Clinical Significance Of ST-T Changes Of Holter Monitoring Electrocardiogram In Patients With Negative Coronary Angiography

BackgroundsCoronary heart disease(CHD)is a kind of heart disease caused by coronary atherosclerosis,which leads to stenosis or occlusion of the lumen,ischemic hypoxia or necrosis of myocardial cells.It is also called ischemic heart disease(IHD),and it is a common disease that seriously endangers human health.At present,selective coronary angiography is still the internationally recognized gold standard for the diagnosis of coronary heart disease.It is generally believed that coronary angiography is positive for stenosis of left and right main coronary artery and their branches with diameter more than 2 mm or more,which will seriously affect the blood supply of coronary artery and lead to myocardial ischemia and hypoxia.Combined with the relevant clinical manifestations,coronary heart disease can be diagnosed.On thecontrary,coronary angiography is negative for no stenosis or stenosis of lumen less than 50%.However,coronary angiography is an invasive means of examination,which is relatively expensive and requires high equipment,personnel and technology.It can not be used as a screening method for coronary heart disease in clinic.Holter monitoring electrocardiogram(Holter)can continuously record and automatically analyze synchronous 12-lead electrocardiogram for 24 hours or more.Because of its relatively low cost,easy operation,and not limited by time or location,Holter is widely used in the clinical screening of coronary heart disease.The ST-T segment depression detected by Holter is correlated with myocardial ischemia in coronary heart disease.The time of abnormal ECG appearing is contrasted with the patient’s activity and clinical symptoms.The degree and dynamic changes of ST-T segment depression are helpful to the diagnosis of coronary heart disease and occult myocardial ischemia can also be detected.However,it is the response of surface cardiac electrical activity,and can not directly observe the coronary artery.Some other types of heart disease,electrolyte disturbance,drugs and other factors can also affect ventricular repolarization,leading to ST-T changes,so it has a certain false positive rate in the diagnosis of coronary heart disease.At present,there are few reports about the clinical factors related to ST-T changes in ambulatory electrocardiogram with negative coronary angiography.Further studies are needed in order to accurately diagnose coronary heart disease and make appropriate clinical intervention in the future.AimThe purpose of this study was to explore the influencial factors associated with ST-T changes in Hoter minitoring electrocardiogram in patients with negative coronary angiography,and to provide evidence for the management of these patients in the future.MethodsA total of 166 patients with negative coronary angiography were enrolled in Department of Cardiology,the First Affiliated Hospital of Zhengzhou Universityfrom September 2016 to July 2018.The patients were allocated into ST-T changed group(65 cases)and ST-T normal group(101 cases)according to the result of Holter.Clinical data,such as general information(sex,age,hypertension,diabetes mellitus,smoking,drinking,body mass index),laboratory examination(blood routine,fasting blood glucose,electrolyte,lipid,thyroid function),Holter(ST-T changes),cardiac ultrasound(left atrial diameter,left ventricular diameter,interventricular septum thickness,left ventricular posterior wall thickness and left ventricular ejection fraction),were collected and compared between the two groups.The relationship between patients’ influential parameters and ST-T changes of ambulatory electrocardiogram were analyzed by multivariate logistic regression analysis.Results(1)Among 166 patients,68 were males and 98 were females.The incidence of ST-T changes was 39.16%,22.06% for males,51.02% for females.females were higher than that of males(P < 0.05).(2)General clinical data comparison: ST-T change group of all patients was higher than ST-T normal group in female,hypertension,LAD,LVEF,while drinking,smoking,blood potassium,hemoglobin concentration was lower than ST-T normal group(P < 0.05).According to the results of sex stratification analysis,the ST-T change group of female patients was higher than that of ST-T normal group in hypertension,LAD and BMI(P < 0.05),and there was no significant difference in the above-mentioned clinical data between the abnormal ST-T group and the normal ST-T group of male patients(P > 0.05).(3)Multivariate regression analysis: In all patients,the above factors with statistical differences(sex,hypertension,LAD,LVEF,drinking,smoking history,blood potassium,hemoglobin)were analyzed by multiple logistic regression analysis.The results showed that only gender(OR=3.728,95%CI:1.833-7.581,P<0.001)and hypertension(OR=2.243,95%CI:1.150-4.374,P=0.018)were included in the regression equation.ConclusionFemale and hypertension are risk factors for ST-T changes of Holter in patients with negative coronary angiography.