Objective To explore the diagnostic value of intermittent changes in the nocturnal ST segment trend graph in a dynamic electrocardiogram (ECG) for coronary heart disease (CHD). Methods A total of 205 patients who underwent coronary angiography were included in this retrospective study. The study sample was determined through a power analysis aimed at achieving power of 80% with a significance level of 0.05. The participants were divided into the CHD (n = 101) and the non-CHD (n = 104) group, based on the degree of coronary artery diameter stenosis. The morphological changes in the ST segment trend graph were observed and divided into two categories: 'wall-shaped' and 'peak-shaped' changes. Results Among the 205 patients, 94 had nocturnal ST segment dynamic changes and 111 did not. The detection rate of CHD without nocturnal ST segment dynamic changes was 21.59%, significantly lower than the detection rate of 93.18% in those with nocturnal ST segment changes, reflecting a statistically significant difference (P < 0.05). The positive rate of ST segment in patients with single-vessel disease (71.88%) was lower than in patients with multi-vessel disease (78.57%), and both differences were statistically significant (P < 0.05). The duration of ST segment trend graph changes in 94 cases in the CHD group with intermittent changes in the nocturnal ST segment trend graph was higher than in the non-CHD group, but no significant difference was observed (P > 0.05). The detection rate of CHD in the peak-shaped dynamic change group of the nocturnal ST segment trend graph was significantly higher (76/82) than in the wall-shaped (6/82) dynamic change group (P < 0.05). Conclusion Peak-shaped changes in the nocturnal ST segment trend graph indicate coronary artery lesions. Nocturnal ST segment changes observed through dynamic ECG monitoring can serve as a valuable non-invasive predictor for CHD, providing a feasible method for early diagnosis and intervention in clinical practice.

2008年早期复极(early repolarization,ER)首次被Haissa-guerre[1]明确证明和室性心律失常有关. ER一旦出现临床症状,常常表现为胸痛、心悸、晕厥,即形成了早期复极综合征(early repolarization syndrome,ERS), 往往代表其预后不良.ERS患者不明原因晕厥,是"恶性变"的类型,可能是未来的心律失常事件一个重要的预测因子.

Objective To evaluate the relationship between cardiovascular responses during the treadmill exercise test and exercise-induced muscle vasodilatation in individuals with suspected coronary heart disease and asymptomatic individuals.Methods The study included 396 subjects (231 females and 165 males) treadmill exercise test.We evaluated the heart rate (chronotropic reserve and heart rate recovery),blood pressure (maximum systolic and diastolic blood pressure) and exercise capacity during treadmill exercise testing.At the same time,measurement of forearm blood flow and vascular response during isometric handgrip test.Results Forearm blood flow increase during the handgrip exercise was positively correlated with heart rate recovery during treadmill exercise testing.The increasement of forearm vascular conductance during the handgrip exercise was negatively correlated with exercise diastolic blood pressure during exercise treadmill testing.No significant association was found between exercise capacity and exercise-induced muscle vasodilation.Conclusions Exercise-induced muscle vasodilatation is correlated with heart rate and blood pressure responses during treadmill exercise testing,but is not correlated with exercise capacity.These findings suggest that favorable hemodynamic and chronotropic responses are correlated with better vasodilator capacity,but exercise capacity does not predict muscle vasodilatation.

目的 评价平板运动试验后心率恢复、心率变异性与冠心病的关系及临床意义.方法 对310例拟诊为冠心病的患者行活动平板运动试验,并对照其冠状动脉造影结果,将患者分为冠心病组106例和非冠心病组204例.比较两组患者的心率恢复值、达标时间、静息心率及运动最大心率,分析心率恢复异常与冠心病.同时评估短期心率变异性.结果 冠心病组运动后心率恢复值低于非冠心病组,差异有统计学意义;冠心病组心率变异性与非冠心病组相比,差异有统计学意义.结论 冠心病组与非冠心病组相比,心率恢复异常及心率变异性差异均有统计学意义,两者综合评价冠心病的准确率更高.

目的：探讨平板运动试验对冠脉支架术后患者运动治疗效果的评价价值。方法：对300例接受单支冠脉支架术的病例，按运动治疗依存性为标准进行分组，每组各150例，所有患者分别在术后半年，1年，2年，3个时间点进行平板运动试验，分别记录试验过程中的静息心率，ST段最大压低水平，最大代谢当量（ MFTS），总运动时间和最大心率5项指标。结果：两组3个时间点的5项观察指标中的最大MFTS，总运动时间和最大心率两组间差异有统计学意义（ P<0．05）。同时，运动依从性好的一组，五项观察指标中的最大MFTS，总运动时间和最大心率随运动治疗的时间延长，数值均增高，差异有统计学意义（ P<0．05）。结论：平板运动试验可作为评价冠脉支架术后患者运动治疗效果的一项客观指标。

近年来，随着人们对高血压认识不断深入，自主神经功能对高血压影响越来越受到重视。自主神经不单对血压、心率调控起重要作用，同时影响血压变异性（BPV）和心率变异性（HRV）。美国心脏病学会的研究发现BPV能对脑卒中和冠状动脉事件风险作出强有力的预测［1］，而HRV也可作为一个强有力的心血管事件的预测因子。文献［2，3］中有报道老年高血压患者家庭自测BPV与HRV的相关性及老年冠心病患者的动态血压变化与HRV的关系。但鲜有关于健康人群及高血压人群BPV与HRV的相关性报告。本研究通过进行动态心电图及动态血压检查，检测HRV和BPV，旨在探究健康人群及高血压人群BPV与HRV的相关性。

目的：探讨异丙肾上腺素在无创电生理检查中的应用价值。方法：a）疑似室上速病例100例，50例行基础食管电生理诱发；50例静滴异丙肾上腺素后诱发。b）疑似神经血管性晕厥100例，50例行基础倾斜试验诱发晕厥；50例静滴异丙肾上腺素后诱发。结果：食管组：基础有11例诱发心动过速；异丙肾上腺素组23例诱发心动过速。晕厥组：基础有9例诱发晕厥；异丙肾上腺素组有31例诱发晕厥。结论：异丙肾上腺素在食管调搏和直立倾斜试验中有肯定的应用价值。

慢性心率增快是指24 h动态心电图中平均心率≥80次／min。其作为一个独立的心血管危险因素，危害仅次于吸烟，可导致病死率明显升高。越来越受到临床医生，尤其是心血管医生的重视，而慢性心率增快本身现已作为一个独立的治疗指征。但慢性心率增快与何种疾病相关性好，即何种疾病常伴有慢性心率增快是本分析旨在讨论的方向。

目的 探讨食道调搏术在治疗阵发性室上性心动过速中的最佳刺激方式和治疗效果.方法 选取我院近年来收治的92例阵发性室上性心动过速患者,分为房室折返性心动过速(AVRT)组和房室结内折返性心动过速(AVNRT)组,两组室上速患者分别以超速抑制法及猝发脉冲法进行终止,观察其治疗效果、成功率,进行统计对比.结果 AVRT中猝发脉冲法终止成功率为85.7%;超速抑制法终止成功率57.1%,两种方法间差别有统计学意义(P＜0.05).AVNRT中猝发脉冲法终止成功率92%;超速抑制终止成功率68%,两种方法间差别有统计学意义(P＜0.05).结论 猝发脉冲法相较于超速刺激法更容易终止室上性心动过速.

<正>慢性心率增快是指2 4h动态心电图中平均心率≥8 0次/min。它作为一个独立的心血管危险因素,其危害仅次于吸烟,可导致死亡率明显升高,越来越受到临床医生,尤其是心血管医生的重视,而慢性心率增快本身现已作为一个独立的治疗

目的探讨原发性高血压病患者血压昼夜节律与心率变异性的关系。方法将400例原发性高血压患者行24h动态血压监测,根据血压昼夜节律分为杓型组、非杓型组,分别观察两组的低频(LF)、高频(HF)、LF/HF变化。结果杓型组病人昼夜LF均高于非杓型组(P<0.05),夜间LF明显高于日间,而非杓型组昼夜变化无统计学意义(P>0.05)。结论杓型组病人夜间迷走神经受损,非杓型病人日间交感神经受损,夜间交感神经,迷走神经均受损。

Category: 27. Clinical Electrophysiology—Ventricular ArrhythmiasSession-Poster Board Number: 1057-381 Authors: Yoshihiro Yamashina, Tetsuo Yagi, Akio Namekawa, Akihiko Ishida, Hirokazu Sato, Takashi Nakagawa, Manjirou Sakuramoto, Eiji Sato, Tomoyuki Yambe, Sendai City Hospital, Sendai, Japan, Tohoku University School of Medicine, Sendai, Japan Background: The relationship between J waves during sinus rhythm and idiopathic ventricular tachycardia (VT) or premature ventricular complexes (PVCs) originating from the right ventricular outflow tract (RVOT) has not been reported. The aim of this study was to investigate the prevalence and characteristics of idiopathic RVOT-VT/PVCs associated with J waves. Methods: The study enrolled 121 consecutive idiopathic RVOT-VT/PVC patients (mean age 45 ± 16 years, 46 males) undergoing radiofrequency catheter ablation (RFCA). The prevalence of J waves was assessed. The clinical and electrophysiological data were compared between the patients with J waves (J-wave group) and those without (Non-J-wave group). Results: J waves were present in 53 (43.8%) idiopathic RVOT-VT/PVC patients. The distribution of the J waves was as follows: Inferior leads = 62%, inferior-lateral leads = 24.5% and lateral leads = 13.2%. The J-wave group had a higher incidence of sustained VT (22.6% vs. 3.5%, P<0.01), shorter VT cycle length (303 ± 56 msec vs. 351 ± 62 msec, P<0.01) and more episodes of syncope (16% vs. 3%, P<0.05) than did the Non-J-wave group. There were no significant differences between the 2 groups in terms of the success rate of RFCA (90.9% vs. 88.8%, P= 0.72) or clinical outcome: No ventricular fibrillation, syncope or cardiac sudden death were observed in any patients during the follow up period. Conclusions: There was a high prevalence of J waves in the idiopathic RVOT-VT/PVC patients. J waves may play an important arrhythmogenic role in high risk idiopathic RVOT-VT patients.

目的分析正常变异J波与异常J波形态之间的区别,探讨J波形态在冠心病诊断方面的临床意义。方法健康体检者心电图出现J波122例(健康组),冠心病患者心电图显示J波者106例(冠心病组),对J波的形态进行分析。结果健康组122例J波呈尖峰型95例,呈顿挫型15例,呈驼峰型12例;106例冠心病患者中J波呈尖峰型6例,顿挫型39例,驼峰型61例。顿挫型及驼峰型分别与尖峰型比较,差异有统计学意义(P<0.05);两组内顿挫型与驼峰型间比较,差异无统计学意义(P>0.05)。讨论J波形态与心脏事件及心肌缺血的发生有一定的关系。

目的探讨先天性心脏病(CHD)患儿常规12导联心电图中ST-T改变与缺损大小、心脏功能状态的相关性,以找出ST-T改变临床意义的层次。方法选择12岁(含12岁)以下的非紫紺型左向右分流的单纯性房间隔缺损(ASD)、单纯性室间隔缺损(VSD)共300例。搜集其术前、术后一年静息12导联心电图、心脏彩超、普通X线胸片各一份,对其ST-T改变与缺损大小、心脏功能状态的关系进行横向、纵向比较,对照并统计分析。结果VSD者ST-T改变与缺损大小有统计学意义(P<0.01),ASD、VSD者ST-T改变均与心脏功能状态有统计学意义(P<0.01)。结论ST-T改变对VSD的缺损大小有一定的评估价值。CHD者术前、术后一年的ST-T改变对心脏功能状态有一定的评估价值。

<正>本文旨在探讨应用异丙肾上腺素药物激发后倾斜试验的敏感性、特异性、重复性。1资料与方法1.1一般资料:患者来源于在2002年9月至2005年5月本院住院及门诊不明原因晕厥患者90例,其中男性42例,女

患者男,50岁.于2008年2月9日晚自觉头晕、胸痛伴心悸不适,于2月10日起床站立时突然意识丧失昏倒在地,约10 min意识清楚,有小便失禁,无四肢抽搐,住院期间再次发生一次短暂的意识丧失,约数分钟,头颅CT检查无异常,入院时2月9日查心电图.V1 V2V3导联QRS波群呈典型的穹隆型改变,有明显的J波,T波倒置,ST段呈下斜型抬高,于2月18日查心电图示:V1 V2 V3导联ORS波群呈典型的马鞍型改变,临床诊断为Brugada综合征.

食管心房调搏安全、简便、可靠,对快速心律失常的诊断、鉴别诊断与定位有着重要的临床价值.本文通过对食道调搏时被诊断为顺向型房室折返性心动过速(OAVRT)的58例患者,进行旁道定位与心内电生理检查结果的对比,评价食管心房调搏对OAVRT旁道定位的作用.

患者男性,50岁.因饮酒及洗澡时各晕厥1次,于2003年5月12日在我院门诊.检查一般情况好,心肺(-),心率68次/min,律齐,未闻及杂音.辅助检查:颈椎片、心电图、脑电图、脑地形图、CT、MRI均正常,随行直立倾斜试验.

1概述 倾斜试验(TTT)应用于我国已将近20年,作为不明原因晕厥的诊断与评价的"准金标准"已越来越受到心血管、心电生理、神经科以及航天航空事业的重视.对于它的敏感性、特异性、重复性以及与自主神经的功能[1]以及与一些扩血管药物的配合使用[2]已有一些报道.但临床价值方面各方报告不一,尤其是TTT阳性结果在临床诊断、治疗及预后有何价值?本文就这些问题谈一点认识.

238例急性心肌梗死(AMI)中检出U波倒置64例,以前壁AMI较多见.U波倒置与AMI部位密切相关,见于心功能较差者,提示其与预后有关.