Diagnostic significance of echocardiography in coronary heart disease without obvious ST-T changes in electrocardiogram: Based on coronary flow velocity and ventricular wall motion
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摘要:
目的 研究超声心动图检测患者冠状动脉相关血流速度联合节段性室壁运动对经心电图检测ST-T段未见明显改变的冠状动脉粥样硬化性心脏病中的诊断意义。 方法 回顾性分析2020年1月~2021年6月在我院心内科住院的经冠脉造影证实为冠心病且血管狭窄大于50%但未完全闭塞的患者并进行心电图检查，将其中无明显ST-T段改变的患者40例作为冠心病组；同时选取冠状动脉造影证实血管狭窄小于50%的患者30例作为对照组，所有的患者均在入院期间进行超声心动图检查，观察冠状动脉血流及室壁运动情况。 结果 冠心病组中冠脉舒张期血流速度高于对照组，差异有统计学意义（P < 0.05）。超声心动图显示舒张期节段性血流峰值流速对诊断冠心病的准确性为92.3%，敏感度为82.4%，特异性为90%，临界值为94.5 cm/s；节段性室壁运动诊断冠心病的敏感度为55.9%，特异性为86.7%，二者联合诊断冠心病的敏感度为84.2%，特异性为92.5%。 结论 超声心动图对冠状动脉血流速度联合节段性室壁运动情况可以明显提高无明显ST-T改变的冠心病患者的诊断率，有利于减少临床上对冠心病患者的误诊率。 -
关键词:
- 超声心动图 /
- 节段性室壁运动 /
- 心电图无明显ST-T改变 /
- 冠心病 /
- 冠脉血流速度
Abstract:Objective To explore the diagnostic significance of echocardiographic of coronary artery related blood flow velocity combined with segmental wall motion in patients with atherosclerotic heart disease with no significant change in ST-T segment detected by electrocardiogram. Methods A retrospective study was conducted on patients admitted to the Department of Cardiology in our hospital from January 2020 to June 2021 who were confirmed by coronary angiogrophy as coronary heart disease with vascular stenosis greater than 50% but not completel occlusion. The patients were performed with electrocardiogram examination. Forty patients without significant ST-T segment changes were selected as coronaty artery disease group. Meanwhile, 30 patients with vascular stenosis less than 50% confirmed by coronary angiography were selected as control group. All patients underwent echocardiography during admission to observe coronary blood flow and ventricular wall motion. Results The diastolic blood flow velocity in the coronaty artery disease group was significantly higher than that in the control group (P < 0.05). Echocardiography showed that the accuracy of diastolic segmental peak flow velocity in the diagnosis of coronaty artery disease was 92.3%, the sensitivity was 82.4%, the specificity was 90%, the critical value was 94.5 cm/s, the sensitivity of segmental wall motion in the diagnosis of coronary heart disease was 55.9%, the specificity was 86.7%, and the sensitivity and specificpatity of combined diagnosis of coronary heart disease were 84.2% and 92.5%. Conclusion Echocardiographic coronary flow velocity combined with segmental ventricular wall motion can improve the diagnostic rate of patients with coronary heart disease without obvious ST-T change. It is beneficial to reduce the misdiagnosis rate of clinical misdiagnusis of coronary heart disease patients. -
图 1 冠脉造影血管狭窄程度与超声心动图舒张期血流
A:冠状动脉造影示左前支近端狭窄90%; B:超声心动图示左冠脉舒张期流速121 cm/s; C:冠状动脉造影示右冠脉近段狭窄80%; D:超声心动图示右冠脉舒张期流速140 cm/s.
Figure 1. Coronary angiography stenosis degree and echocardiographic diastolic blood flow.
图 2 冠状动脉血流速度在冠心病诊断中的ROC曲线
Figure 2. ROC curve of coronary blood flow velocity in the coronary heart disease.
表 1 冠状动脉血流速度与室壁运动在冠心病诊断中的ROC分析
诊断 曲线下面积 阈值 敏感度(%) 特异性(%) 舒张期血流速度 0.92 94.5 cm/s 82.4 90.0 节段性室壁运动 55.9 86.7 二者联合 84.2 92.5 
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