|
|
|
| Clinical Value of 18-Lead Electrocardiogram Combined with Echocardiography in Diagnosing Coronary Heart Disease with Myocardial Ischemia and Localizing Culprit Vessels |
| LI Xiaomin |
| Department of Electrocardiography, Xun County People's Hospital, Hebi Henan 456250 |
|
|
|
|
Abstract 【Objective】 To explore the clinical value of 18-lead electrocardiogram (ECG) combined with echocardiography in diagnosing coronary heart disease (CHD) complicated with myocardial ischemia and localizing culprit vessels. 【Methods】 A total of 82 patients with suspected CHD scheduled for coronary angiography admitted to our hospital from June 2023 to January 2025 were prospectively enrolled. According to coronary angiography findings, patients were divided into observation group (hemodynamically significant stenosis, n=56) and control group (no significant stenosis, n=26). The diagnostic performance of 18-lead ECG, echocardiography and their combination (defined as positive if either test showed positive result) was compared. Hierarchical Logistic regression models were established: Model 1 contained clinical baseline data; Model 2 added 12-lead ST-T changes based on Model 1; Model 3 supplemented ST-T abnormalities from additional leads of 18-lead ECG on the basis of Model 2; Model 4 incorporated echocardiographic wall motion abnormalities into Model 3. The area under the receiver operating characteristic curve (AUC) and incremental diagnostic value of each model were analyzed. 【Results】 Fifty-six patients were confirmed to have hemodynamically significant coronary stenosis. For the diagnosis of myocardial ischemia, 18-lead ECG yielded a sensitivity of 76.79%, specificity of 73.08% and AUC of 0.749; echocardiography showed a sensitivity of 73.21%, specificity of 76.92% and AUC of 0.751. Combined detection achieved a higher sensitivity of 91.07%, specificity of 69.23% and AUC of 0.802, which were all superior to single examination (P<0.05). The AUC values of Model 1 to Model 4 were 0.702, 0.752, 0.781 and 0.832 respectively. Compared with Model 4, Model 1, Model 2 and Model 3 had significantly lower AUCs with DeLong test P values of 0.004, 0.021 and 0.047 separately. The variance inflation factor (VIF) of all models was less than 5 without obvious multicollinearity, and the Hosmer-Lemeshow test showed P>0.05 for all models. 【Conclusion】 In patients admitted to chest pain center, 18-lead ECG and echocardiography have respective advantages in identifying hemodynamically significant myocardial ischemia in CHD patients. Their combination presents favorable overall diagnostic efficiency, which can be applied as a comprehensive evaluation protocol for patients with moderate-to-high risk suspected coronary heart disease.
|
|
Received: 27 January 2026
|
|
|
|
|
|
[1] 葛均波, 徐永健, 王辰. 内科学[M]. 9版. 北京:人民卫生出版社, 2018: 218.
[2] 张凌志,余凌祺,王云鹤,等.十二导联心电图的起始激动速度和终末激动速度在宽QRS心动过速鉴别诊断中的价值研究[J].中国实用内科杂志,2024,44(11):921-927.
[3] 曹玉怡,覃华,卢才德.多导联心电图识别的稳定步长ResNet深度网络[J].广西大学学报(自然科学版),2024,49(2):374-385.
[4] 梁丽杰,刘慧临,李璐,等.超声心动图结合血清bFGF、MCP-1水平对无症状性心肌缺血冠脉病变程度的诊断价值[J].中国老年学杂志,2023,43(24):5892-5895.
[5] 李全池,黄鑫,罗成思,等.融合单导联心电图传统与深度特征的常见心律失常识别方法研究[J].中国生物医学工程学报,2022,41(1):31-40.
[6] NIJJER S S, PABARI P A, STEGEMANN B, et al. The ischaemic constellation: an alternative to the ischaemic cascade: implications for the validation of new ischaemic tests[J].Open Heart,2015,2(1):e000178.
[7] 何静,吴俊林.导联动态心电图诊断冠心病心肌缺血的检测作用[J].现代科学仪器,2023,40(1):91-95.
[8] 郭潮,张慧,陈敏,等.血清miR-24联合动态心电图在冠心病无症状心肌缺血患者中的诊断价值[J].西部医学,2023,35(3):372-376.
[9] 黄莉,任梅梅.冠心病合并心力衰竭患者心电图PTFV1绝对值与左心室舒张功能的相关性[J].医学临床研究,2024,41(3):379-381.
[10] 崔岩,封杰,许科鹏,等.动态心电图联合冠状动脉CT血管成像在诊断冠心病心肌缺血中的应用[J].医学影像学杂志,2024,34(7):160-161.
[11] PELLIKKA P A, ARRUDA-OLSON A, CHAUDHRY F A, et al. Guidelines for performance, interpretation, and application of stress echocardiography in ischemic heart disease: from the American Society of Echocardiography[J].J Am Soc Echocardiogr,2020, 33(1):1-41.
[12] 王清松,陈韬,韩宝石,等.智能可穿戴十二导联心电图在心血管疾病远程诊疗中的应用研究[J].中国循环杂志,2022,37(7):738-744.
[13] 陈茜茜,冉红. 超声心动图在冠心病诊疗中的应用现状及研究进展[J].心血管病学进展,2024,45(9):782-786.
[14] 李媛媛,袁先琢,汪俊秋,等.24 h动态心电图联合血清H-FABP、cys C、BNP水平检测对老年冠心病心肌缺血的诊断价值[J].贵州医科大学学报,2025,50(2):294-299. |
|
|
|
2026, Vol. 43 
