Tp-ec、Tp-e/QT比值与CABG后静脉旁路移植血管狭窄程度的关系及对恶性心电生理事件的预测价值

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目的:分析校正Tp-e间期(Tp-ec)、Tp-e/QT比值与冠状动脉左主干狭窄患者冠状动脉旁路移植术(CABG)后静脉旁路移植血管狭窄程度的关系,及对恶性心电生理事件的预测价值。方法:选取首都医科大学附属北京安贞医院2018年1月至2019年8月期间就诊的169例患者,其中男113列,女59例;年龄41~79岁,平均(62.58±4.23)岁。纳入标准为CABG后5~7年,因症状复发复查冠状动脉造影,大隐静脉旁路移植血管(SVG)再狭窄>50%者。根据旁路移植血管造影狭窄程度分为A组(SVG再狭窄程度50%~70%,105例)和B组(SVG再狭窄程度>70%,64例)。患者均行常规心电图检查,测量校正QT间期(QTc)、Tp-ec和Tp-e/QT比值,随访6个月,观察恶性心电生理事件发生情况,使用受试者工作特征(n ROC)曲线下面积(n AUC)定量评价Tp-ec、Tp-e/QT比值对恶性心电生理事件的预测效能。n 结果:B组QTc、Tp-ec、Tp-e/QT比值均明显大于A组,差异均有统计学意义(n P70%的独立影响因素(n P70%, 64 cases), routine electrocardiogram examination, measurement and correction of QT interval(QTc), Tp-ec and Tp-e/QT ratio were made. Patients were followed up 6 months, the occurrence of malignant ECG events is observed, and the area under the receiver operating characteristic( n ROC) curve(n AUC) was used to quantitatively evaluate the predictive power of Tp-ec and Tp-e/QT ratios for malignant ECG events.n Results:The QTc, Tp-ec and Tp-e/QT ratios in group B were significantly greater than those in group A, and the differences were statistically significant(n P70%(n P<0.05). Aftern Pearson correlation analysis, both the Tp-ec and Tp-e/QT ratios were positively correlated with the degree of vein bridge vessel stenosis(n r= 0.384 and 0.457, both n P=0.000). A total of 162 cases(95.86%) were followed up, 25 cases of malignant electrophysiological events occurred. After n ROC curve analysis, Tp-ec combined with Tp-e/QT ratio predicted coronary malignant electrophysiological events in patients with left main artery stenosis after GABG with n AUC=0.924, which was significantly greater than 0.698 of the single index Tp-ec and 0.712 of the Tp-e/QT ratio, the differences were both statistically significant(n P<0.05).n Conclusion:Tp-ec and Tp-e/QT ratios are both positively correlated with the degree of vein bridge vessel stenosis after CABG in patients with left main coronary artery stenosis, the combined effect of them in predicting the occurrence of malignant electrocardiological events is good, and it is worth further research and application.
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