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• 2016 Volume 25 Issue 4
  Published: 28 August 2016

    

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  Relationship between cardiac repolarization abnormality and sudden cardiac death

  ZHENG Ming-Qi, LIU Yan-Gong

  2016, 25(4): 229-232. https://doi.org/10.13308/j.issn.2095-9354.2016.04.001

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  Sudden cardiac death(SCD) is a leading cause for sudden death, which is characterized by rapid progression and no omen before the onset of disease. Therefore, it is of great value clinically to identify the patients with high risk of SCD. With the deepening of research, the relationship between cardiac repolarization abnormality and SCD has been gradually revealed. This paper briefly describes the relationship between the manifestations of cardiac repolarization abnormality and SCD, and the underlying mechanisms.
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  Diagnostic value of ECG ST-T changes for coronary heart disease

  SU Guan-Li, HAN Cai-Li, JI Wen-Qiang, LIU Gang

  2016, 25(4): 233-239. https://doi.org/10.13308/j.issn.2095-9354.2016.04.002

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  Objective   To judge whether the diagnostic value of ST-T changes for coronary heart disease(CHD) is higher than other indices. Methods    A total of 385 patients were enrolled in our study, who had been admitted in the department of Cardiology in our hospital and underwent coronary arteringraphy(CAG). The ST-T changes of their ECGs were recorded statistically by Minnesota code, and the relationship between CAG results and ECG changes was analyzed. In addition, the patients with positive CAG results were classified according to the severity of CHD, and the relationship between ST-T changes of ECG and the severity of CHD was evaluated. Results    In all the 385 cases who had undergone CAG examination, there were 297 cases with positive results in whom 177 were observed positive ECG changes; there were 88 cases with negative results in whom 30 were observed positive ECG changes, and the difference was statistically significant(P＜0.000 1). Among the patients with positive CAG results, 97 cases were diagnosed with single vessel disease including 48 case with positive ECG results and 49 with negative ECG results; Two hundred cases were diagnosed with multivessel coronary artery disease including 129 case with positive ECG results and 71 with negative ECG results, and the difference was statistically significant(P＜0.05). Conclusion    If we analyze ECG with the standard of ST-T changes by Minnesota code, ST-T changes will be found clinically valuable in diagnosing CHD. Among the patients who were diagnosed with CHD, ST-T changes prove to have diagnostic value for the ones with multi-coronary artery disease.
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  Research progress on the relativity between fragmented QRS complex and sudden cardiac death

  LIU Gang, MA Fang-Fang

  2016, 25(4): 240-243. https://doi.org/10.13308/j.issn.2095-9354.2016.04.003

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  Fragmented QRS complex(fQRS) is regarded to derive from conduction delay caused by myocardial scar, which is commonly seen in patients with coronary heart disease and myocardial infarction, and also in patients suffering from cardiomyopathy and congenital heart disease. Clinically, fQRS plays important roles in the prediction, prevention and treatment of arrhythmogenic right ventricular cardiomyopathy, and the early warning of Brugada syndrome and nonischemic cardiomyopathy. Since the risk stratification of sudden cardiac death(SCD) is obviously bounded in major risk factors and predictors, it is required to explore new noninvasive electrocardiologic examination method. fQRS can be considered as one of the important parts in the risk stratification or risk score of SCD.
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  Clinical value of treadmill exercise test in the diagnosis and prognosis risk evaluation of coronary heart disease

  XU Yong-Shun, LIU Gang, WANG Mei-Fang

  2016, 25(4): 244-247. https://doi.org/10.13308/j.issn.2095-9354.2016.04.004

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  Objective    To investigate the clinical value of treadmill exercise test(TET) in the diagnosis and prognosis risk evaluation of coronary heart disease. Methods   A total of 206 patients with suspected coronary heart disease were selected who had been admitted in our hospital from March 2012 to March 2014. All the enrolled cases underwent examinations of coronary angiography(CAG) and TET within two weeks after admission. Taking CAG results as diagnostic criteria, we evaluated the accuracy of TET results. Result    In the diagnosis of coronary heart disease by TET, the diagnostic accordance rate was 84.1%, the specificity was 73.2%, the sensitivity was 89.7%, and the diagnostic accuracy was 62.4%. The positive rate was 79.3%, 83.1% and 100% respectively for patients separately with lesions in single vessel, two and three vessels; pairwise comparison among the three groups indicated that the differences were statistically significant(P<0.05). Conclusion    TET is a noninvasive inspection method with relatively high diagnostic accordance rate, specificity and sensitivity. It is worthy of being promoted and applied clinically.
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  Recent progress on vasospastic angina and ECG changes of early repolarization

  GU Yun-Fei

  2016, 25(4): 249-250. https://doi.org/10.13308/j.issn.2095-9354.2016.04.005

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  Vasospastic angina(VSA) is one of the causes of pectoralgia in patients without obvious coronary artery stenosis. It can be accompanied with malignant arrhythmias such as ventricular tachycardia and ventricular fibrillation. ECG of early repolarization was mostly considered to be benign change in the past. Recently, more research verifies the predictive value of ECG changes of early repolarization for the occurrence of malignant arrhythmias. However, less research concerns on the role ECG changes of early repolarization take in predicting the occurrence of malignant arrhythmias among VSA patients. This paper reviews the latest clinical research.
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  Electrocardiographic features of vasospastic angina

  YANG Qin, ZHANG Qi, WANG An-Cai, WANG De-Guo

  2016, 25(4): 251-256. https://doi.org/10.13308/j.issn.2095-9354.2016.04.006

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  Vasospastic angina (VSA) is usually seen in patients with normal coronary artery or no severe coronary artery stenosis. This paper mainly focuses on the ECG changes of VSA patients. Typically ECG changes are usually observed in VSA patients. Peaked and symmetrical T waves appeared in the ECGs of nearly half of them; progressive elevating ST segment appeared if the spasm continued and then gradually fell down after a few minutes. The ECG changes associated with ST-segment elevation also included R-wave heightening and S-wave diminution; the rise of TQ-segment slope, and electrical alternations of ST-segment elevation and T-wave deeply inversion were observed in some cases. In addition, ventricular arrhythmia is usually accompanied with VSA.
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  Current status of clinical application of remote ECG monitoring

  DING Yu-Ting, WANG De-Guo, WANG An-Cai

  2016, 25(4): 261-264. https://doi.org/10.13308/j.issn.2095-9354.2016.04.008

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  Cardiovascular diseases mostly have high mortality with rapid and dangerous occurrence, which are usually detected by routine electrocardiogram(ECG) or 24hour ambulatory electrocardiography(AECG). However, restricted by recording time, location and other factors, it is often difficult for ECG and AECG to capture abnormal ECG signals in time. Remote ECG monitor is small and portable, which makes it suitable for longterm and realtime monitoring. Therefore, in order to reduce the incidence of cardiovascular events effectively, it is essential to apply remote ECG monitoring in detecting abnormal ECG signals in time for diagnosis and treatment at an early phase. This paper briefly reviews the current status of clinical application of remote ECG monitoring.
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  Clinical application value of telemonitoring ECG information system

  SHENG Jing-Yu, SHI Hong-Jian, SUN Wei-Hong, YANG Ling-Ling

  2016, 25(4): 265-267. https://doi.org/10.13308/j.issn.2095-9354.2016.04.009

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  Objective    To discuss the clinical application value of telemonitoring ECG(TTECG) information system. Methods    The Holter data of 63 patients were selected which were transmitted from branch hospital to ECG consultation center of central hospital from June 2015 to May 2016. The enrolled patients were divided into network transmission group(31 cases) and artificial transmission group(32 cases). Holter recorder was utilized in collecting Holter data in primary hospital; the data were then transmitted to ECG consultation center artificially or by local area network, respectively; ECG specialist physicians made diagnosis. The starting time of diagnosis was classified into within 1 h, 1-5 h and 5-10 h. During different time periods, the diagnosed cases were made comparison and analysis between the two groups. Results    The starting time of diagnosis in network transmission group was significantly earlier than that in artificial transmission group[(1.2±0.5) h vs. (8.7±2.0) h，P＜0.05]. If the starting time of diagnosis was within one hour, network transmission group diagnosed 26 cases(83.9%) in all while none of the patients was diagnosed by artificial transmission group. If the starting time of diagnosis was 1-5 h, the diagnosed cases were separately 5 cases(16.1%) and 12 cases(37.5%) in the two groups. If the starting time of diagnosis was 5-10 h, none of the patients was diagnosed by network transmission group while artificial transmission group diagnosed 20 cases(62.5%). The difference was statistically significant(P＜0.01). Conclusion    TTECG information system applied in primary hospitals can shorten consultation hours for patients, and realize remote data sharing and consultation. It also has advantage in detecting cardiovascular events in time. It may improve the level of diagnosis and treatment in primary hospitals, and has great clinical practical value.
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  Relationship between TpR index and symptoms of idiopathic outflow tract premature ventricular contraction

  ZHANG Qi, ZHAO Chun-Mei, WANG De-Guo, YANG Qin, LI Xiao-Rong, ZHANG Feng-Xiang, CAO Ke-Jiang

  2016, 25(4): 271-274. https://doi.org/10.13308/j.issn.2095-9354.2016.04.011

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  Objective    To analyze the relationship between arrhythmic symptoms of the patients with outflow tract premature ventricular contraction(PVC) and characteristics of surface electrocardiogram(ECG), and to explore its clinical significance. Methods    According to the existence of PVCrelated arrhythmic symptoms, 97 outflow tract PVC patients were divided into two group: symptomatic group(60 cases) and asymptomatic group(37 cases). The examination of echocardiography and standard 12 lead surface ECG were performed on all the patients. The measured parameters included PVC burden, the width of PVC complex, coupling interval, index of PVC coupling interval(PVC coupling interval÷sinus RR cycle×100%), TpR interval of PVC(the duration from sinus T peak before PVC to the starting point of PVC) and TpR index of PVC(TpR interval of PVC÷sinus TpR interval×100%). The relationship between the above measured parameters and arrhythmic symptoms was analyzed. Results    In the symptomatic group, the index of PVC coupling interval, TpR interval of PVC and TpR index of PVC were significantly higher than those in the asymptomatic group(P<0.05). However, there was no statistically significant difference of PVC burden, origin of PVC or other ECG parameters between the two groups. Spearman correlation analysis showed that PVCrelated symptoms were significantly positively correlated with the index of PVC coupling interval(r=0.324, P<0.05), TpR interval of PVC(r=0.272, P<0.05) and TpR index of PVC(r=0.457, P<0.05). Conclusion    PVCrelated symptoms are associated with higher index of PVC coupling interval and TpR index for patients with outflow tract PVC. Those symptoms are related to the delayed emergence of PVC, which is helpful in the control of PVC clinically.
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  Atrioventricular block in patients with acute inferior wall myocardial infarction and the infarction related artery

  YANG Xiao-Yun

  2016, 25(4): 275-277. https://doi.org/10.13308/j.issn.2095-9354.2016.04.012

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  Atrioventricular block is a common complication of acute inferior wall myocardial infarction. Both of left and right coronary artery disease can lead to inferior wall myocardial infarction. Since coronary artery supplies blood flow to different sites and areas of myocardium, the degree and scope of myocardial infarction resulted from artery lesions are also different, corresponding to various ECG manifestations. Abundant clinical experience and electrocardiographic knowledge help to identify the infarction related coronary artery and determine the sites of occlusion(proximal end, middle or distal end) and also help to work out a reasonable emergency reperfusion therapy to save patients lives.
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  Predictive effect of heart rate turbulence on longterm prognosis of old myocardial infarction patients

  LU Ting-Yi, CHEN Jiao, TIAN Hong

  2016, 25(4): 278-281. https://doi.org/10.13308/j.issn.2095-9354.2016.04.013

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  Objective    To explore the predictive effect of heart rate turbulence(HRT) on longterm prognosis of old myocardial infarction(OMI) patients. Methods    A total of 127 OMI patients who had been admitted in our hospital from March 2014 to June 2015 were selected.[JP] According to the range of Nterminal probrain natriuretic peptide(NT-proBNP) value and HRT, they were classified into NT-proBNP＜1 800 ng/L group and NT-proBNP≥1 800 ng/L group, and HRT normal group(TO＜0 and TS＞2.5) and HRT abnormal group[TO≥0 and(or) TS≤2.5]. In the follow-up one year later, the incidences of major adverse cardiovascular events(MACE) were analyzed statistically; the difference and relativity of MACE incidences between HRT normal group and HRT abnormal group, HRT normal group and NT-proBNP＜1 800 ng/L group, and HRT abnormal group and NT-proBNP≥1 800 ng/L group were separately compared. Results     The incidences of MACE(except for the rate of sudden death) in HRT abnormal group were all significantly higher than those in HRT normal group, with statistically significant differences. However, neither of the differences of MACE incidences(except for the rate of sudden death) between HRT normal group and  NT-proBNP＜1 800 ng/L group, and HRT abnormal group and NT-proBNP≥1 800 ng/L group was statistically significant. Conclusion    HRT has some predictive effect on longterm prognosis of OMI patients. The difference of predictive effect between HRT and NT-proBNP is not obvious.
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  Relativity between morning blood pressure and 24hour blood pressure in elderly people

  CHEN Xu-Feng, DENG Xiao-Yan, FAN Jing-Jing, LIN Fan, HUANG Fen, XU Chun-Fang, YANG Xiao-Yun

  2016, 25(4): 282-284. https://doi.org/10.13308/j.issn.2095-9354.2016.04.014

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  Objective    To investigate the relationship between morning blood pressure  and 24 hour blood pressure in elderly people. Methods    The research objects were selected from the elderly people who had undergone ambulatory blood pressure monitoring(ABPM) in our hospital from September to October in 2015. According to ABPM results, 44 hypertensive patients with increased average 24hour blood pressure and another 44 cases with normal average 24hour blood pressure were taken into our study, separately as hypertension group(group A) and control group(group B). Between the two groups, both of the average morning and 24hour blood pressure were compared, and the relativity between morning and 24hour systolic(diastolic) pressure was explored. Results    In group A, the average level of morning and 24hour blood pressure were higher than those in group B. The morning systolic(diastolic) pressure in group B was positively correlated with 24hour systolic(diastolic) pressure, and the differences were statistically significant(P ＜0.001). Conclusion    To a certain extent, morning blood pressure can reflect the level of 24hour blood pressure in elderly people. It is suggested to promote morning blood pressure management actively in elderly people.
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  Application of ECG in diagnosing acute myocardial infarction in hyperacute phase

  HUANG Dong

  2016, 25(4): 285-287. https://doi.org/10.13308/j.issn.2095-9354.2016.04.015

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  Objective    To investigate the clinical value of ECG in diagnosing acute myocardial infarction(AMI) in hyperacute phase. Methods    Ninety patients diagnosed with AMI in hyperacute phase by our hospital from January 2013 to January 2015 were selected. They were randomly divided into three groups: A(55 cases), B(18 cases) and C(17 cases), with onset time of ≤2 h, 2-6 h and 6-8 h, respectively. Twenty-four hour ECG monitoring was carried out on the three groups. The changes of Q-wave, ST-segment and T-wave were carefully recorded, and the rates of positive changes were made statistic analysis. Results    It was observed by 24hour ECG monitoring that positive ECG changes of all the enrolled cases were mainly Q-wave, ST-segment and T-wave changes. The sensitivity and specificity, and positive and negative predictive value of STsegment and T-wave changes were all higher than those of Qwave changes in diagnosing AMI in hyperacute phase. The incidence of positive ECG changes among the three groups was 81.82%, 38.89% and 17.65% in turn, with the rate of group A significantly higher than that of group B and C(P＜0.05). In the patients of group A, the diagnostic positive rate of ECG in the cases with STsegment elevation myocardial infarction was significantly higher than that in non-ST-segment elevation myocardial infarction patients(34.09% vs. 18.18%, P＜0.05). Conclusion    It is critical to carry out 24-hour ECG monitoring on AMI patients in hyperacute phase, especially those within 2 hours of onset, in order to make accurate diagnosis and timely treatment. Wide and towering T-, and ST-segment elevation can be regarded as characteristic ECG manifestations of AMI in hyperacute phase, which provide references for clinical diagnosis and treatment.
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  Analysis of deceleration capacity of rate and heart rate variability in patients with liver cirrhosis

  XUE Ni-Na, WU Yue-Ping

  2016, 25(4): 288-290. https://doi.org/10.13308/j.issn.2095-9354.2016.04.016

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  Objective    To investigate the changes of autonomic nervous function in patients with liver cirrhosis. Methods    Time domain analysis of heart rate variability(HRV) and analysis of heart rate deceleration(DC) were performed on 90 patients in liver cirrhosis group and 78 normal cases in control group. Results    Compared with the control group, SDNN, SDANN, rMSSD and pNN50 significantly decreased(P<0.01) in liver cirrhosis group, and so did DC(P<0.05). For liver cirrhosis patients with different Childpugh classification, the more severe the degree of liver cirrhosis was, the more significantly the time domain indices of HRV, and DC decreased. Conclusion    Autonomic nervous dysfunction can occur in patients with postvirushepatitis cirrhosis at different level of liver function damage.
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  About the incorrect description of ventricular repolarization order: discussion on ventricular depolarization and repolarization process, and direction consistency mechanism of QRS-T

  YUAN Jie

  2016, 25(4): 291-293. https://doi.org/10.13308/j.issn.2095-9354.2016.04.017

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  In traditional opinion, the direction consistency of QRST is resulted from the fact that the location depolarized first is repolarized after. It confuses the concepts of depolarization and repolarization, in which 3 phases are mistakenly regarded as the whole of repolarization, 2 phases are taken as the continuation of depolarization, and the variation of repolarization process is attributed to external causes without noticing the huge difference of electrophysiologic features in ventricular myocytes. Actually, where is depolarized first is necessarily repolarized first, but where is depolarized after is repolarized faster and finishes earlier, which makes membrane potential gradient of the whole ventricle points to outer membrane. Therefore, the vectors of QRS and T orient to almost the same direction.
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  Relationship between gastroesophageal reflux disease and atrial fibrillation

  CUI Li, LI Guang-Ping, LIU Tong

  2016, 25(4): 294-297. https://doi.org/10.13308/j.issn.2095-9354.2016.04.018

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  Atrial fibrillation(AF) is the most common sustained arrhythmia which contributes to the increasing mortality risk in clinical practice. Gastroesophageal reflux disease(GERD) is commonly seen in the department of Gastroenterology. It refers to discomfortable symptoms and(or) complications caused by the reflux of gastric contents into esophagus. It was reported that gastroesophageal reflux may give rise to AF. Inflammation, vagal stimulation and chronic atrial ischemia may be important potential mechanisms; inflammatory responses and autonomic nervous dysfunction take part in the onset and development of AF and GERD. Based on correlative domestic and foreign references, this paper reviews the relationship between AF and GERD, and its possible mechanisms.
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  New insight into the mechanisms of new onset atrial fibrillation after acute myocardial infarction and methods for risk prediction

  LUO Jia-Chen, DAI Li-Ming, WEI Yi-Dong

  2016, 25(4): 298-302. https://doi.org/10.13308/j.issn.2095-9354.2016.04.019

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  Newonset atrial fibrillation(NOAF) after acute myocardial infarction(AMI) is a kind of arrhythmia commonly seen after myocardial infarction, with an incidence rate ranging from 5% to 23%. It has been verified by several clinical research that NOAF can significantly increase the mortality during hospitalization of AMI patients or outofhospital longterm risk of death. This paper reviews the pathogenic mechanisms of NOAF after AMI and risk prediction methods in recent years. At present, there is still no enough evidence of evidencebased medicine for the treatment of this kind of arrhythmia, which is especially important for the prevention of NOAF. It is critical for its prevention to understand its pathophysiological mechanism and thus to master the method for identifying the highrisk patients as early as possible.