目的:探讨持续性心房颤动(房颤)导管射频消融术后P波时限及离散度与术后早期与晚期复发房颤的关系。方法:连续入选80例首次行导管射频消融术的持续性房颤患者,其中男性46例,女性34例,平均年龄(60.6±8.1)岁,平均随访(9.3±2.9)...目的:探讨持续性心房颤动(房颤)导管射频消融术后P波时限及离散度与术后早期与晚期复发房颤的关系。方法:连续入选80例首次行导管射频消融术的持续性房颤患者,其中男性46例,女性34例,平均年龄(60.6±8.1)岁,平均随访(9.3±2.9)个月。根据3个月之内(早期)和之外(晚期)复发房颤情况,分为两个对比组:早期复发组和早期未复发组;晚期复发组和晚期未复发组。所有患者术后24 h内均记录12导联心电图,并测量P波时限,计算出最长P波时限(Pmax),最短P波时限(Pmin),以及两值之差即P波离散度(Pd),分析P波时限及离散度与术后早期与晚期复发房颤的关系。结果:17例患者早期复发房颤,与早期未复发组患者比较,Pd明显增长[(74.35±17.78) ms vs (60.73±18.37) ms,P=0.008];12例早期复发患者(70.6%)出现延迟恢复,未发现早期复发为晚期复发预测因子。14例患者晚期复发房颤,与晚期未复发组患者相比,Pd明显增长[(75.71±16.49)ms vs (61.06±18.59) ms,P=0.008]。通过观察不同临界值,发现Pd≥60 ms对预测术后晚期复发房颤有一定价值,敏感度85%、特异度50%、阳性预测值26.7%、阴性预测值94.3%。结论:Pd与持续性房颤导管射频消融术后早期及晚期复发有关,其中Pd≥60 ms对预测持续性房颤术后晚期复发有一定的价值,其中阴性预测价值更高。展开更多
Objective: The aim of the study was to investigate the impact of P-maximum and P-wave dispersion on the long term clinical outcome after successful percutaneous balloon mitral valvuloplasty (PBMV) in patients with mit...Objective: The aim of the study was to investigate the impact of P-maximum and P-wave dispersion on the long term clinical outcome after successful percutaneous balloon mitral valvuloplasty (PBMV) in patients with mitral stenosis (MS) and sinus rhythm. Also to test the correlation between P-variables and right ventricular function and pulmonary artery pressure before and after PMBV. Methods: Eighty-five patients undergoing PMBV were enrolled in this study. We evaluated P-maximum, P-minimum and P-wave dispersion before and one month after PBMV. We studied the changes in pulmonary arterial pressure (PAP), left atrial (LA) dimension, mitral diastolic gradient, and mitral valve area, in addition to the changes in right ventricular function utilizing tissue Doppler assessment both before and after PMBV, in addition the role of the P-wave dispersion in predicttion of late cardiac events. Results: There were significant decreases in mean diastolic gradient, PAP, and LA size and significant improvement in right ventricular tissue Doppler indices after PMBV. Ac- company these hemodynamic changes after PMBV. P-maximum and P-wave dispersion were found to be decreased (P < 0.001). Patients developed cardiac events during follow-up had a higher P-maximum and P-dispersion than those without late cardiac events (P < 0.001). Moreover the changes in P-maxi- mum and P-dispersion before and after PMBV in patients with cardiac events were not significant, while P-maximum and P-dispersion significantly (P < 0.002) decreased in patients without events It was revealed with linear regression and correlation analy- sis that the degree of and the changes in P-maximum and P-wave dispersion were correlated with devel- opment of late cardiac events after PMBV, with Cut-off values of ≥62.8 msec for P-wave dispersion and 118 mes for P-maximum.ROC curve showed AUC of 0.919 for P-wave dispersion and 0.913 for P-maximum (P < 0.001). Conclusion: P-wave maximum and dispersion are significantly increased in patients with mitral stenosis. These changes decreased significantly after PMBV. The P-maximum and P-wave dispersion changes were correlated with significant impairment of right dysfunction and the degree of pulmonary artery pressure. P-maximum and P-wave dispersion could be considered as independent predictors of late outcome of patients with MS after successful PMBV (AF, recurrent hospital admission, embolic phenomenon deterioration of right ventricular function).展开更多
目的分析心电图P波特征指标、心房颤动血栓危险度评分(congestive heart failure hypertension age diabete mellitus stroke-vascular disease age sex category,CHA_(2)DS_(2)-VASc)联合血清糖链抗原125(carbohydrate antigen 125,CA1...目的分析心电图P波特征指标、心房颤动血栓危险度评分(congestive heart failure hypertension age diabete mellitus stroke-vascular disease age sex category,CHA_(2)DS_(2)-VASc)联合血清糖链抗原125(carbohydrate antigen 125,CA125)指标对住院心力衰竭患者新发心房颤动的预测价值。方法选取2022年1月至2023年8月在南京市浦口人民医院治疗的235例心力衰竭患者为研究对象,根据患者心房颤动的发生情况将其分为新发心房颤动组和非新发心房颤动组,收集患者的临床资料,对比新发心房颤动组和非新发心房颤动组患者的心电图P波特征指标,包括最小P波时限(minimum P-wave duration,P_(min))、最大P波时限(maximum P-wave duration,P_(max))、V_(1)导联P波终末电势(P terminal force in lead V_(1),PTFV_(1))、CHA_(2)DS_(2)-VASc评分、CA125等指标的差异,应用Pearson相关性分析P_(min),P_(max),PTFV_(1),CHA_(2)DS_(2)-VASc评分,CA125与心力衰竭患者新发心房颤动的相关性,最后通过受试者工作特征(receiver operating characteristic,ROC)及曲线下面积(area under curve,AUC)评价P_(min),P_(max),PTFV_(1),CHA_(2)DS_(2)-VASc评分,CA125对心力衰竭患者新发心房颤动的诊断价值。结果新发心房颤动组患者心电图P波特征指标P_(min)低于非新发心房颤动组患者,而P_(max),PTFV_(1)和CHA_(2)DS_(2)-VASc评分及CA125高于非新发心房颤动组患者[(68.05±9.34)ms/(75.36±10.61)ms、(163.76±14.35)ms/(148.90±12.47)ms、(0.065±0.015)mm/s/(0.059±0.008)mm/s、(3.91±1.52)分/(3.05±1.15)分、(84.62±18.54)U/mL/(71.28±16.34)U/mL];logistic回归分析显示,P_(max),PTFV_(1),CHA_(2)DS_(2)-VASc评分,CA125水平升高和P_(min)降低是新发心房颤动的危险因素(OR=1.059,95%CI:1.021~1.098,P<0.05;OR=1.963,95%CI:1.185~3.250,P<0.05;OR=1.474,95%CI:1.064~2.042,P<0.05;OR=1.049,95%CI:1.016~1.082,P<0.05;OR=-0.051,95%CI:0.913~0.989,P<0.05)。P_(max),PTFV_(1),CHA_(2)DS_(2)-VASc评分及CA125与心力衰竭患者新发心房颤动呈正相关(r=0.374,P<0.001;r=0.334,P<0.001;r=0.302,P<0.001;r=0.288,P<0.001),而P_(min)与心力衰竭患者新发心房颤动呈负相关(r=-0.278,P<0.001)。ROC曲线结果显示,P_(min),P_(max),PTFV_(1),CHA_(2)DS_(2)-VASc评分,CA125联合检测预测心力衰竭患者新发心房颤动的AUC值高于各指标单独检测(0.916/0.687、0.771、0.707、0.671、0.729,P<0.05)。结论心力衰竭住院患者P_(min),P_(max),PTFV_(1),CHA_(2)DS_(2)-VASc评分及CA125水平与心力衰竭住院患者新发心房颤动的发生有较高相关性,且心电图P波特征指标、CHA_(2)DS_(2)-VASc评分和血清CA125联合检测心力衰竭住院患者新发心房颤动的诊断效能优于各指标单独检测。展开更多
文摘目的:探讨持续性心房颤动(房颤)导管射频消融术后P波时限及离散度与术后早期与晚期复发房颤的关系。方法:连续入选80例首次行导管射频消融术的持续性房颤患者,其中男性46例,女性34例,平均年龄(60.6±8.1)岁,平均随访(9.3±2.9)个月。根据3个月之内(早期)和之外(晚期)复发房颤情况,分为两个对比组:早期复发组和早期未复发组;晚期复发组和晚期未复发组。所有患者术后24 h内均记录12导联心电图,并测量P波时限,计算出最长P波时限(Pmax),最短P波时限(Pmin),以及两值之差即P波离散度(Pd),分析P波时限及离散度与术后早期与晚期复发房颤的关系。结果:17例患者早期复发房颤,与早期未复发组患者比较,Pd明显增长[(74.35±17.78) ms vs (60.73±18.37) ms,P=0.008];12例早期复发患者(70.6%)出现延迟恢复,未发现早期复发为晚期复发预测因子。14例患者晚期复发房颤,与晚期未复发组患者相比,Pd明显增长[(75.71±16.49)ms vs (61.06±18.59) ms,P=0.008]。通过观察不同临界值,发现Pd≥60 ms对预测术后晚期复发房颤有一定价值,敏感度85%、特异度50%、阳性预测值26.7%、阴性预测值94.3%。结论:Pd与持续性房颤导管射频消融术后早期及晚期复发有关,其中Pd≥60 ms对预测持续性房颤术后晚期复发有一定的价值,其中阴性预测价值更高。
文摘Objective: The aim of the study was to investigate the impact of P-maximum and P-wave dispersion on the long term clinical outcome after successful percutaneous balloon mitral valvuloplasty (PBMV) in patients with mitral stenosis (MS) and sinus rhythm. Also to test the correlation between P-variables and right ventricular function and pulmonary artery pressure before and after PMBV. Methods: Eighty-five patients undergoing PMBV were enrolled in this study. We evaluated P-maximum, P-minimum and P-wave dispersion before and one month after PBMV. We studied the changes in pulmonary arterial pressure (PAP), left atrial (LA) dimension, mitral diastolic gradient, and mitral valve area, in addition to the changes in right ventricular function utilizing tissue Doppler assessment both before and after PMBV, in addition the role of the P-wave dispersion in predicttion of late cardiac events. Results: There were significant decreases in mean diastolic gradient, PAP, and LA size and significant improvement in right ventricular tissue Doppler indices after PMBV. Ac- company these hemodynamic changes after PMBV. P-maximum and P-wave dispersion were found to be decreased (P < 0.001). Patients developed cardiac events during follow-up had a higher P-maximum and P-dispersion than those without late cardiac events (P < 0.001). Moreover the changes in P-maxi- mum and P-dispersion before and after PMBV in patients with cardiac events were not significant, while P-maximum and P-dispersion significantly (P < 0.002) decreased in patients without events It was revealed with linear regression and correlation analy- sis that the degree of and the changes in P-maximum and P-wave dispersion were correlated with devel- opment of late cardiac events after PMBV, with Cut-off values of ≥62.8 msec for P-wave dispersion and 118 mes for P-maximum.ROC curve showed AUC of 0.919 for P-wave dispersion and 0.913 for P-maximum (P < 0.001). Conclusion: P-wave maximum and dispersion are significantly increased in patients with mitral stenosis. These changes decreased significantly after PMBV. The P-maximum and P-wave dispersion changes were correlated with significant impairment of right dysfunction and the degree of pulmonary artery pressure. P-maximum and P-wave dispersion could be considered as independent predictors of late outcome of patients with MS after successful PMBV (AF, recurrent hospital admission, embolic phenomenon deterioration of right ventricular function).
文摘目的分析心电图P波特征指标、心房颤动血栓危险度评分(congestive heart failure hypertension age diabete mellitus stroke-vascular disease age sex category,CHA_(2)DS_(2)-VASc)联合血清糖链抗原125(carbohydrate antigen 125,CA125)指标对住院心力衰竭患者新发心房颤动的预测价值。方法选取2022年1月至2023年8月在南京市浦口人民医院治疗的235例心力衰竭患者为研究对象,根据患者心房颤动的发生情况将其分为新发心房颤动组和非新发心房颤动组,收集患者的临床资料,对比新发心房颤动组和非新发心房颤动组患者的心电图P波特征指标,包括最小P波时限(minimum P-wave duration,P_(min))、最大P波时限(maximum P-wave duration,P_(max))、V_(1)导联P波终末电势(P terminal force in lead V_(1),PTFV_(1))、CHA_(2)DS_(2)-VASc评分、CA125等指标的差异,应用Pearson相关性分析P_(min),P_(max),PTFV_(1),CHA_(2)DS_(2)-VASc评分,CA125与心力衰竭患者新发心房颤动的相关性,最后通过受试者工作特征(receiver operating characteristic,ROC)及曲线下面积(area under curve,AUC)评价P_(min),P_(max),PTFV_(1),CHA_(2)DS_(2)-VASc评分,CA125对心力衰竭患者新发心房颤动的诊断价值。结果新发心房颤动组患者心电图P波特征指标P_(min)低于非新发心房颤动组患者,而P_(max),PTFV_(1)和CHA_(2)DS_(2)-VASc评分及CA125高于非新发心房颤动组患者[(68.05±9.34)ms/(75.36±10.61)ms、(163.76±14.35)ms/(148.90±12.47)ms、(0.065±0.015)mm/s/(0.059±0.008)mm/s、(3.91±1.52)分/(3.05±1.15)分、(84.62±18.54)U/mL/(71.28±16.34)U/mL];logistic回归分析显示,P_(max),PTFV_(1),CHA_(2)DS_(2)-VASc评分,CA125水平升高和P_(min)降低是新发心房颤动的危险因素(OR=1.059,95%CI:1.021~1.098,P<0.05;OR=1.963,95%CI:1.185~3.250,P<0.05;OR=1.474,95%CI:1.064~2.042,P<0.05;OR=1.049,95%CI:1.016~1.082,P<0.05;OR=-0.051,95%CI:0.913~0.989,P<0.05)。P_(max),PTFV_(1),CHA_(2)DS_(2)-VASc评分及CA125与心力衰竭患者新发心房颤动呈正相关(r=0.374,P<0.001;r=0.334,P<0.001;r=0.302,P<0.001;r=0.288,P<0.001),而P_(min)与心力衰竭患者新发心房颤动呈负相关(r=-0.278,P<0.001)。ROC曲线结果显示,P_(min),P_(max),PTFV_(1),CHA_(2)DS_(2)-VASc评分,CA125联合检测预测心力衰竭患者新发心房颤动的AUC值高于各指标单独检测(0.916/0.687、0.771、0.707、0.671、0.729,P<0.05)。结论心力衰竭住院患者P_(min),P_(max),PTFV_(1),CHA_(2)DS_(2)-VASc评分及CA125水平与心力衰竭住院患者新发心房颤动的发生有较高相关性,且心电图P波特征指标、CHA_(2)DS_(2)-VASc评分和血清CA125联合检测心力衰竭住院患者新发心房颤动的诊断效能优于各指标单独检测。
