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Received:August 25, 2019 Published Online:April 20, 2020
Received:August 25, 2019 Published Online:April 20, 2020
中文摘要: 目的 探讨二维超声心动图(2DE)联合心电图(ECG)检查在急性心肌梗死(AMI)患者左前降支病变评估中的应用价值。
方法 选取2016年12月至2018年10月收治的196例AMI患者进行回顾性研究。患者入院后均进行冠状动脉造影（CAG）、ECG及2DE检查。以CAG检查结果为作金标准,将存在左前降支病变者为病变组,非左前降支病变者为对照组,并分析患者ECG检查情况(T波倒置、R波波幅增高及ST段抬高)、2DE检查情况［左心室舒张末期内径(LVDd)、左心室收缩末期内径(LVDs)、左心室后壁厚度(LVPW)、舒张期室间隔厚度(IVSd)、左心室射血分数(LVEF)、左心房内径(LAD)、左心室缩短分数(FS)］及ECG与2DE对AMI左前降支病变单独及联合检测的诊断效能。
结果 CAG检查可知,共64例患者发生左前降支病变(病变组),132例未发生左前降支病变(对照组)。病变组T波倒置、R波波幅增高及ST段抬高大于对照组(P均<0.01);病变组FS、LVDd、LVDs与对照组间无统计学差异(P均>0.05),但LVEF低于对照组,LVPW、IVSd、LAD大于对照组(P均<0.01);ECG及2DE联合检测、ECG单独检测、2DE单独检测对左前降支病变诊断的灵敏度分别为92.19%、64.06%和70.31%,准确度分别为89.80%、80.61%和83.67%,三者差异有统计学意义(P<0.01,P<0.05),均以联合诊断最高;联合检测的诊断特异度(88.64%)与ECG(88.64%)及2DE(90.15%)间无统计学差异(P>0.05)。
结论 联合采用ECG及2DE检测可有效检出AMI患者左前降支病变情况,敏感度与准确度较高,可为临床及早采取防治措施提供客观依据,对改善患者整体疗效与预后效果具有积极意义。
Abstract:Objective To investigate the value of two dimensional echocardiography (2DE) combined with electrocardiogram (ECG) in the evaluation of left anterior descending coronary artery(LAD) lesion in patients with acute myocardial infarction (AMI).
Methods A total of 196 patients with AMI admitted from December 2016 to October 2018 were retrospectively studied.All patients were examined by coronary angiography(CAG),ECG and 2DE.According to the results of CAG as the golden standard,the patients with LAD lesion were taken as the pathological group and those without LAD lesion were taken as the control group.
ECG (T wave inversion,R wave amplitude increase and ST segment elevation),2DE ［left ventricular end-diastolic dimension (LVDd),ventricular end-systolic diameter (LVDs),left ventricular posterior wall thickness (LVPW),interventricular septum thickness in end-diastole(IVSd),left ventricular ejection fraction(LVEF),left atrial dimension(LAD) and fraction shortening (FS)］ were analyzed statistically.The diagnostic efficacy of single detection of ECG or 2DE or combined detection of ECG and 2DE in the detection of LAD lesion in AMI was analyzed.
Results CAG showed that LAD lesion in 64 patients (lesion group),the non-LAD lesion in 132 patients (control group).The T wave inversion,R wave amplitude and ST segment elevation in the lesion group were higher than those in the control group (all P<0.01);
there was no significant difference in FS,LVDd,LVDs between two groups(all P>0.05),but LVEF was lower in lesion group than that that in control group,LVPW,IVSd and LAD were higher in lesion group than that those in control group (all P<0.01).The sensitivity of ECG and 2DE combined detection,ECG single detection and 2DE single detection to the diagnosis of LAD was 92.19%,64.06% and 70.31% respectively,
and the accuracy was 89.80%,80.61% and 83.67%,respectively,so as the combined diagnosis was the highest(P<0.01,P<0.05).There was no significant difference between the diagnostic specificity of combined detection (88.64%) and ECG (88.64%) and 2DE (90.15%) (P>0.05).
Conclusions The combination of ECG and 2DE detection can effectively detect LAD lesions in patients with AMI,which the sensitivity and accuracy are high.It can provide objective basis for early clinical prevention and treatment,and has positive significance for improving the overall efficacy and prognosis of patients.
keywords: Two dimensional echocardiography Electrocardiogram Acute myocardial infarction Left anterior descending artery lesion Diagnostic efficacy Coronary angiography Left ventricular ejection fraction
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