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• 2016 Volume 25 Issue 3
  Published: 28 June 2016

    

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  Clinical value and accuracy evaluation of portable remote multi-parameter monitoring system

  GUO Ping, ZHANG Yan, CHEN Guang-Zhi, WANG Yan, WANG Dao-Wen

  2016, 25(3): 153-158. https://doi.org/10.13308/j.issn.2095-9354.2016.03.001

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  Objective  To evaluate the accuracy of portable remote multiparameter monitor in clinical application for patients with cardiovascular diseases, and to explore its clinical value preliminarily. [WTHZ]Methods[WT]A total of 160 inpatients in our hospital were selected as research objects. According to blood pressure, oxygen saturation(SaO₂) and ECG results, they were divided into hypertension group, hypotension group, normal blood pressure group, low SaO₂ group, normal SaO₂group, arrhythmia group, ST-T change group and normal ECG group, each with 20 cases. With portable remote multiparameter monitor, ECG, blood pressure and SaO₂ of all the patients were measured. ECG data obtained from routine 12 lead electrocardiograph, blood pressure measured from mercury sphygmomanometer and SaO₂  value acquired from blood oxygen saturation meter were regarded as “reference standards”. Correlation analysis was carrid out between the observed results from remote multi-parameter monitor such as arrhythmia, changes of ST segment, blood pressure, SaO₂, etc. and the reference standards. The diagnostic coincidence rates of multi-parameter monitor and “reference standards” were evaluated. Results  The measured results of blood pressure and SaO₂  by remote multi-parameter monitor were highly correlated with the reference standards. There was no statistically significant difference between the two sets of data(P＞0.05). ECG monitoring had exactly the same ability of identifying arrhythmia and ST-T changes as routine 12 lead electrocardiograph.Conclusion  The remote multi-parameter monitor has a high correlation with commonlyused monitoring instruments. By realtime observation, timely detection and early warning of abnormalities, effective intervention measures can be taken at an early phase. It has relatively high clinical application value.
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  Application and effect evaluation of remote ECG monitoring network system in regional medical center

  LI Hou-Rong, DU Guo-Wei, YIN Bo, XIANG Juan, LI Qian, JIN Hai-Yan, RAN Liang

  2016, 25(3): 159-164. https://doi.org/10.13308/j.issn.2095-9354.2016.03.002

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  In view of the status that medical resources are deficient and spatially uneven in the northeast area of Chongqing and the ECG diagnostic ability of primary care doctors is relatively low, Chongqing Three Gorges Central Hospital constructed regional remote ECG monitoring network center of diagnosis and consultation with the core of “four unifications”and “one in share” in the mode of “1+Ｘ” in June 2014. It facilitates regional patients with cardiovascular diseases to enjoy homogeneous ECG examination and treatment in medical institutions at different levels. This paper introduces the organizational(technology) structure, working system, operating mechanism and application effect of the consultation network, and shares experience and suggestions about its construction and operation. It also anticipates further development of its other applications, structure transformation based on cloud computing and the realization of wisdom healthcare system for community residents.
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  Clinical significance of networked ECG system applied in community

  LI Xiao-Xia, YANG Ling-Ling, CAI Gao-Jun

  2016, 25(3): 165-166. https://doi.org/10.13308/j.issn.2095-9354.2016.03.003

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  Objective       To discuss the clinical significance of networked ECG system applied in community.  Methods       Primary care doctors of community health center screen out the ECGs which require to be consulted or difficult ones, and upload these ECG data to ECG network in our hospital by networked ECG system. Our fulltime clinicians of consultation center consult on those ECGs and provide feedback to community health center. Results       A total of 378 strips of ECGs were collected in our study among which 213 cases were abnormal and 29 were possibly prone to develop malignant cardiovascular events. The missed diagnosis was made in 184 cases (48.68%) and misdiagnosis in 45 ones (11.90%).  Conclusion       The application of networked ECG system in community health center helps in finding critical ECGs timely, correcting misdiagnosis or missed diagnosis and reducing the occurrence of malignant cardiac events. At the same time, it solves the problem of the weak diagnostic ability of primary ECG physicians and improves the medical service of community health center, with favorable results achieved.
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  Application of ECG scatterplot in diagnosis and differential diagnosis of sinus arrhythmia

  ZHANG Xia-Lin

  2016, 25(3): 167-176. https://doi.org/10.13308/j.issn.2095-9354.2016.03.004

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  To discuss the correspondence between ECG manifestation of sinus arrhythmia and figures of Lorenz-RR scatterplot and t-RR scatterplot, and to make secondary differential diagnosis on atypical or easily confused ECG figures, we comparatively analyzed different characteristics of ambulatory electrocardiography(AECG) of 4 kinds of sinus arrhythmias, including nodal tachycardia, sinus bradycardia, sinus irregularity and sinus premature beats, with reverse analysis function of AECG. Non-homologous rhythm can be distinguished out by attractor of Lorenz-RR scatterplot and featured manifestations of graphic distribution of t-RR scatterplot. Every kind of sinus arrhythmia has its characteristic ECG scatterplot which helps in making correct analysis and judgment clinically if combined with ECG.
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  Square shaped figure at the distal end of 45° line in Lorenz scatterplot: analysis on four cases

  WANG Rui, LIU Mo-Qing, ZHANG Xia-Lin

  2016, 25(3): 177-180. https://doi.org/10.13308/j.issn.2095-9354.2016.03.005

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  To investigate the forming principal of square figure at the distal end of 45° line in Lorenz scatterplot and the application of reverse analysis technology in analyzing this kind of figures, this paper analyzes 4 cases whose characteristic manifestation of Lorenz scatterplot matched up with the squareshaped figures produced by escape beat or VVI pacing. By derivation based on mapping principle of scatterplot and reverse analysis, it was found that the squareshaped figure can produce uniquely representative changes according to different dominant rhythm, escape interval, and frequency before and after escape beat. With the reverse analysis technology of ECG scatterplot, the efficiency and accuracy in analyzing and diagnosing such cases can be elevated quickly.
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  Characteristics of electrocardiogram and vectorcardiogram of idiopathic ventricular premature contraction originating from right ventricular outflow tract septum

  JIANG Zhi-Shan, FAN Yong-Mei, XIAO Chun-Xia

  2016, 25(3): 181-187. https://doi.org/10.13308/j.issn.2095-9354.2016.03.006

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  Objective       To investigate the characteristics of electrocardiogram(ECG) and vectorcardiogram(VCG) of idiopathic ventricular premature contraction(IPVC) originating from right ventricular outflow tract septum(RVOTS) verified by radiofrequency ablation(RFA).        Methods       We collected and analyzed the parameters of 12 lead ECG and Frank lead VCG among 14 RVOTS originated IPVC patients verified by RFA with CARDIOView ECG workstation.        Results       In 12 lead ECG, RVOTS originated IPVC was shaped like left bundle branch block. There were 12 cases(85.7%) with precordial transition ratio≥0, 14 cases(100%) with Rwave duration index＜50% in lead V₂, 13 cases(92.9%) with R/Swave amplitude index＜30% in lead V₂, and 12 cases(85.7%) with SV₂/RV₃ index＞1.5. The characteristics of VCG were as follows. In F plane, QRS loop operated in a clockwise(CW) and counterclockwise(CCW) direction in 5 cases(35.7%) respectively; in H plane, it operated in CCW direction in 10 cases(71.4%); in S plane, its operating direction was CW in all the cases(100%); at the first 0.04 s, the amplitude of QRS loop gradually increased, and most of it was oriented leftward, anteriorly and inferiorly; In the period of 0.01[CD*2]0.04 s, leftward vectors gradually increased while anterior ones gradually decreased; the largest vector of QRS loop and the majority of its area was located leftward, inferiorly and backward.        Conclusion       ECG is proved to have high accuracy in the location and diagnosis of RVOTS originated IPVC. Typical characteristics of VCG are found in RVOTS originated IPVC.
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  Diagnostic significance of lead aVR for left main coronary artery disease among acute myocardial infarction patients

  WANG Yu-Ting

  2016, 25(3): 188-192. https://doi.org/10.13308/j.issn.2095-9354.2016.03.007

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  Objective       To explore the diagnostic value of electrocardiogram(ECG) for left main coronary artery disease(LMCA-D) by analyzing the 12 lead ECG of acute myocardial infarction(AMI) patients.  Methods       A total of 4 914 patients were enrolled in our study who had been diagnosed with AMI and undergone coronary arteriography(CAG). In stratified random sampling method and based on CAG results, the sample was divided into LMCA-D group and nonLMCA-D group. We recorded the general clinical data of the two groups and their ECGs in blind measurement. By comparison of ECGs between the two groups, we obtained LMCA-D predictors. Results       Binary logistic regression analysis indicated that ST-segment elevation in lead aVR≥0.05 mV（OR：8.160，P<0.05）was an independent predictor of LMCA-D. With a combination of the five noninvasive indices including ST-elevation in lead aVR≥0.05 mV, ST-segment depression in lead V₄-V₆, the quantity of leads with STsegment depression≥5, low voltage in lead aVF, and QRS complex duration＞100 ms, the diagnostic probability of LMCA-D increased from 25.19% to 69.24%. The five indicators identified LMCA-D with positive predictive values of 52.63%, 32.73%, 26.39%, 16.22% and 22.22%, respectively.  Conclusion       ECG is feasible for predicting LMCA-D in AMI patients and ST-segment elevation in lead aVR≥0.05 mV is quite a favorable ECG indicator. Combination of various indicators helps to improve the diagnostic value of ECG for LMCA-D.
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  Clinical value of ECG in presumptive diagnosis of malignant pericardial effusion

  HUANG Rui-Yan, HAN Feng

  2016, 25(3): 193-195. https://doi.org/10.13308/j.issn.2095-9354.2016.03.008

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  Objective       To explore the clinical value of ECG in presumptive diagnosis of malignant pericardial effusion. Methods       Retrospective analysis was performed on 149 malignant tumor patients complicated with pericardial effusion. The etiology distribution of pericardial effusion was observed and ECG changes were analyzed.  Results       The patients with lung cancer, mammary cancer and lymphadenoma accounted for the majority of the 149 cases. Compared with the patients with benign pericardial effusion, the detection rates of nodal tachycardia, low voltage in chest/full leads and ST-T changes were significantly higher in the cases with malignant pericardial effusion, with statistically significant differences(P＜0.01).  Conclusion       The above ECG changes in primary tumor patients strongly suggest complicated malignant pericardial effusion. Other imaging data such as ultrasonic cardiogram or CT should be combined with ECG for further diagnosis.
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  ECG characteristics of outflow tract originated premature ventricular contraction and their location value for radiofrequency ablation target

  SUN Wei-Hong, LI Wen-Hua

  2016, 25(3): 196-200. https://doi.org/10.13308/j.issn.2095-9354.2016.03.009

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  Objective       To explore the ECG characteristics of premature ventricular contraction(PVC) and their location value for outflow tract originated PVC.        Methods       Retrospective analysis was performed on the figures of 68 successfully ablated cases with right ventricular outflow tract (RVOT) PVC or left ventricular outflow tract (LVOT) PVC. We measured R/S value of precordial leads, switch site of R/S, QRS complex duration of V₂ lead, amplitude and duration indices of R wave in V₂ lead, and then discussed the relationship between each of the above index and radiofrequency ablation target.  Results       There was no significant difference in general circumstances between 54 RVOTPVC and 14 LVOT-PVC patients. The duration of RVOT-PVC was shorter than that of LVOTPVC(P＜0.05). There were 12 cases with R/S switch in V₁-V₂ lead, including 11  LVOT-PVC ones with a specificity of 91.67% and a sensibility of 78.57%; there were 24 cases with R/S switch in V₃ lead, including 21 RVOT-PVC ones with a specificity of 87.50% and a sensibility of 38.89%; there were 32 RVOTPVC cases with R/S switch in V₄-V₆ lead with a specificity of 100% and a sensibility of 59.26%. The location value of amplitude and duration indices of R wave in V₂ lead for RVOT-PVC was low than that for LVOTPVC(P＜0.05). Conclusion       R/S switch has greater diagnostic value for LVOT-PVC in or before V₂ lead and for RVOT-PVC in or before  V₄ lead. When R/S switches in V₂-V₃ lead, the three indices of QRS complex duration, R wave duration index and R wave amplitude index of V₂ lead play important roles in identifying the origin sites of PVC.
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  The relativity between P wave terminal force in lead V₁ and cardiac insufficiency

  JIANG Shan, ZHOU Bei-Bei, WANG Fu

  2016, 25(3): 201-203. https://doi.org/10.13308/j.issn.2095-9354.2016.03.010

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  Objective       To investigate the clinical value of P wave terminal force in lead V₁（PtfV₁） among patients with cardiac insufficiency and the relationship between PtfV₁and left ventricular ejection fraction （LVEF）.Methods       A total of 87 patients with cardiac insufficiency were selected as experimental group who had been admitted by the department of  cardiology in our hospital. Another 85 cases of healthy people were enrolled as control group. We measured and calculated their PtfV₁ in body surface ECG and LVEF in echocardiogram. The differences of the two indices were compared between experimental and control groups. At the same time, we compared the changes of PtfV₁ in experimental group with mild, moderate and severe decline of LVEF[(40-50)%,(30-40)%, and (＜30%)] respectively as well as the index separately between the three subgroups in experimental group and control group. Results       (i) The LVEF value of experimental group was significantly lower than that of control group[(37.32±8.36)% vs. (60.79±6.56)%, P＜0.05], and so was PtfV₁ value[(－0.067±－0.021) mm·svs. (－0.017±－0.009) mm·s, P＜0.05].     (ii) Among the patients separately with mild, moderate and severe decline of LVEF, PtfV₁ value orderly decreased[(－0.047±－0.007) mm·s, (－0.071±－0.010) mm·s, and (－0.095±－0.013) mm·s]. The PtfV₁ value in each of the three subgroups was lower than that in control group, with statistically significant difference(P＜0.05). It indicated that PtfV₁ reduced with the decrease of LVEF. Conclusion       In the patients with cardiac insufficiency, PtfV₁ declines significantly with the decrease of LVEF and the index is positively correlated with the severity of cardiac insufficiency. Therefore,PtfV₁ can be applied in evaluating the severity of cardiac insufficiency as a practical index.
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  ECG characteristics and clinical analysis of atrial flutter complicating alternating Wenckebach phenomenon

  SHEN Li-Ping, XIONG Wang-Qiong, XU Chun-Hong

  2016, 25(3): 204-206. https://doi.org/10.13308/j.issn.2095-9354.2016.03.011

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  Objective       To discuss the ECG characteristics of atrial flutter complicating alternating Wenckebach phenomenon and corresponding clinical significance.        Methods       Retrospective analysis was performed on clinical data of 13 patients with atrial flutter complicating alternating Wenckebach phenomenon. According to ECG manifestations, the research objects can be classified into type A and B.        Results       Ten out of 13 cases were patients with organic heart disease and 3 were nonorganicheartdisease one. Among the 10 organicheartdisease patients, first degree atrioventricular block(AVB) or second degree typed Ⅰ AVB still remained in 7 cases after conversion to sinus rhythm with amiodarone or propafenone. It implied that alternating Wenckebach phenomenon in the 7 cases were mainly pathological block. Two (patients with pneumonia and traumatic brain injury) out of the 3 patients without organic heart disease restored to sinus rhythm and no AVB was found, suggesting functional block. All the 13 patients were clinically cured, or improved and discharged from hospital.        Conclusion       Atrial flutter complicating alternating Wenckebach phenomenon is actually double layer block of atrioventricular node, and type B is slightly more than type A. If the phenomenon is seen in patients with organic heart disease, AVB mostly exists after conversion to sinus rhythm, suggesting a possibility of pathological block. If it is, the dose of antiarrhythmic drugs should be reduced adequately to avoid high or third degree AVB.
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  Application of ECG in clinical detection and prognosis analysis on patients with acute cerebral infarction and cerebral hemorrhage

  ZHANG Xi-Lan

  2016, 25(3): 207-209. https://doi.org/10.13308/j.issn.2095-9354.2016.03.012

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  Objective       To investigate the application of electrocardiogram(ECG) in clinical detection and prognosis analysis on patients with acute cerebral infarction and cerebral hemorrhage.        Methods       Retrospective analysis was performed on clinical data of 105 cases with cerebrovascular diseases, acute cerebral infarction and cerebral hemorrhage, who had been admitted in our hospital. All the enrolled patients were diagnosed by magnetic resonance imaging(MRI) and cranial computer tomography(CT). Comparative analysis was made among the results of MRI, CT and ECG.        Results       Among the 105 cases, there were 69 with ECG abnormalities, and the rate was 65.7%. Specifically, ECG abnormalities were found in 36(63.2%) out of 57 cases with acute cerebral infarction and in 33(68.8%) out of 48 cases with cerebral hemorrhage. ECG abnormalities were mainly arrhythmia, QT interval prolongation, STT changes, obvious U wave, abnormal Q wave, T wave changes and so on. The rate of ECG abnormalities was related to diseased regions. The rate of patients with thalamic lesions was significantly higher than that of patients with other diseased regions. Among 36 cases with normal ECG, 2(5.6%) died while among 69 cases with abnormal ECG, 9(13.0%) died. The difference was statistically significant（P<0.05）.The rate of ECG abnormalities was 48.5%(33/68) among 68 patients without disturbance of consciousness while the rate was 83.8%(31/37) among 37 patients with disturbance of consciousness. The difference was also statistically significant（P<0.05）.  Conclusion       The rate of ECG abnormalities is relatively high in patients with acute cerebral infarction and cerebral hemorrhage, and the types of abnormalities are various. ECG changes can preliminarily serve as evaluation indicators of severity and prognosis.
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  Observation on microembolic signal and D-dimer level of atrial fibrillation patients before and after anticoagulant therapy

  XU Yun, WANG Bing, JIANG Li-Jiao, LU Xiao-Ping, ZHAO Xiao-Ying, WANG Fang

  2016, 25(3): 210-212. https://doi.org/10.13308/j.issn.2095-9354.2016.03.013

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  Objective       To observe the microembolic signal(MES) and D-dimer level of atrial fibrillation patients before and after warfarin anticoagulant therapy.        Methods       A total of 40 persistent atrial fibrillation patients with CHADS2 score≥1 were selected. Each of research object underwent MES monitoring and D-dimer level detection before and after warfarin anticoagulant therapy. We compared the results before and after the treatment.        Results       Before anticoagulant therapy, there were 12 cases with positive MES and 28 with negative MES; after the treatment, 5 cases were positive in MES and 35 were negative.      The positive rate of MES significantly decreased after anticoagulant therapy（30.0% vs. 12.5%，χ²=3.66，P<0.05）.The level of D-dimer was (273±81) μg/L  before anticoagulant therapy and (170±67) μg/L after the therapy. The level of plasmatic D-dimer significantly reduced after the treatment(t=10.09，P<0.05).        Conclusion       Both of MES and  D-dimer level can be regarded as risk evaluation indicators of embolism in atrial fibrillation patients.
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  Predictive value of fragmented QRS complex for cardiovascular events in myocardial infarction patients

  TAN Qi-Rong, FAN Yong-Mei, XIAO Chun-Xia

  2016, 25(3): 213-216. https://doi.org/10.13308/j.issn.2095-9354.2016.03.014

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  As a new noninvasive electrophysiological index, fragmented QRS complex(fQRS) is commonly seen in patients with myocardial infarction. Recently, it is also seen among patients with nonischemic cardiomyopathy, arrhythmogenic right ventricular dysplasia cardiomyopathy, Brugada syndrome and other diseases. fQRS can providing helps in assistance in the diagnosis of myocardial infarction and predicting cardiac mortality and the occurrence of major cardiovascular events of those patients. It also plays significant role in evaluating the therapeutic effect of vascular reperfusion therapy. This paper reviews on the application of fQRS in the prognosis judgment and risk stratification among myocardial infarction patients
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  Advances of research on statin’s application in atrial fibrillation control

  WANG Yong-Sheng, ZHANG Xiao-Hong

  2016, 25(3): 217-221. https://doi.org/10.13308/j.issn.2095-9354.2016.03.015

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  Atrial fibrillation(AF) is the most common public health problem. It has been revealed by research that inflammation and oxidative stress of cardiac muscle cell involve in the structural and electrical remodeling of atrium, which becomes the underlying pathogenesis of AF furtherly. Statins is a kind of 3-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitor. Besides the efficacy of lipidlowering, statin drugs are also anti-inflammatory and antioxidativestress, which improves the remodeling of atrium and thus reduces the incidence of AF. However, the anti-arrhythmic property of statin has not been completely illuminated in clinical practice. Conclusions about its application in the primary or secondary prevention of AF remain controversial.