【作者】 陈宁；

【导师】 陈明龙；

【作者基本信息】 南京医科大学 ， 内科学（心血管病）（专业学位）， 2024， 硕士

【摘要】 背景:既往研究提出多种基于体表心电图(electrocardiogram,ECG)的指标用于预测特发性室性心律失常(idiopathic ventricular arrhythmias,IVAs)的起源,但准确性欠佳或计算繁琐限制了这些指标的临床应用。本研究旨在探讨体表ECG胸前导联参数及其组合成的指标对于鉴别右室流出道(right ventricular outflow tract,RVOT)和主动脉窦(aortic sinus of Valsalva,ASV)起源的IVAs的价值。方法:我们回顾性连续纳入2018年3月1日至2021年12月1日期间于南京医科大学第一附属医院接受RVOT和ASV起源的IVAs消融并且获得成功的患者。分别在室性心律失常下测量体表ECG所有胸前导联R波和S波的振幅和时限参数。我们将这些参数两两之间进行求和、减法、乘法或除法运算以组成各种指标。根据曲线下面积(area under the curve,AUC),我们得到准确性最高的指标,并将其与既往研究提出的指标进行比较。结果:本研究共纳入150例IVAs患者(男性:60例,平均年龄:45.3±16.4岁)。在460种体表ECG参数组合成的预测指标中,RV1+RV3指数(V1导联和V3导联的R波振幅之和)的AUC值最高(0.942),并且高于目前所报道的其他12导联ECG指标:R/S波振幅指数(AUC=0.904)、R波时限指数(AUC=0.867)、V2S/V3R指数(AUC=0.890)、V2移行比(AUC=0.882)、V1-V2S-R差值(AUC=0.849)和移行区指数(AUC=0.785)。RV1+RV3指数>1.3m V预测ASV IVAs的敏感度为95%,特异性为83%。在V3导联移行的患者中,RV1+RV3指数的AUC值为0.892,RV1+RV3指数>1.3m V预测ASV IVAs的敏感度为93%,特异性为75%。结论:RV1+RV3指数是可以准确区分RVOT IVAs和ASV IVAs的一种简单、新颖的指标,其预测性能优于既往研究提出的指标。RV1+RV3指数可以作为预测IVAs起源的一项重要指标。更多还原

【Abstract】 Background:Previous studies have proposed a variety of electrocardiogram（ECG）-based indexes to predict the origin of idiopathic ventricular arrhythmias（IVAs）,however,their clinical application is limited by the accuracy and availabilty.This study aimed to investigate the predictive value of parameters of every precordial lead and their combinations in differentiating between idiopathic ventricular arrhythmias（IVAs）from the right ventricular outflow tract（RVOT）and aortic sinus of Valsalva（ASV）.Methods:Between March 1^st,2018 and December 1^st,2021,consecutive patients receiving successful ablation of RVOT or ASV IVAs were enrolled.The amplitude and duration of the R wave and S wave were measured in every precordial lead during IVAs.These parameters were either summed,subtracted,multiplied,or divided to create different indexes.The index with the highest area under the curve（AUC）to predict ASV IVAs was developed and compared with established indexes.Results:A total of 150 patients（60 male;mean age,45.3±16.4 years）were included in the study.The RV1+RV3 index（summed R wave amplitude in leads V1 and V3）had the greatest AUC（0.942）,which is greater than the established indexes:R/S amplitude index（0.904）,R duration index（0.867）,V2S/V3R index（0.890）,V2 transition ratio（0.882）,V1-V2 S-R difference（0.849）and transition zone index（0.785）.An RV1+RV3 index>1.3 m V could predict ASV IVAs with a sensitivity of 95%and a specificity of 83%.In patients with V3 R/S transition,an RV1+RV3 index>1.3 m V could predict ASV IVAs,with an AUC of 0.892,a sensitivity of 93%and a specificity of 75%.Conclusions:The RV1+RV3 index is a simple and novel criterion that accurately differentiates between RVOT and ASV IVAs.Its performance outperformed established indexes,making it a valuable tool in clinical practice.更多还原