摘要
Abstract
Objective To investigate the application of electrocardiographic fragmented QRS(fQRS)combined with echocardiography in the diagnosis of acute myocardial infarction(AMI)and the assessment of ventricular arrhythmias in elderly patients.Methods 100 elderly AMI patients admitted to Wuming Hospital Affiliated to Guangxi Medical University from Jan-uary 2022 to March 2024 were retrospectively selected as the observation group.Another 100 patients who were admitted to the hospital due to chest pain and chest tightness during the same period but were ruled out for AMI after examination were selected as the control group.All underwent ECG monitoring and color Doppler echocardiography at admission.ECG index(fQRS oc-currence)and echocardiography indexes[left ventricular ejection fraction(LVEF),left ventricular end-systolic diameter(LVESD),left ventricular end-diastolic diameter(LVEDD)]were compared between the two groups.The receiver operating characteristic(ROC)was used to analyze the diagnostic efficacy of the two examinations for AMI in elderly patients.6 months later,patients in the observation group were divided into arrhythmia subgroup(41 cases)and non-arrhythmia subgroup(59 ca-ses)according to presence or absence of ventricular arrhythmia.The basic data were compared between the two subgroups.Multivariate Logistic regression analysis was performed to identify risk factors for ventricular arrhythmias in elderly AMI pa-tients.ROC analysis assessed the predictive value of ECG and echocardiographic indicators for ventricular arrhythmias.Results The incidence of ECG fQRS in the observation group was higher than that in the control group(31.00％vs 4.00％),LVEF was lower than that in the control group,while LVESD and LVEDD were higher than those in the control group(P＜0.05).The area under the curve(AUC)of the combined diagnosis of fQRS occurrence and echocardiographic indicators for AMI in elderly patients was 0.944,which was higher than the AUC of single diagnosis of each indicator(0.685,0.792,0.794,0.772),and the combined diagnostic value was higher.There were no statistically significant differences in gender,age,smoking history,drinking history,hypertension,hyperlipidemia,diabetes,and the proportion of infarction site between the ventricular arrhythmia subgroup and the non-ventricular arrhythmia subgroup(P＞0.05).The incidence of fQRS in the ar-rhythmia subgroup was higher than that in the non-arrhythmia subgroup,LVEF was lower than that in the non-arrhythmia sub-group,LVESD and LVEDD were higher than those in the non-arrhythmia subgroup(P＜0.05).The results of multivariate lo-gistic regression analysis showed that high incidence of fQRS,LVESD,LVEDD,and low LVEF were risk factors for ventricu-lar arrhythmia in elderly AMI patients(P＜0.05).The AUC value of fQRS,LVEF,LVESD,and LVEDD combined in pre-dicting ventricular arrhythmia in elderly AMI patients was 0.921,which was higher than the single prediction value of each in-dicator.Conclusion The ECG fQRS and echocardiographic indicators of elderly AMI patients show abnormal manifestations,and their combined detection has certain value in the diagnosis of AMI and prediction of ventricular arrhythmia in elderly patients.关键词
老年/急性心肌梗死/室性心律失常/心电图碎裂QRS波/超声心动图/预测价值Key words
elderly/acute myocardial infarction/ventricular arrhythmia/ECG fragmentation QRS wave/echocardio-graphy/predictive value
