CAJ | 학술논문

目的比较3种判断流出道室性心律失常起源部位方法的准确性.方法入选来自北京3家三甲医院2008年1月1日至2010年9月30日共110例(首都医科大学附属北京朝阳医院65例,阜外心血管病医院36例,北京军区总医院9例)成功消融的室性心律失常患者,标准12导联心电图均表现为左束支阻滞图形伴电轴下偏.3种心电图判断方法包括:①胸前导联移形区指数;②V2导联移形指数;③V2导联R波时限指数及R波振幅指数.结果总体患者中,V2导联移形指数敏感性最高(92.3％),V2导联R波时限指数及R波振幅指数特异性最高(93.9％),并且其ROC曲线下面积最大(0.925);心电图提示心脏转位的患者中,V2导联移形指数敏感性最高(94.1％),V2导联R波时限指数及R波振幅指数特异性最高(87.5％),V2移形指数ROC曲线下面积最大(0.892).结论 3种方法中,V2移形指数敏感性最高,V2导联R波时限指数及R波振幅指数特异性最高.总体患者中,V2导联R波时限指数及R波振幅指数ROC曲线下面积最大;心电图提示心脏转位的患者中,V2移形指数ROC曲线下面积最大.
목적 비교3충판단류출도실성심률실상기원부위방법적준학성.방법 입선래자북경3가삼갑의원2008년1월1일지2010년9월30일공110례(수도의과대학부속북경조양의원65례,부외심혈관병의원36례,북경군구총의원9례)성공소융적실성심률실상환자,표준12도련심전도균표현위좌속지조체도형반전축하편.3충심전도판단방법포괄:①흉전도련이형구지수;②V2도련이형지수;③V2도련R파시한지수급R파진폭지수.결과 총체환자중,V2도련이형지수민감성최고(92.3％),V2도련R파시한지수급R파진폭지수특이성최고(93.9％),병차기ROC곡선하면적최대(0.925);심전도제시심장전위적환자중,V2도련이형지수민감성최고(94.1％),V2도련R파시한지수급R파진폭지수특이성최고(87.5％),V2이형지수ROC곡선하면적최대(0.892).결론 3충방법중,V2이형지수민감성최고,V2도련R파시한지수급R파진폭지수특이성최고.총체환자중,V2도련R파시한지수급R파진폭지수ROC곡선하면적최대;심전도제시심장전위적환자중,V2이형지수ROC곡선하면적최대.
Objective To evaluate which algorithms is the most accurate for differentiating the origins of outflow tract ventricular arrhythmia(OTVA).Methods This study comprised 110 consecutive patients from 3 tertiary hospitals in Beijing(65 from Beijing ChaoYang hospital,36 from Beijing FuWai hospital,9 from Beijing military general hospital),between January 1st 2008 and Suptember 30th 2010.Patients enrolled in this study with OTVA in whom the surface ECG showed typical left bundle branch block morphology with an inferior axis.All the ECG tracings were retrospectively analyzed using the following 3 ECG algorithms published recently:the transitional zone (TZ) index; the V2 transition ratio; V2 R-wave duration and R/S-wave amplitude indices.Results In all patients,the V2transition ratio had the highest sensitivity(92.3％),while the R-wave duration and R/S-wave amplitude indices in V2 had the highest specificity(93.9％).The latter showed the maximal area under the ROC curve(0.925).In patients with precordail transition,the V2 transition ratio had the highest sensitivity(94.1％),while the R-wave duration and R/S-wave amplitude indices in V2 had the highest specificity(87.5％).The former showed the maximal area under the ROC curve(0.892).Conclusion All 3 published ECG algorithms are effective in differentiating the origin of OTVA,while the V2 transition ratio is more sensitive and the V2 R-wave duration and R/S-wave amplitude indices is more specific.In all patients,the latter has the maximal area under the ROC curve,but in patients with rotation the former is the maximum.