| 64 | 0 | 207 |
| 下载次数 | 被引频次 | 阅读次数 |
目的 探讨单导联心电图识别急性冠脉综合征(ACS)患者长QTc间期心电图的可行性及规律，为便携式心电图设备开发相应功能提供理论依据。方法 本研究回顾性分析了自2020年7月至2022年1月就诊于吉林大学中日联谊医院，临床诊断为ACS的674例患者的临床资料。统计分析了便携式心电图设备所能获取的双极导联心电图(Ⅰ、Ⅱ、Ⅲ导联)以及常规心电图中9个单极导联(V1-V6、aVR、aVL、aVF导联)心电图长QTc间期发生的规律，验证单一双极导联(Ⅰ、Ⅱ、Ⅲ导联)及常规单极导联在急性ST段抬高型心肌梗死(STEMI)、急性非ST段抬高型心肌梗死(NSTEMI)、不稳定性心绞痛(UA)患者识别长QTc间期时的实用价值。结果 在ACS患者中，单一双极导联Ⅰ、Ⅱ、Ⅲ导联在12导联心电图中出现最长QTc间期的概率分别为3.9%、4.6%、4.5%,显著低于各胸前单级导联(校正P值<0.0083)。胸前单级导联V2、V3、V4导联出现最长QTc间期的概率分别为24.2%、19.2%、14.1%,显著高于肢体双导联Ⅰ、Ⅱ、Ⅲ(校正P值<0.0167)。在STEMI组、NSTEMI组、UA组的患者中，异常长QTc间期(QTc>440 ms)更多发生在胸前导联，其中概率最大的导联分别为V2、V3、V4导联，与双极导联(Ⅰ、Ⅱ、Ⅲ导联)相比，差异有统计学意义(校正P值<0.0167)。结论 在ACS患者中，单一双极导联(Ⅰ、Ⅱ、Ⅲ导联)准确识别长QTc间期的价值具有局限性；胸前V2、V3导联识别长QTc间期的价值更高。
Abstract：Objective To explore the feasibility and patterns of identifying the QTc intervals in patients with acute coronary syndrome(ACS) using single lead ECGs, in order to provide a theoretical basis for the development of portable ECG devices.Methods Clinical data of 674 patients diagnosed with ACS in China-Japan union hospital from July 2020 to January 2022 were retrospectively analyzed.The long QTc interval occurrence was statistically analyzed in the bipolar leads(Ⅰ,Ⅱ,Ⅲ leads) of portable ECG devices and 9 unipolar leads(V1-V6,aVR,aVL,aVF leads) in regular ECGs.The value of single bipolar leads(Ⅰ,Ⅱ,Ⅲ leads) and conventional unipolar leads in identifying the long QTc interval in patients with acute ST-segment elevation myocardial infarction(STEMI),acute non-ST-segment elevation myocardial infarction(NSTEMI),and unstable angina(UA) patients was validated.Results In ACS patients, the occurrence rate of the longest QTc interval in Ⅰ,Ⅱ,and Ⅲ leads were 3.9%,4.6%,and 4.5%,significantly less than those of the regular precordial unipolar leads(adjusted P-value<0.0083).The incidence rate of the longest QTc interval in leads V2,V3,and V4 leads were 24.2%,19.2%,and 14.1%,significantly higher than those in Ⅰ,Ⅱ,and Ⅲ leads(adjusted P-value<0.0167).In patients with STEMI,NSTEMI,and UA,precordial leads had a statistically greater probability of the longest QTc interval(QTc>440ms) occurrence, especially in lead V2,V3,V4,compared to bipolar leads(Ⅰ,Ⅱ,Ⅲ leads)(adjusted P-value<0.0167).Conclusion The value of accurately identifying prolonged QTc intervals using single bipolar leads(Ⅰ,Ⅱ,Ⅲ leads) is limited in ACS patients.The precordial leads V2,V3 have a further value in identifying the long QTc interval.
[1]国家心血管病中心，中国心血管健康与疾病报告编写组.中国心血管健康与疾病报告2024概要[J].中国循环杂志，2025,40(6):521-559.NATIONAL CENTER FOR CARDIOVASCULAR DISEASES,WRITING GROUP OF REPORT ON CARDIOVASCULAR HEALTH AND DISEASES IN CHINA.Report on cardiovascular health and diseases in China 2024:an updated summary[J].Chin Circ J,2025,40(6):521-559.
[2]ZEPPENFELD K,TFELT-HANSEN J,DE RIVA M,et al.2022 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death[J].European Heart Journal,2022,43(40):3997-4126.
[3]DAY J W,FINKEL R S,CHIRIBOGA C A,et al.Onasemnogene abeparvovec gene therapy for symptomatic infantile-onset spinal muscular atrophy in patients with two copies of SMN2(STR1VE):an open-label,single-arm,multicentre,phase 3 trial[J].The Lancet Neurology,2021,20(4):284-293.
[4]HUANG S,ZHAO T,LIU C,et al.Portable device improves the detection of atrial fibrillation after ablation[J].Int Heart J,2021,62(4):786-791.
[5]OLFF M,HEIN I,AMSTADTER A B,et al.The impact of trauma and how to intervene:a narrative review of psychotraumatology over the past 15 years[J].European Journal of Psychotraumatology,2025,16(1):2458406.
[6]SCHMIDT A,BALITZKI J,GRMACA L,et al.“Digital biomarkers” in preclinical heart failure models-a further step towards improved translational research[J].Heart Failure Reviews,2023,28(1):249-260.
[7]SANDERS D J,WASSERLAUF J.Holding still for AF ablation[J].Journal of cardiovascular electrophysiology,2022,33(8):1723-1724.
[8]张新超，于学忠，陈凤英，等.急性冠脉综合征急诊快速诊治指南(2019)[J].临床急诊杂志，2019,20(4):253-262.ZHANG X C,YU X Z,CHEN F Y,et al.Guidelines for the rapid diagnosis and treatment of acute coronary syndrome in emergency department (2019)[J].J Clin Emerg,2019,20(4):253-262.
[9]许原，杨钧国.准确测量QT间期的方法[J].心电图杂志(电子版),2014,3(1):52-53.XU Y,YANG J G.Methods for accurate measurement of QT interval[J].J Electrocardiol (Electron Ed),2014,3(1):52-53.
[10]LIN J F,HSU S Y,WU S,et al.QT interval independently predicts mortality and heart failure in patients with ST-elevation myocardial infarction[J].Int J Med Sci,2015,12(12):968-973.
[11]TSE M K,WONG Y H.Neuronal functions of activators of G protein signaling[J].Neuro-Signals,2013,21(3-4):259-271.
[12]GARCIA-AGUILAR J,WILLIAMS H,FOKAS E,et al.Reply to the Letter to the Editor by Perez et al.regarding “Survival among patients treated with total mesorectal excision or selective watch-and-wait after total neoadjuvant therapy:a pooled analysis of the CAO/ARO/AIO-12 and OPRA randomized phase II trials”[J].Annals of Oncology,2025,36(6):705-706.
[13]ZABALLOS M,FERNáNDEZ I,RODRíGUEZ L,et al.Feasibility of using KardiaMobile-L6 for QT interval monitoring during the early phase of the COVID-19 pandemic in critical care patients[J].Sci Rep,2023,13(1):10985.
[14]GONZáLEZ N T,ACOSTA L á,MIRANDA D V,et al.QT interval measurement with portable device during COVID-19 outbreak[J].International journal of cardiology.Heart & Vasculature,2020(30):100644.
[15]MINGUITO-CARAZO C,ECHARTE-MORALES J,BENITO-GONZáLEZ T,et al.QT interval monitoring with handheld heart rhythm ECG device in COVID-19 patients[J].Global heart,2021,16(1):42.
[16]SPACCAROTELLA C A M,POLIMENI A,MIGLIARINO S,et al.Multichannel electrocardiograms obtained by a smartwatch for the diagnosis of ST-segment changes[J].JAMA Cardiol,2020,5(10):1176-1180.
基本信息:
中图分类号:R540.41;R541.4
引用信息:
[1]葛晓瑜,唐文娟,王婷,等.简化导联心电图快速识别急性冠脉综合征长QTc间期的应用价值评价[J].中国实验诊断学,2025,29(12):1382-1387.
基金信息:
吉林省卫生科研人才专项项目资助(2019SCZ024;2020SCZ14)
2025-12-24
2025-12-24