| Purpose:With the rapid development of the cure for coronary disease in clinical trial, an increasing number of doctor will be seemed as a preferred alternative of therapeutic intervention to coronary disease. Therapeutic intervention indeed improves the prognosis of the patient with coronary heart disease. Whereas along with huge amount of clinical research, it turns out that not all the patient with therapeutic intervention get benefit from it. As the case stands, whether the interventional treatment can produce benefit or not depends on a certain amount of viable myocardium in distal lesion. At the moment, ahead of clinical therapeutic intervention for stenosis of coronary heart disease, the means for accurate evaluation of viable myocardium distal vascular criminal case are such as MRI, PET-CT, and OCT, etc. that are expensive and long learning curve inspection items. And now coronary intervention treatment is widely popular in the primary hospital, whereas the popularity of these expensive and time-consuming inspection items are far behind the pace of development of interventional therapy. Therefore, among all the patients received interventional treatment, only a small number of cases involved in taking these evaluation tools to assess whether it is beneficial. Thus, at present, for coronary intervention is still based on the judgment of anatomy, it uses the degree of stenosis as decisions indicators to determined whether to intervene.Since the standard surface-lead ECG and ECG monitoring began clinical applications, clinical studies mostly focused on the change of ECG morphology and parameters during the time period from ischemic myocardial to necrosis occurred. At the moment, according to the study of physiological and pathological myocardium, ECG parameter changes directly representing the change of the viable cardiac electrophysiological function, it can be considered that Ischemia-induced electrocardiographic changes are on behalf of the existence of viable myocardium. But the vast majority of patients in interventional therapy are with stable clinical condition, and the insufficient distal Lesion blood supply caused by intervention is only short-term transient myocardial ischemia. So unfortunately, now most of the clinical findings are not supposed to be applied blindly in clinical application by standard lead ECG monitoring to judge whether middle and distal myocardium after an intervention will have acute myocardial ischemia. At present, only a few targeted research in this change on ECG parameter for brief transient myocardial ischemia.This study is use of transient blocking in coronary blood flow caused by balloon dilatation during the process of interventional treatment to the patient with coronary heart disease, simulating acute myocardial ischemic attack, to collect the changes between hyper acute standard lead ECG monitoring and baseline after an attack of myocardial ischemia. It can be summed up with the clinical ECG indicators therefrom in use of evaluating ischemia through super acute myocardial ischemia. Clinically, this indicator can not only be applied in hyper acute myocardial ischemia diagnosis, in the meanwhile, based on the study of relationship between ECG changes and pathophysiology of coronary heart disease, after distal coronary blood flow briefly blocked, but also assess whether the presence of viable myocardium occurs or not.Method:From October 2014 to October 2015, there are 54 patients diagnosed with coronary heart disease by coronary arteriography. Application of Coronary intervention in patients with onset of dynamic ECG changes, decreased movement echocardiography, myocardial voltage mapping and other means to determine the culprit vessels in patients with myocardial ischemia caused. During the procedure, it's as usual to inspect standard surface lead ECG monitoring and intercept its segment before balloon dilatation to collect ECG indicators such as repolarization of the cardiac parameters, cardiac depolarization parameters, and cardiac basic rhythm indicators, etc. And then within 1 to 5 minutes after balloon dilatation, the most obvious changes of standard lead ECG, it's time once again to collect ECG indicators mentioned above. Thereby analyze ECG indicators changes of standard surface lead ECG monitoring in the course of acute myocardial ischemia.Results:1 Repolarization index:The difference was statistically significant in QT interval before and after balloon dilatation(P<0.05). The difference was statistically significant in Tp-Te interval before and after balloon dilatation(P<0.05). The difference was statistically significant in QTc interval before and after balloon dilatation( P<0.05). The difference was statistically significant in JTc interval before and after balloon dilatation(P<0.05).2 Changes of QTc interval in patients with different coronary artery branches after intervention:QTc interval prolongation group occurred in the intervention of the left coronary artery, the anterior wall of the myocardium and ischemic injury of the side wall(P<0.05). QTc shortened group and no significant changes group didn't have obvious different in the intervention of different coronary artery(P>0.05).3 Arrhythmia: There was statistical significance in the difference of ventricular premature contraction before and after balloon dilation(P<0.05). Before and after the intervention, there was statistical significance in the occurrence of atrioventricular block(P<0.05). The intervention of bundle branch block is also the same with statistical significance(P<0.05). The occurrence of arrhythmia in patients with acute myocardial ischemia was statistically significant(P<0.05).4 Compared with the arrhythmia group and non-arrhythmia group: The Tp-Te interval between the two groups after balloon dilation has significant statistical difference(P<0.05).5 Composite ECG index: QTc/RR has significant difference before and after balloon dilatation(P<0.05). JTc/RR has significant difference before and after balloon dilatation(P<0.05).Conclusion:Non-cardiac repolarization index, comparing to simulation of balloon dilatation for acute myocardial ischemia(AMI), its index indeed has an obvious change, which represents that in early acute myocardial ischemia(AMI), myocardial function is only abnormal in repolarization, yet depolarization function works properly. Traditional ST-T changes, and arrhythmias are also of significance for hyper acute myocardial ischemia(AMI). Nevertheless, due to the short time of myocardial blood supply interruption, ST-T changes and arrhythmias myocardial ischemia are not like traditional typical findings of myocardial ischemia ECG possibly. Among the patient with coronary heart disease and arrhythmias, compared to the other cases of ECG repolarization indicators, its index has obvious changes during the period of Tp-Te, which means that the repolarization process of three-tier structure of ventricular myocardium, that are not synchronized, causes increased dispersion of repolarization that is the main reason of arrhythmias attacks, and also means that repolarization dysfunction patients may have a greater risk of arrhythmias. Compared to the traditional ECG indicators that predicts the onset of acute myocardial ischemia and arrhythmia, new composite ECG index in this study also showed a good clinical value in the changes of QTc/RR and JTc/RR in acute myocardial ischemia(AMI). |
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