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目的研究心肌缺血对T波峰末间期(Tpeak-Tendinterval,TpTe)的影响,探讨TpTe与心室肌跨壁复极离散度之间的关系。方法选取运动平板试验诱发心肌缺血的冠心病患者25例和运动平板试验阴性的正常对照30例作为研究对象,所有入选对象均经选择性冠状动脉造影证实。记录所有受试者运动平板试验前静息、运动后恢复期第3min的同步15导联心电图。对研究对象分组、分导联进行同期、运动前后的TpTe、TpTe/RR～(1/2)进行分析。结果①运动平板试验前冠心病组在无心肌缺血的静息状态时,TpTe在V2、V6导联上大于正常对照组有显著性差异(p<0.05);而TpTe/RR～(1/2)在V2～V6导联均与正常对照组无显著性差异(p>0.05)。②在对运动平板试验后的冠心病组和对照组进行比较时发现,诱发心肌缺血的冠心病组的TpTe在V2～V5导联大于正常对照组(p<0.05);而TpTe/RR～(1/2)在V2～V4导联大于正常对照组有显著性差异(p<0.05)。③正常对照组在运动后心率增大时,各导联运动后较运动前的TpTe均明显缩短(p<0.05)、TpTe/RR～(1/2)则无显著性差异(p>0.05)。结论①TpTe、TpTe/RR～(1/2)可以作为反映跨壁复极离散度的无创心电学指标。TpTe/RR～(1/2)独立于心率改变可以作为评价跨壁复极离散度的特征性指标;②运动平板试验中TpTe/RR～(1/2)的增大可作为判断心肌缺血发生的一项指标。
Objective To investigate the effect of myocardial ischemia on Tpeak-Tendinterval (TpTe) and to explore the relationship between TpTe and ventricular transmural repolarization dispersion. Methods Twenty five patients with coronary heart disease induced by exercise treadmill test and 30 normal controls with negative treadmill exercise test were selected as study subjects. All subjects were confirmed by selective coronary angiography. All subjects were recorded before resting treadmill exercise test, exercise 3min after the concomitant recovery of 15-lead ECG. The subjects were divided into groups, sub-lead for the same period, before and after exercise TpTe, TpTe / RR ~ (1/2) were analyzed. Results ①TpTe / RR ~ (1 / T) cells in coronary heart disease group were significantly higher than those in control group at the time point of no myocardial ischemia at treadmill exercise test (P> 0.05) 2) There was no significant difference in the lead of V2 ~ V6 with the normal control group (p> 0.05). (2) Compared with coronary heart disease group and control group after exercise treadmill test, TpTe of lead-induced coronary artery disease in V2 ~ V5 lead group was higher than that of normal control group (p <0.05); while TpTe / RR ~ (1/2) in V2 ~ V4 lead than the normal control group were significantly different (p <0.05). (3) When the heart rate of the control group increased after exercise, the TpTe of each lead was significantly shortened (p <0.05) and TpTe / RR ~ (1/2) no significant difference (p> 0.05) . Conclusion ①TpTe, TpTe / RR ~ (1/2) can be used as a noninvasive ECG to reflect the transmural repolarization dispersion. The change of TpTe / RR ~ (1/2) independent of heart rate can be used as a characteristic index to evaluate the transmural repolarization dispersion. ② The increase of TpTe / RR ~ (1/2) in treadmill exercise test can be used to judge the myocardial ischemia An indicator of what happened.