| Chronic coronary insufficiency refers to blood flow through incompletely blocked coronary arteries,or complete occlusion of the coronary arteries on the basis of collateral circulation,resulting in impaired myocardial blood supply.In coronary atherosclerotic heart disease,referred to as CHD,the location,extent and degree of myocardial ischemia are closely related to the degree of vascular atherosclerosis and the number of lesions.In general,patients with more lesions and severe coronary stenosis will have more severe myocardial ischemia and wider ischemic areas.The golden standard diagnosising approach of myocardial ischemia of CHD is coronary angiography,while ECG is widely used in clinical screening or newly diagnosed CHD because of non-invasive and inexpensive practicality?Compared to the surface ECG,the Vectorcardiogram records the direction and size of electrodynamic force in space generated by each moment of cardiac activity,which can more fully reflect the atrial and ventricular depolarization and repolarization.Stereocardiogram technology has been inherited and developed on the basis of the theory and technology of electrocardiogram and vectorcardiogram in recent years,Observing ECG changes from a three-dimensional perspective of space,the three-dimensional rotation observation function(3D image)is more helpful to observe the situation of myocardial ischemia.In order to further explore the diagnostic value and advantages of Stereocardiogram for myocardial ischemia,we have designed this study.Objective :Coronary angiography results as the gold standard,compared analyzed and probe the sensitivity of the conventional 12-lead electrocardiogram?vectorcardiogram and Sereocardiogram in diagnosising myocardial ischemia of CHD,and observed the changes and characteristics of 3D images,evaluated the value of SECG in the diagnosis of myocardial ischemia in patients with CHD.Method:A total of 156 patients undergoing coronary artery angiography were randomly selected and divided into CHD group(n = 103)and non-CHD group(n = 56)according to the criteria of CHD.Analyze the synchronized ECG,VCG and SECG data of the same ECG workstation and compare the detection results of these three methods.Result:1.To determine myocardial ischemia in CHD:The detection rate of SECG was higher than that of VCG and ECG in the diagnosis of myocardial ischemia of CHD(P <0.05).The specificity,sensitivity,correctness index and diagnostic coincidence rate of SECG in diagnosing myocardial ischemia of CHD was higher than VCG?ECG;2.The detection rate of different lesions of CHD:There was no difference between ECG and VCG in the diagnosis of CHD with multiple coronary lesion in CHD.There was a significant difference between SECG and ECG in one lesion and two lesions,the detection rate was significantly higher than ECG(P <0.05);However,compared with VCG,there was no statistically significant difference(P>0.05).3.Coronary stenosis severity detection rate in CHD:The detection rate of coronary stenosis severity of CHD:The detection rate of SECG was significantly higher than that of ECG in the diagnosis of ? ~ ? stenosis group of CHD(P <0.05),,but there was no significant difference compared with VCG(P >0.05);In the complete occlusion group,although the detection rate of SECG was higher than that of VCG and ECG,the results were not statistically different(P> 0.05).4.By analyzing the features of 3D images and 3D related parameters of CHD group and N-CHD group:Compared with N-CHD group,the proportion of difference between T-ring space orientation and QRS-ring space orientation in CHD group was higher,the difference was significant;The space T ring aspect ratio and ST vector values of CHD group were more than N-CHD group,P<0.05;In other space QRS ring,T-ring,Ta vector,ventricular repolarization gradient and other related parameters,CHD group and N-CHD group showed no significant difference(P>0.05);The two parameters of T-ring L/W ratio and ST-vector were analyzed by ROC curve.The T-ring L/W curve AUC was0.61 and the cut-off value was 0.865.The ST vector AUC was 0.654 and the cut-off was0.095 mv.The results of diagnostic tests showed that the sensitivity of T-ring L/W ratio in diagnosing myocardial ischemia of CHD was 93.81%,and the specificity of ST vector in diagnosing myocardial ischemia of CHD was 83.33%.Conclusion:SECG in the diagnosis of myocardial ischemia of CHD had a certain diagnostic value,and better than VCG?ECG.It is more helpful to diagnose myocardial ischemia of CHD by the changing of three-dimensional T-ring and ST vectors(different orientation of T-ring and QRS annulus,T-ring aspect ratio and space ST vector).It can be used as a noninvasive new technical indicator for clinical diagnosis of myocardial ischemia of CHD. |
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