摘要
目的 探讨心电向量图参数与儿童肺动脉压相关性及对肺动脉高压(pulmonary hypertension,PH)的预测效能.方法 选取2020 年2 月—2024 年2 月收治的124 例疑似PH患儿,根据临床最终诊断结果分为PH组60 例和无PH组64 例,入院后均行心电图检查,同步记录常规心电图、心电向量图,比较 2 组基线资料及平均肺动脉压(mPAP)及心电图向量参数(QRS最大向量振幅、心室复极梯度方位角、QRS最大向量仰角、心室复极梯度仰角、QRS最大向量方位角、心室复极梯度振幅、QRS-T比值、QRS-T夹角),分析心电图向量参数与mPAP相关性及对PH的影响,受试者工作特征(ROC)曲线分析心电图向量参数对PH的预测效能.结果 PH组窦性心律患儿占比低于无PH组,房性心动过速、右心室肥大、房室传导阻滞患儿占比及mPAP高于无PH组(P＜0.01).PH组心室复极梯度方位角、QRS最大向量仰角、心室复极梯度仰角、QRS最大向量方位角、QRS-T夹角高于无PH组,心室复极梯度振幅低于无PH组(P＜0.01).心室复极梯度方位角、QRS最大向量仰角、心室复极梯度仰角、QRS最大向量方位角、QRS-T夹角与mPAP呈正相关(r=0.697、0.766、0.836、0.623、0.793,P＜0.001、＜0.001、＜0.001、＜0.001、＜0.001),心室复极梯度振幅与mPAP呈负相关(r=-0.828,P＜0.001).Logistic回归分析显示,心室复极梯度方位角、QRS最大向量仰角、心室复极梯度仰角、QRS最大向量方位角、心室复极梯度振幅、QRS-T夹角对PH有影响(P＜0.01).ROC曲线分析显示,心室复极梯度方位角、QRS最大向量仰角、心室复极梯度仰角、QRS最大向量方位角、心室复极梯度振幅、QRS-T夹角联合预测PH的AUC为0.924,敏感度为78.33%,特异度为92.19%.结论 心电向量图参数与肺动脉压力具有显著相关性,临床可通过心电向量图参数预测评估PH,以针对性制订干预方案,改善预后.
Abstract
Objective To investigate the correlation between vectorcardiogram(VCG)parameters and pulmonary hy-pertension(PH)in children and their predictive efficacy.Methods A total of 124 children with suspected PH admitted from February 2020 to February 2024 were selected and divided into the PH group(n=60)and the non-PH group(n=64)ac-cording to the final results of clinical diagnosis.Electrocardiogram(ECG)examination was performed after admission,and routine ECG and VCG were recorded simultaneously.Baseline data,mean pulmonary artery pressure(mPAP)and VCG pa-rameters(QRS maximum vector amplitude,ventricular repolarization gradient azimuth,QRS maximum vector elevation,ven-tricular repolarization gradient elevation,QRS maximum vector azimuth,ventricular repolarization gradient amplitude,QRS-T ratio,and QRS-T angle were higher in PH group than in non-PH group,while between the two groups.The correlation be-tween VCG parameters and mPAP and their impact on PH were analyzed,and the predictive efficiency of VCG parameters on PH was analyzed by receiver operating characteristic(ROC)curve.Results The proportion of children with sinus rhythm in PH group was lower than that in PH group,while the proportion of children with atrial tachycardia,right ventricular hypertro-phy,atrioventricular block block and mPAP were higher than those in PH group(P＜0.01).The ventricular repolarization gradient azimuth,QRS maximum vector elevation,ventricular repolarization gradient elevation,QRS maximum vector azimuth and QRS-T angle in PH group were higher than those in PH group,and the ventricular repolarization gradient amplitude was lower than that in PH group(P＜0.01).Ventricular repolarization gradient azimuth,QRS maximum vector elevation,ven-tricular repolarization gradient elevation,QRS maximum vector azimuth and QRS-T angle were positively correlated with mPAP(r=0.697,0.766,0.836,0.623,0.793,P＜0.001、＜0.001、＜0.001、＜0.001、＜0.001),while ventricular repolar-ization gradient amplitude was negatively correlated with mPAP(r=-0.828,P＜0.001).Logistic regression analysis showed that ventricular repolarization gradient azimuth,QRS maximum vector elevation angle,ventricular repolarization gradi-ent elevation Angle,QRS maximum vector azimuth angle,ventricular repolarization gradient amplitude,QRS-T angle had effects on PH(P＜0.01).ROC analysis showed that the AUC of ventricular repolarization gradient azimuth,QRS maximum vector elevation angle,ventricular repolarization gradient elevation angle,QRS maximum vector azimuth angle,ventricular re-polarization gradient amplitude,and QRS-T angle in combination to predict PH was 0.924,with a sensitivity of 78.33%and a specificity of 92.19%.Conclusion VCG parameters have significant correlation with pulmonary artery pressure,and PH can be predicted and evaluated by VCG parameters in clinical practice,so as to formulate targeted intervention plan and im-prove prognosis.
维普
万方数据