心电图T波异常在冠心病诊断中的临床价值

目的通过对心电图T波异常的可疑冠心病患者的冠状动脉造影结果的分析,探讨心电图T波异常对冠心病的诊断价值。方法回顾性收集2010～2011年486例心电图T波异常住院患者的临床资料及检查资料,根据冠状动脉造影结果分为阳性组（104例）和阴性组（382例）。比较两组性别、年龄、体重指数、心率、收缩压、舒张压和是否抽烟。分析各因素对冠状动脉造影结果的影响。结果 （1）造影阳性者104例,阳性率为21.4%。（2）T波异常时,男性较女性患者冠状动脉造影阳性率高（27.0%vs15.9%）,特异性62.5%,敏感性53.9%。（3）T波异常时,心率偏慢的患者冠状动脉造影阳性率高（27.9%/17.6%）,特异性48.1%,敏感性66.2%。（4）联合性别和心率对冠状动脉造影阳性预测敏感性27.9%,特异性83.5%。结论单独心电图T波异常对冠心病诊断的敏感性低,但联合性别和心率可以提高对冠心病诊断的特异性,有助于临床初步筛选冠心病。

Clinical value of T wave on resting electrocardiogram in the diagnosis of coronary heart disease

Objective Through the analysis of the resuhs of eoronms angiography in patients with suspected coronary artery with abnormal T-wave on resting ECG,we investigated the diagnostic value of T-wave abnnrmalities on coronary artery disease. Methods Retrospectively eollected clinical data of 486 cases of atmomlal T-wave on resting ECG in hospitalized patients in 2010- 2011. Patients were divided into the positive group （104 cases）and negative group （382 eases）according to the results of coronary angiography. Factors including gender,age,body mass index,the resting heart rate,systolic blood pressure,diastolic blood pressure, smoking and other factors on the results olc coronary angiography were analyzed. Results （ 1 ）114 cases were angiography-positive, the positive rate was 20.1%. （2）The coronary angiography positive rate in male was higher than that in female patients in ]＇-wave abnormalities（27.0% vs 15.9%）. The specificity was 62.5% and the sensitivity was 53.9%. （3）Of the abnormal T-wave,patients with slower resting heart rate had higher coronary angiography-positive rate （27.9% vs 17.6% ）,the speeificity was 48.1% and the sensitivity was 66.2%. （4）Combined gender and resting heart rate,the positive predictive sensitivity of coronary angiography was 27.9% ,specificity 83.5%. Conclusions Combined diagnosis of gender and resting heart rate yields higher specificity and sensitivity than abnormal T-wave on resting ECG,thus contribute to the clinical preliminary screening of coronary heart disease.