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• 2015 Volume 24 Issue 3
  Published: 28 June 2015

    

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  The important concepts, terms and their connotations of Lorenz plot

  LI Fang-Jie

  2015, 24(3): 153-157. https://doi.org/10.13308/j.issn.2095-9354.2015.03.001

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  With deepening understanding of the graphic mechanism of Lorenz plot, the related concepts and terminologies have been increasing rapidly and their connotations require to be expounded. This paper focuses on explaining several common clinical concepts at present, including RR interval difference Lorenz plot, tRR scatterplot, electrocardioattractor, big data, “two ends, two lines, and eight regions”, “four diagnostic essentials” for arrhythmia (number of subgraphs, graphic shapes, locations of graphs, and B linear slope), preceding point of premature beat, main point of premature beat, following point of premature beat, preceding block point, following block point, homogeneous attractors with the same origin, homogeneous attractors with different origins, etc.
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  ECG scatterplot characteristics of pararrhythmia

  JING Yong-Ming, HUANG Yan

  2015, 24(3): 158-160. https://doi.org/10.13308/j.issn.2095-9354.2015.03.002

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  Pararrhythmia is usually misdiagnosed as ordinary premature beats by fragments of body surface ECG while its three ECG characteristics are often found by longterm ambulatory electrocardiography(AECG). Comparatively, the ECG scatterplot features of pararrhythmia by analysis software are more clearly and regular, providing reliable references for diagnosing pararrhythmia quickly and accurately. In this paper, models of Lorenz scatterplot and difference scatterplot are made by dynamic mapping function and trajectory tracking function of the Geometers Sketchpad. Once the scatterplot characteristics are grasped, it is easy to identify pararrhythmia in AECG.
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  Different manifestations of pararrhythmia in ECG scatterplots

  WANG Man-Ping, LIU Ming, XIANG Li-Ming

  2015, 24(3): 161-164. https://doi.org/10.13308/j.issn.2095-9354.2015.03.003

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  By Lorenz plot and tRR interval scatterplot, ventricular parasystole with different characteristics and manifestations was identified in three patients diagnosed with frequent ventricular premature beat by ambulatory electrocardiography(AECG). It implies that proper application of ECG scatterplot as a tool in AECG analysis will greatly increase the detection rate of complex arrhythmias.
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  Rapid diagnosis by ECG scatterplot in three cases with arrhythmia hard to be differentiated by ordinary 12-lead ECG

  Lv Hang , LIU Ming, XIANG Li-Ming

  2015, 24(3): 165-168. https://doi.org/10.13308/j.issn.2095-9354.2015.03.004

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  ECG scatterplot can be utilized in diagnosing arrhythmias which are difficult for ordinary ECG to specify or capture. This paper selects three patients who underwent ambulatory electrocardiography in hospital. Their characteristic graphs of ECG scatterplots were analyzed and used for diagnosis. ECG scatterplot not only records a large amount of information, but also gives specific qualitative diagnosis easy to be understood, which avoids missed diagnosis and misdiagnosis, and provides references in diagnosing arrhythmia clinically.
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  Electrocardiographic features of epicardial ventricular tachycardia

  ZHANG Hai-Tao, ZHANG Shu-Long

  2015, 24(3): 172-179. https://doi.org/10.13308/j.issn.2095-9354.2015.03.006

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  Epicardial ventricular tachycardial(VT) demonstrates common electrocardiographic features: QRS duration ≥200 ms, however, it ≤120 ms partly; There is false Δ wave ≥34 ms at the beginning; Left axis deviation is in majority; Precordial leads migrate after V2 lead; The time to reach the peak for R wave is prolonged by over 85 ms in V2 lead; The shortest RS duartion ≥121 ms. The following features help to identify epicardial VT originating from left ventricle: VT originating from the base and apex of heart with Q waves inⅠlead; Basal VT without Q waves in Ⅱ, Ⅲ, and aVF leads; VT originating from the upper base and apex of heart with Q waves in Ⅱ, Ⅲ, and aVF leads. Maximum deviation index(MDI) can be used in identifying epicardial VT originating from left ventricular outflow tract. When MDI ≥0.55, epicardial VT originating far from aortae sious can be identified. The following features help to identify epicardial VT originating from right ventricle: it implies big chance of epicardial VT when there is Q wave in Ⅰlead and QS in right ventricular anterior wall lead; Epicardial VT originating from right ventricle can be observed during synchronous electrophysiological mapping when there are initating Q waves in Ⅱ, Ⅲ, and aVF leads. However, VT with different originating locations and different causes possess its unique electrocardiographic features. Before VT ablation, accurate location by surface ECG proves to be instructive.
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  The role of competitive mechanism of autonomic nerves in triggering atrial fibrillation after lobectomia pulmonalis

  HE Geng-Xu, YAO Tong, WANG Chun-Guang, LIU Jun-Tang, LI Hai-Ying, CAI Bao-Song, PU Ren-Fu, ZHOU Feng, ZHANG Yan

  2015, 24(3): 180-184. https://doi.org/10.13308/j.issn.2095-9354.2015.03.007

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  Objective  To evaluate the role of competitive mechanism of autonomic nerves in triggering atrial fibrillation（AF） after lobectomia pulmonalis.  Methods  Ambulatory electrocardiography(AECG) monitoring was carried out 24 hours before the operation and consecutively 96 hours after the operation on 281 patients over 60 who had received total pneumonectomy or lobectomia pulmonalis. For patients with appearance of AF, it was 2 hours before the operation, and 60 minutes, 30 minutes, and 5 minutes before the onset of AF when the heart rate variability(HRV) indices of AECG were analyzed. With an interval of 5 minutes chosen, the trend of HRV changes at the four time points before the onset of AF was studied, and so were tension variations of autonomic nerves and vagus. Results  In 281 pneumonectomy patients, 48 was diagnosed with AF postoperatively, with an incidence of 17.1%. The indexes reflecting tension of vagus such as SDNN, rMSSD, pNN50, and HF all increased significantly, 60 minutes, 30 minutes, and 5 minutes before the onset of AF,however, the index of LF/HF which reflected the balance of autonomic nerves and parasympathetic was proned to descend gradually. The fact that the indexes of SDNN, rMSSD, pNN50, and HF increased significantly and the ratio of LF/HF decreased significantly 5 minutes before the onset of AF indicated a significant increase of vagus tension and a gradual decrease of RR interval before the onset of AF. Conclusion  After lobectomia pulmonalis and before the onset of AF, there is a significant increase in HRV. Against the background of significantly increased autonomic nerves tension after lobectomia pulmonalis, the competitive increase of vagus tension may be an important mechanism of the onset of AF.
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  Comparative analysis between results of treadmill exercise test and coronary angiography among patients with coronary heart disease

  JIANG Yuan-Yuan, CHU Wei

  2015, 24(3): 185-187. https://doi.org/10.13308/j.issn.2095-9354.2015.03.008

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  Objective  To explore the clinical significance of positive results of treadmill exercise test(TET) in diagnosing coronary heart disease, by comparing with those of coronary angiography(CAG).Methods  One hundred and twenty-eight patients with suspected coronary heart disease underwent TET and CAG separately. The results of two kinds of testings were comparatively analysed. Results  For the diagnosis of coronary heart disease, the sensitivity and specificity of TET was 88.76% and 61.54%, respectively. For male patients with coronary heart disease, the sensitivity and specificity of TET was 96.92% and 71.43%, respectively, both significantly higher than those of female patients, with statistically significant difference. In diagnosing coronary heart disease patients with multivessel coronary artery lesions, the true positive rate was higher than that of patients with single vessel disease, and the difference was statistically significant. Conclusion  Although there might be false positive or false negative results, TET still proves to have relatively high sensitivity and specificity in diagnosing coronary heart disease. It worths of being promoted clinically for its safety, non-invasiveness, convenience, economy and other advantages.
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  Diagnostic value of ECG in acute pulmonary embolism

  XIANG Zhi-Qing, TIAN Jun-Hua

  2015, 24(3): 188-189. https://doi.org/10.13308/j.issn.2095-9354.2015.03.009

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  Objective  ]To analyze the application value of ECG in diagnosing acute pulmonary embolism.Methods  Fifty-four patients diagnosed with acute pulmonary embolism in our hospital were selected. Their clinical manifestations and ECG examination results were statistically analyzed.Results  Among the 54 patients, there were 52 cases with ECG changes, including 40 with sinutachycardia,2 with supraventricular tachycardia,38 with atrial premature beats, 17 with inverted T_V1-T_V3, 9 with S_ⅠQ_ⅢT_Ⅲ , and 12 with right bundle branch block. Conclusion  Obvious ECG changes will be found in patients with acute pulmonary embolism. It is clinically significant to master ECG characteristics to diagnose of the disease, which deserves to be promoted and applied in practice.
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  Clinical value of deceleration capacity and heart rate deceleration runs in predicting sudden death of patients with acute myocardial infarction

  SONG Kuang-Rong, LENG Yong-Qun, LU Jia-Jia, ZHANG Shuo, TU Wan-Hua, YE Jing

  2015, 24(3): 190-193. https://doi.org/10.13308/j.issn.2095-9354.2015.03.010

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  Objective  To make risk stratification of patients with acute myocardial infarction(AMI) by detecting deceleration capacity(DC) and heart rate deceleration runs(DRs), and to investigate the clinical significance of the two detection technics in the early warning of cardiac sudden death. Methods  Comparative analysis was carried out between 90 AMI patients diagnosed with coronary heart disease by coronary angiography(CAG) (AMI group) and 90 healthy people with normal CAG results(normal group). The two groups underwent 24hour ambulatory electrocardiography examination while values of DC and DRs were automatically analysed and calculated by software.  Results  The values of DC and DRs descended significantly in AMI group, and the difference was statistically significant(P＜0.01) if compared with those in normal group. There were statistically significant differences of DC and DRs values between the AMI subgroups divided by the course of the disease and normal group. When the the course of AMI was over 6 months, the risk of cardiac sudden death decreased significantly. Meanwhile, the higher the risk indicated by DC and DRs was, the more severe the disease was, which coincided with the quantity and extent of lesioned vessels by CAG.  Conclusion  DC and DRs can be utilized to analyze vagus nerve function quantificationally and independently. The combined use of the two parameters is quite valuable in prewarning AMI high risk group.
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  Correlation between ECG manifestation and recent left ventricular function in patients with ST-segment elevation acute myocardial infarction

  LI Qiang, TIAN Wen-Fen, YE Zhuo-Lian-

  2015, 24(3): 194-195. https://doi.org/10.13308/j.issn.2095-9354.2015.03.011

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  Objective  To explore the correlation between ECG manifestation and recent left ventricular function in patients with ST-segment elevation acute myocardial infarction(STEAMI). Methods  Examinations of ECG and echocardiogram were carried out on 60 STEAMI patients on admission and three months later. The results were analyzed. Results  In lead V₁－V₆, the ST-segment elevation magnitude was summed up to 1.72 mV, R-wave amplitude to 3.28 mV, and Q-wave amplitude to 2.83 mV. Q-wave was found in 5 leads. The maximum amplitude of ST-segment elevation was 4.32 m. The left ventricular end diastolic dimension(LVEDd) was 51.34 mm. The left ventricular ejection fraction(LVEF) in acute phase was 56.19%. By Killip classification, 32 cases were classified into grade 1, 15 in grade 2, 10 in grade 3, and 3 in grade 4. After three months, LVEDd and LVEF was 45.87 mm and 59.20%, respectively. The sum of ST-segment elevation magnitude and Q-wave amplitude, and the lead number of Q-wave behaved positively correlated to Killip classification and LVEDd three months later (r=0.54, 0.52) while they were negatively correlated to LVEF three months later (r=-0.56). The sum of R-wave amplitude was also negatively correlated to LVEDd three months later (r=-0.61), and positively correlated to LVEF three months later (r=0.46). Conclusion  The ST-segment elevation magnitude, R-wave amplitude, Q-wave amplitude, lead number of Q-wave, etc. prove to be closely related to left ventricular function for STEAMI patients, which could be applied in predicting recent left ventricular function.
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  Clinical value of deceleration capacity and QT dispersion in predicting cardiac sudden death of patients with chronic heart failure

  ZHANG Shuo, LENG Yong-Qun, LU Jia-Jia, SONG Kuang-Rong, DENG Yu-Ying

  2015, 24(3): 196-199. https://doi.org/10.13308/j.issn.2095-9354.2015.03.012

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  Objective  To investigate the values of deceleration capacity(DC) and QT dispersion(QTd) in predicting cardiac sudden death(CSD) of patients with chronic heart failure(CHF). Methods  One hundred CHF patients(CHF group) were randomly selected and followed up during one year. According to the existence of ventricular arrhythmia(VA), they were divided into VA group(43 cases) and non-VA group(57 cases). According to the existence of CSD, the enrolled cases were also divided into CSD group(18 cases) and survival group(82 cases). Meanwhile, another 100 healthy people examinated in our hospital were regarded as control group. In an early phase, the values of DC and QTd were measured in each group, and statistically analysed. Results  Separately compared with control group, non-VA group, and survival group, differences of DC and QTd values were all statistically significant (P<0.05) in CHF group, VA group, and CSD group, respectively. The value of QTd was negative to that of DC among CHF patients. Conclusion  DC and QTd values of CHF patients were associated with the severity of attacks, which can be regarded as sensitive indices to predict CSD among CHF patients.
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  Twenty-four hour ambulatory electrocardiography analysis of 120 atrial fibrillation patients

  TU Ji

  2015, 24(3): 200-203. https://doi.org/10.13308/j.issn.2095-9354.2015.03.013

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  Objective  To analyze the 12 lead ambulatory electrocardiography(AECG) of patients with atrial fibrillation(AF), and to explore the relationship between the concomitant abnormal manifestations and ages, disease diagnosis and organic heart disease, respectively, in order to know about paroxysmal atrial fibrillation(PAF) further. Methods  The AECG data of 120 patients were collected who were diagnosed with AF or PAF by Holter examination. Those data were retrospectively analysed and summarized against the background of baseline, according to the concomitant abnormal manifestations during AF recorded by AECG. Results  (i) There were 68 out of 120 AF cases complicating various types of ECG abnormalities by Holter examination, with an incidence rate of 56.7%(68/120). The most common ECG abnormalities were rapid ventricular rate and ventricular premature beats, accounting for 30.8%(37/120) and 29.2%(35/120), respectively. ST-T changes, conduction block and long R-R intervals (＞2.0 s) successively took the next places, accounting for 26.7%(32/120), 24.2%(29/120), and 19.2%(23/120) , respectively. Among the AF patients over 65, there were sometimes two or more types of concomitant ECG abnormalities in the same case. (ii) There were 18 out of 120 AF cases diagnosed with PAF, accounting for 15%(18/120), mostly triggered by atrial premature beats. In pulmonary heart disease group， coronary disease group, surgery examination group and rheumatic heart disease group, ventricular premature beat was common, accounting for 45%(5/11)， 50.0%(11/22)，42.9%（2/7） and 30.0%（3/10）, respectively. In hypertension group, ST-T changes were more common, accounting for 44.1%(15/34). Rapid ventricular rate was mostly seen in chest suppressionpalpitation group, hyperthyreosis group and diabetes group, accounting for 38.0%(8/21), 33.3%(1/3), and 22.2%(2/9), respectively. In syncope group, there was one case complicating rapid ventricular rates, and one with long RR intervals (＞2.0 s). The incidence of concomitant AECG abnormality can be as high as 67.4% among patients with organic heart disease. Conclusion  Holter can accurately reveal the concomitant AECG abnormalities among AF patients, which may be two or even more types in the AF patients complicating organic heart disease and(or) the ones over 65, and determine the initiating factors and site of PAF.
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  The combination of Mexiletine Hydrochloride and metoprolol tartrate tablets in treating premature ventricular beat caused by left ventricular false chordae tendineae

  ZENG Qiang, ZHANG Ya, LI Yan-Hua

  2015, 24(3): 204-205. https://doi.org/10.13308/j.issn.2095-9354.2015.03.014

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  Objective  To know the drug therapy for premature ventricular beat(PVB) caused by left ventricular false chordae tendineae(LVFCT). Methods  Fifty-one patients diagnosed with PVB for the past two years were enrolled in our study. The possibility of organic heart disease was excluded. Echocardiographic examination indicated LVFCT while electrocardiogram and ambulatory electrocardiography inspections revealed frequent PVB. The combination of Mexiletine Hydrochloride and metoprolol tartrate tablets was taken by the patients following oral administration. Results  After the drug therapy, the frequency of premature beats and the incidence of PVB all decreased for all the enrolled case. Conclusion  The therapeutic effect of the combination of Mexiletine Hydrochloride and metoprolol tartrate tablets proves to be more remarkable in treating PVB caused by LVFCT.
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  Report on progress in heart rate variability and ventricular arrhythmia of patients with maintenance hemodialysis

  QIN Xiao-Bo, CHEN Meng-Hua

  2015, 24(3): 209-212. https://doi.org/10.13308/j.issn.2095-9354.2015.03.016

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  The incidence rate of cardiac sudden death is high among the patients with maintenance hemodialysis, and ventricular arrhythmia is a major incentive. It is revealed that the attack of ventricular arrhythmia is associated with autonomic nervous dysfunction, and heart rate variability(HRV) is acknowledged as a noninvasive index to detect autonomic nervous function. Recent research mainly focuses on ventricular arrhythmia, and the changes of HRV and influencing factors in the process of maintenance hemodialysis. However, reports on the relationship between HRV and ventricular arrhythmia are few. Therefore, for the patients with maintenance hemodialysis, it implies vital clinical significance in improving the prognosis to carry out studies in this field, look for early warning indices of ventricular arrhythmia, and timely adjust hemodialysis therapy.
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  Pay high attention to ECG’s diagnostic value for acute pulmonary embolism

  ZHANG Zhao-Guo

  2015, 24(3): 213-214. https://doi.org/10.13308/j.issn.2095-9354.2015.03.017

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  Pulmonary embolism is clinically common and characterized by its diversity, atypism and great criticality. However, the capacity of  knowing and identifying  of acute pulmonary embolism can vary greatly among clinicians. Clinicians, especially the ones in primary hospitals, should elevate their understandings of the disease by ECG, which will help to reduce the rate of missed diagnosis and misdiagnosis rate significantly, and also improve the accuracy and timeliness in diagnosing pulmonary embolism clinically.
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  Clinical  diagnostic value of early morning blood pressure and morning surge in blood pressure

  LIN Bei-Bei, YU Xia, KUANG Guo-Fang

  2015, 24(3): 215-216. https://doi.org/10.13308/j.issn.2095-9354.2015.03.018

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  Objective  To discuss the clinical value of early morning blood pressure in disease diagnosis. Methods  Statistical treatment was carried out on 24hour ambulatory blood pressure data collected in our ABPM Room during the latest three months. For patients with cardiocerebrovascular disease, their 24hour ambulatory blood pressure was analyzed and the conditions of morning blood pressure were studied. Results  There were 202 patients who had poor control of blood pressure in the early morning among 308 ordinary hypertension patients , and the proportion was 70%-80% among the patients with cardiocerebrovascular disease. Conclusion  The incidence of blood pressure increase in the early morning among hypertension patients is relatively high and risky, closely related to cardiocerebrovascular events. The early morning blood pressure proves to be clinically significant in diagnosing masked hypertension.