The analysis of coronary angiography results in patients with ST-segment depression during paroxysmal supraventricular tachycardia episodes
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摘要:
目的 探讨阵发性室上性心动过速(PSVT)发作时ST段压低患者冠状动脉造影结果的影响因素及与ST段压低形态的关系。 方法 选取PSVT发作时伴ST段压低,且已行腔内电生理检查及冠状动脉造影术的患者74 例,根据冠状动脉造影结果分为造影阴性组(n=47)与造影阳性组(n=27)。比较两组患者临床资料、血液生化指标、PSVT类型、10年动脉粥样硬化性心血管疾病(ASCVD)风险及ST段压低形态,分析冠状动脉造影结果的影响因素。 结果 与冠状动脉造影阴性组相比较,造影阳性组患者年龄更大(63±10 vs. 55.2±9)岁, P<0.01,合并高血压的比例更高(48 % vs. 15 %),P<0.01,出现胸闷/胸痛症状的比例更高(96 % vs. 66 %), P<0.05,但出现心悸症状的比例显著降低(82 % vs. 98 %), P<0.05,而10年ASCVD风险显著增高(P<0.01)。两组患者ST段压低形态无显著差异。单因素分析中,年龄、心悸症状、胸闷/胸痛症状、高血压、10年ASCVD风险对冠状动脉造影结果有影响。多因素Logistic回归分析表明胸闷/胸痛症状(OR=11.437, 95%CI 1.315~99.488, P<0.05)、10年ASCVD风险(OR=2.570, 95%CI 1.205~5.481, P<0.05)是冠状动脉造影结果的独立影响因素。 结论 PSVT发作时ST段压低形态对冠状动脉造影结果无显著预测价值。10年ASCVD风险越高,且伴有胸闷/胸痛症状的患者,对冠状动脉造影可能有一定预测价值。 -
关键词:
- 阵发性室上性心动过速 /
- ST段压低形态 /
- 危险因素 /
- 症状 /
- 冠状动脉造影
Abstract:AIM To investigate the influencing factors of coronary angiography results in patients with ST-segment depression during paroxysmal supraventricular tachycardia (PSVT) episodes, and its relationship with ST-segment depression types. METHODS 74 patients with ST segment depression during the onset of PSVT and who had undergone intracavitary electrophysiological examination and coronary angiography were selected. According to the results of coronary angiography, they were divided into negative angiography group (n=47) and positive angiography group (n=27). The clinical data, blood biochemical indexes, PSVT type, 10-year risk of atherosclerotic cardiovascular disease (ASCVD) and ST segment depression type were compared between the two groups, and the influencing factors of coronary angiography results were analyzed. RESULTS Compared with the negative group of coronary angiography, the patients in the positive group were older (63 ± 10 vs. 55.2 ± 9, P<0.01), and the proportion of hypertension was higher (48% vs. 15%, P<0.01). The incidence of chest tightness and chest pain was higher (96% vs. 66%, P<0.05), but the incidence of palpitation was significantly lower (82% vs. 98%, P<0.05), and the 10-year risk of ASCVD was significantly higher (P<0.01). There was no significant difference in ST segment depression between the two groups. In univariate analysis, age, palpitation symptoms, chest tightness/chest pain symptoms, hypertension and 10-year ASCVD risk had an impact on the results of coronary angiography. Logistic regression analysis showed that chest tightness/chest pain symptoms (OR=11.437, 95% CI 1.315~99.488, P<0.05) and 10-year ASCVD risk (OR=2.570, 95% CI 1.205~5.481, P<0.05) were independent influencing factors of coronary angiography results. CONCLUSION The shape of ST segment depression during the onset of PSVT has no significant predictive value for the results of coronary angiography. The higher the risk of ASCVD in 10 years, and the patients with chest tightness/chest pain symptoms may have a certain predictive value for coronary angiography. -
表 1 冠状动脉造影阳性患者相关因素的单因素分析
项目 造影阴性组
(n=47)造影阳性组
(n=27)男性 24(51) 16(59) 年龄(岁) 55±9 63±10 b 症状 心悸 46(98) 22(82)a 头晕 13(28) 11(41) 胸闷/胸痛 31(66) 26(96)a 呼吸困难 13(28) 12(44) 吸烟 10(21) 10(37) 高血压 7(15) 13(48)b 糖尿病 4(8) 3(11) 胆固醇(mmol/L) 4.2±1.0 3.9±1.1 HDL-C(mmol/L) 1.1±0.3 1.0±0.3 LDL-C(mmol/L) 2.5±0.8 2.5±0.9 肌酐(μmol/L) 54±12 59±17 血钾(mmol/L) 3.9±0.4 4.0±0.2 NT-proBNP(pg/mL) 91(46, 209) 138(84, 272) hs-TNT(ng/mL) 0.007(0.005, 0.013) 0.009(0.004, 0.220) h-TSH(μIU/mL) 1.6(1.1, 2.4) 1.7(1.0, 3.0) PSVT心率(bpm) 183±25 176±22 PSVT类型 AVRT 16(34) 8(30) AVNRT 31(66) 19(70) 10年ASCVD风险 低危 36(77) 10(37)b 中危 6(13) 10(37)b 高危 5(11) 7(26)b V3-V6导联ST段形态 水平型压低 35(74) 15(56) 上斜型压低 7(15) 7(26) 下斜型压低 5(11) 5(18) Ⅱ、Ⅲ、aVF导联ST段形态 水平型压低 22(47) 10(37) 上斜型压低 5(11) 7(26) 下斜型压低 20(43) 10(37) 表中计数资料均为[例数(%)]。与造影阴性组相比,aP<0.05, bP<0.01 表 2 单因素Logistic回归分析冠状动脉造影结果的影响因素
因素 β值 Wald OR值 95%CI P值 男性 −0.332 0.462 0.717 0.275-1.869 0.496 年龄 0.092 9.448 1.096 1.034-1.162 0.002 心悸 −2.347 4.347 0.096 0.011-0.869 0.037 胸闷/胸痛 2.597 5.95 13.419 1.666-108.108 0.015 吸烟 0.778 2.116 2.176 0.763-6.207 0.146 高血压 1.669 8.808 5.306 1.762-15.975 0.003 糖尿病 0.295 0.135 1.344 0.277-6.511 0.714 LDL-C −0.056 0.037 0.946 0.533-1.679 0.848 肌酐 0.027 2.341 1.027 0.992-1.063 0.126 NT-proBNP 0.000 0.003 1.000 0.999-1.001 0.958 PSVT心率 −0.013 1.460 0.987 0.967-1.008 0.227 PSVT类型 −0.204 0.152 0.816 0.293-2.269 0.696 10年ASCVD风险 0.966 8.135 2.628 1.353-5.104 0.004 V3-V6导联ST段形态 0.503 2.298 0.130 0.863-3.166 0.130 Ⅱ、Ⅲ、aVF 导
联ST段形态0.051 0.037 1.052 0.627-1.765 0.847 表 3 多因素Logistic回归分析冠状动脉造影结果的影响因素
因素 β值 Wald OR值 95%CI P值 心悸 −1.847 2.415 0.12 0.015-1.62 0.120 胸闷/胸痛 2.437 4.875 11.437 1.315-99.488 0.027 10年ASCVD风险 0.944 5.969 2.570 1.205-5.481 0.015 -
[1] 中华医学会, 中华医学会杂志社, 中华医学会全科医学分会, 等. 室上性心动过速基层诊疗指南(2019年)[J]. 中华全科医师杂志, 2020, 19(8): 667 – 671. doi: 10.3760/cma.j.cn114798-20200518-00588 [2] Habash F, Albashaireh A, Madmani ME, et al. ST segment elevation and depressions in supraventricular tachycardia without coronary artery disease[J]. Case Rep Cardiol, 2018, 2018: 2716312. doi: 10.1155/2018/2716312 [3] Dorenkamp M, Zabel M, Sticherling C. Role of coronary angiography before radiofrequency ablation in patients presenting with paroxysmal supraventricular tachycardia[J]. J Cardiovasc Pharmacol Ther, 2007, 12(2): 137 – 144. doi: 10.1177/1074248407300775 [4] Bukkapatnam RN, Robinson M, Turnipseed S, et al. Relationship of myocardial ischemia and injury to coronary artery disease in patients with supraventricular tachycardia[J]. Am J Cardiol, 2010, 106(3): 374 – 377. doi: 10.1016/j.amjcard.2010.03.035 [5] Riva SI, Della Bella P, Fassini G, et al. Value of analysis of ST segment changes during tachycardia in determining type of narrow QRS complex tachycardia[J]. J Am Coll Cardiol, 1996, 27(6): 1480 – 1485. doi: 10.1016/0735-1097(96)00013-7 [6] Erdinler I, Okmen E, Oguz E, et al. Differentiation of narrow QRS complex tachycardia types using the 12-lead electrocardiogram[J]. Ann Noninvasive Electrocardiol, 2002, 7(2): 120 – 126. doi: 10.1111/j.1542-474X.2002.tb00152.x [7] Nelson SD, Kou WH, Annesley T, et al. Significance of ST segment depression during paroxysmal supraventricular tachycardia[J]. J Am Coll Cardiol, 1988, 12(2): 383 – 387. doi: 10.1016/0735-1097(88)90410-X [8] 中华医学会心血管病学分会, 中国康复医学会心脏预防与康复专业委员会, 中国老年学和老年医学会心脏专业委员会, 等. 中国心血管病一级预防指南[J]. 中华心血管病杂志, 2020, 48(12): 1000 – 1038. doi: 10.3760/cma.j.cn112148-20201009-00796 [9] 李 芳, 罗玉寅, 沈 艳, 等. 窄QRS波群室上性心动过速时ST-T改变的临床意义[J]. 心电学杂志, 2005, 24(4): 201 – 203. doi: 10.3969/j.issn.1002-1094.2005.04.003 [10] Petsas AA, Anastassiades LC, Antonopoulos AG. Exercise testing for assessment of the significance of ST segment depression observed during episodes of paroxysmal supraventricular tachycardia[J]. Eur Heart J, 1990, 11(11): 974 – 979. doi: 10.1093/oxfordjournals.eurheartj.a059637 [11] Gulec S, Ertas F, Karaoouz R, et al. Value of ST-segment depression during paroxysmal supraventricular tachycardia in the diagnosis of coronary artery disease[J]. Am J Cardiol, 1999, 83(3): 458 – 460. [12] 周纪宁, 左 进, 王 芳, 等. 室上性心动过速时缺血型ST段下移与冠心病的关系[J]. 中国心脏起搏与心电生理杂志, 2009, 23(3): 279. doi: 10.13333/j.cnki.cjcpe.2009.03.032 -

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