventricular arrhythmia  ECG fragmentation QRS wave  echocardio-graphy  predictive value

中文摘要:

      目的 探讨心电图碎裂QRS波(f QRS)联合超声心动图在老年急性心肌梗死(AMI)的诊断及室性心律失常的评估中的应用.方法 回顾性选取2022年1月—2024年3月广西医科大学附属武鸣医院收治的老年AMI患者100例为观察组,选取同时期因胸痛、胸闷入院但经检查后排除为AMI的患者100例为对照组.2组在入院时均行心电图监测与彩色多普勒超声心动图检查,对比2组心电图指标(fQRS发生情况)值、超声心动图指标[左室射血分数(LVEF)、左室收缩末期内径(LVESD)、左室舒张末期内径(LVEDD)]值,采用受试者工作曲线(receiver operating characteristic,ROC)分析2种检查对老年AMI的诊断效能.6个月后,将观察组按照是否发生室性心律失常分为室性心律失常亚组(41例)与非室性心律失常亚组(59例),对比2组基本资料,以多因素Logistic回归分析老年AMI患者发生室性心律失常的危险因素,以ROC分析心电图指标与超声心动图指标对老年AMI室性心律失常的预测价值.结果 观察组心电图fQRS发生率31.00％高于对照组4.00％,LVEF低于对照组,LVESD、LVEDD高于对照组,差异均具有统计学意义(P＜0.05);fQRS发生情况与超声心动图指标联合诊断老年AMI的曲线下面积(AUC)0.944,高于各指标单一诊断AUC 0.685、0.792、0.794、0.772,联合诊断价值更高;室性心律失常亚组与非室性心律失常亚组性别、年龄、吸烟史、饮酒史、高血压、高血脂、糖尿病、梗死部位占比均无统计学意义(P＞0.05),室性心律失常亚组fQRS占比高于非室性心律失常亚组,LVEF水平低于非室性心律失常亚组,LVESD、LVEDD水平高于非室性心律失常亚组,差异均具有统计学意义(P＜0.05);多因素Logistic回归分析结果显示,高fQRS发生率、高LVESD、高LVEDD及低LVEF为老年AMI患者发生室性心律失常的危险因素(P＜0.05);fQRS、LVEF、LVESD、LVEDD联合预测老年AMI患者发生室性心律失常的AUC值为0.921,高于各指标单一预测值.结论 老年AMI患者心电图fQRS与超声心动图指标呈异常表达,二者联合用于老年AMI的诊断以及室性心律失常具有一定的预测价值.

英文摘要:

      Objective To investigate the application of electrocardiographic fragmented QRS(fQRS)combined with echocardiography in the diagnosis of acute myocardial infarction(AMI)and the assessment of ventricular arrhythmias in elderly patients.Methods 100 elderly AMI patients admitted to Wuming Hospital Affiliated to Guangxi Medical University from Jan-uary 2022 to March 2024 were retrospectively selected as the observation group.Another 100 patients who were admitted to the hospital due to chest pain and chest tightness during the same period but were ruled out for AMI after examination were selected as the control group.All underwent ECG monitoring and color Doppler echocardiography at admission.ECG index(fQRS oc-currence)and echocardiography indexes[left ventricular ejection fraction(LVEF),left ventricular end-systolic diameter(LVESD),left ventricular end-diastolic diameter(LVEDD)]were compared between the two groups.The receiver operating characteristic(ROC)was used to analyze the diagnostic efficacy of the two examinations for AMI in elderly patients.6 months later,patients in the observation group were divided into arrhythmia subgroup(41 cases)and non-arrhythmia subgroup(59 ca-ses)according to presence or absence of ventricular arrhythmia.The basic data were compared between the two subgroups.Multivariate Logistic regression analysis was performed to identify risk factors for ventricular arrhythmias in elderly AMI pa-tients.ROC analysis assessed the predictive value of ECG and echocardiographic indicators for ventricular arrhythmias.Results The incidence of ECG fQRS in the observation group was higher than that in the control group(31.00％vs 4.00％),LVEF was lower than that in the control group,while LVESD and LVEDD were higher than those in the control group(P＜0.05).The area under the curve(AUC)of the combined diagnosis of fQRS occurrence and echocardiographic indicators for AMI in elderly patients was 0.944,which was higher than the AUC of single diagnosis of each indicator(0.685,0.792,0.794,0.772),and the combined diagnostic value was higher.There were no statistically significant differences in gender,age,smoking history,drinking history,hypertension,hyperlipidemia,diabetes,and the proportion of infarction site between the ventricular arrhythmia subgroup and the non-ventricular arrhythmia subgroup(P＞0.05).The incidence of fQRS in the ar-rhythmia subgroup was higher than that in the non-arrhythmia subgroup,LVEF was lower than that in the non-arrhythmia sub-group,LVESD and LVEDD were higher than those in the non-arrhythmia subgroup(P＜0.05).The results of multivariate lo-gistic regression analysis showed that high incidence of fQRS,LVESD,LVEDD,and low LVEF were risk factors for ventricu-lar arrhythmia in elderly AMI patients(P＜0.05).The AUC value of fQRS,LVEF,LVESD,and LVEDD combined in pre-dicting ventricular arrhythmia in elderly AMI patients was 0.921,which was higher than the single prediction value of each in-dicator.Conclusion The ECG fQRS and echocardiographic indicators of elderly AMI patients show abnormal manifestations,and their combined detection has certain value in the diagnosis of AMI and prediction of ventricular arrhythmia in elderly patients.