Study Of The ECG Waterfall Diagram For Rapid Identification Of ST-T Changes

Object:This paper aims to observe and summarize the morphological characteristics of ECG waterfall diagram in patients with ST-T changes,and compare it with the traditional 24-hour dynamic ECG diagnosis method,and to explore the clinical value of ECG waterfall diagram in rapid identification of ST-T changes,so as to provide new means for rapid identification of ST-T changes.Method:Through the American DMS12.5.0076 a version of dynamic electrocardiogram and ECG waterfall analysis system,the continuous 24-hour dynamic electrocardiogram and ECG waterfall diagram of patients who underwent 24-hour dynamic electrocardiogram examination in the ECG room of the First Affiliated Hospital of Dali University from January16,2020 to January 16,2021 collected by 12-channel dynamic electrocardiogram recording box were retrospectively analyzed.The specific analysis includes : 1.The performance of ST-T changes in ECG waterfall diagram;2.The artificial diagnosis results were used as the gold standard.The sensitivity,specificity,accuracy,positive predictive value and negative predictive value of ECG waterfall diagram and traditional methods in the diagnosis of ST-T changes were analyzed.SPSS26.0 software was used for data analysis.The measurement data were expressed as（x ± s）,and the count data were expressed as n（%）.Kappa test was used to evaluate the consistency of ECG waterfall diagram and traditional methods with gold standard by K value.Mc Nemer test was performed for the diagnosis results of ECG waterfall diagram and traditional method,and P < 0.05 indicated that there was statistical significance.ROC curve was used to compare the diagnostic results of ECG waterfall diagram and traditional methods,and the diagnostic effects of reclassification improvement index（NRI）and comprehensive discriminant improvement index（IDI）were compared.Result:1.A total of 1632 cases were selected,including 931 males（57.05%）and 701 females（42.95 %）.The age of the selected cases was between 5 and 96 years old,with an average age of（58.96 ± 15.957）years old.There were 375 patients with ST-T changes（22.98 %）,including 239 males（63.73 %）and 136 females（36.27 %）.The age was between 14 and89 years old,with an average age of（61.83 ± 13.755）years old.Among them,159 cases（42.40 %）were between 14 and 60 years old,198 cases（52.80 %）were between 61 and 80 years old,and 18 cases（4.80 %）were over 80 years old.2.The ST-T changes in the ECG waterfall diagram are shown as follows :（1）ST segment moves downward : T wave is negative,most of the ST band in the ECG waterfall diagram presents dark blue,and a small part presents blue and black;t wave is positive,ST band is mostly blue-black and a small part is dark blue in ECG waterfall diagram.T wave low level,ST band in ECG waterfall can be expressed as dark blue or blue black;t wave is bidirectional,ST band is dark blue in ECG waterfall diagram;（2）ST segment elevation : T wave is negative.In the ECG waterfall diagram,the ST band increases with the increase of ST segment elevation,and its color has a trend of blue-yellow-red gradual change.T wave forward,in the ECG waterfall,ST band mostly showed bright blue,some showed dark blue;t wave low level,ST band in ECG waterfall diagram showed bright blue;two-way T wave,ST band also increased with ST segment elevation in ECG waterfall diagram,its color has a blue-yellow-red gradient trend;（3）T wave change : T wave is negative,and it is shown as blue-black T valley band in ECG waterfall diagram,which has nothing to do with the change of T wave amplitude and ST segment;t wave is positive,which is shown in the ECG waterfall diagram as the T peak band gradually changing from light blue to bright blue to yellow to red with the increase of T wave amplitude;t wave low level in ECG waterfall diagram showed a light blue band under ST band,which was similar to the color of TP band.T wave two-way,positive and negative two-way in the ECG waterfall diagram shows the top of the color with the positive T wave amplitude changes in the T peak,below the blue and black T valley,negative two-way is the opposite.3.The sensitivity,specificity,accuracy,positive predictive value and negative predictive value of ECG waterfall diagram in identifying ST-T changes were 97.33 %,99.28 %,98.84 %,98.66 % and 99.21 %,respectively.The ECG waterfall diagram was highly consistent with the gold standard（Kappa = 0.967,P < 0.001）.The sensitivity,specificity,accuracy,positive predictive value and negative predictive value of traditional 24 h dynamic electrocardiogram in the diagnosis of ST-T change were 78.13 %,99.92 %,94.91 %,99.65 % and 93.87 %,respectively.The consistency with the gold standard was strong（Kappa = 0.845,P < 0.001）.There were significant differences in the recognition of ST-T changes between ECG waterfall diagram and traditional 24-hour dynamic ECG（P < 0.001）.There was no significant difference in sensitivity between ECG waterfall diagram and traditional 24 h dynamic ECG,and the difference in specificity was statistically significant（P < 0.05）.The area under the ROC curve（AUC）of traditional 24 h dynamic ECG was 0.890,and the AUC of ECG waterfall diagram was 0.983.NRI was 0.1856,IDI was 0.1856（P < 0.001）.Conclusion:1.ST-T changes have characteristic changes in ECG waterfall diagram,which can be used as a fast,simple and accurate method to judge ST-T changes.2.ECG waterfall diagram has more advantages in identifying ST-T changes than traditional 24-hour dynamic ECG method.