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Objective:To explore the relationship between fragmented QRS complex and heart rate variability (HRV) and ventricular arrhythmia in patients with old myocardial infarction.Methods:From August 2018 to October 2019, 200 patients with old myocardial infarction were first treated in the Department of cardiac function examination of the First Affiliated Hospital of Hebei North University. The patients were divided into 99 cases of old myocardial infarction with fragmented QRS wave group and 101 cases of old myocardial infarction without fragmented QRS wave group according to the case bank data and conventional 12 lead ECG diagnosis in our hospital for the first time. Then, the 24-h ambulatory ECG reexamined within 1 year after discharge was retrospectively analyzed. The incidence of ventricular arrhythmia was compared between the two groups by χ 2 test. The difference of heart rate variability between the two groups was compared by rank sum test. Multiple logistic regression was used to analyze the value of different indexes of heart rate variability in the evaluation of fragmented QRS complex in old myocardial infarction. Drawing the receiver operating characteristic (ROC), and the area under the curve (AUC) was used to analyze the diagnostic accuracy of different indexes of heart rate variability in the broken QRS complex of old myocardial infarction. Results:According to the Lown classification of ventricular premature contraction, the number of positive ventricular arrhythmias in patients with Grade Ⅰ of ventricular premature contraction and Grade Ⅲ-Ⅴ of ventricular premature contraction in the old myocardial infarction fragmented QRS group was higher than that in the old myocardial infarction non fragmented QRS group (Grade Ⅰ of ventricular premature contraction: 54.5% (54/99)and 39.6%(40/101); χ 2=4.484, P<0.05;Grade Ⅲ-Ⅴ of ventricular premature contraction: 34.3% (34/99) and 9.9%(10/101); χ 2=17.406, P<0.05)). Ventricular premature contraction Grade 0 old myocardial infarction fragmented QRS group was lower than old myocardial infarction non fragmented QRS group (8.1% (8/99) and 48.5% (49/101); χ 2=37.995, P<0.05). The total number of positive cases of ventricular arrhythmia in the old myocardial infarction group with fragmented QRS wave was higher than that in the old myocardial infarction group without fragmented QRS wave (91.9% (91/99) and 51.5%(52/101); χ 2=57.146, P<0.05)). There was no significant difference in the number of positive ventricular arrhythmias between the old myocardial infarction fragmentation QRS group and the old myocardial infarction non fragmentation QRS group ( P>0.05). The standard deviation of NN intervals (SDNN) and the standard deviation of average NN intervals (SDANN) of HRV time domain indexes in the old myocardial infarction fragmented QRS group were higher than those in the old myocardial infarction non fragmented QRS Group (SDNN:143.00(122.00,166.00) vs. 110.00(95.00,130.50), Z=5.780, P<0.05; SDANN:112.00(100.00,136.00) vs. 96.00(76.00,118.50), Z=4.013, P<0.05). Multiple Logistics regression analysis results of HRV domain shows that HRV time domain SDNN and SDANN have diagnositic value in diagnosis fQRS after OMI(SDNN: OR=0.949, 95% CI:0.922-0.977, P<0.001; SDANN: OR=1.036, 95% CI:1.005-1.068, P=0.022). Area under ROC curve of HRV time domain SDNN and SDANN have particular diagnositic accuracy in diagnosis fQRS after OMI(SDNN: AUC 0.737, 95% CI 0.666-0.807, Sensitivity 0.818, Specificity 0.634; SDANN: AUC 0.664, 95% CI 0.587-0.741, Sensitivity 0.737, Specificity 0.673. 0.5<AUC<1). Conclusion:Fragmented QRS complex was positively correlated with the incidence and severity of ventricular arrhythmia in patients with old myocardial infarction, and positively correlated with time-domain indexes SDNN and SDANN of heart rate variability in patients with old myocardial infarction.
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Objective To investigate the relationships of peripheral blood levels of interleukin 6 receptor (IL-6R),a disintegrin and metalloprotease with thrombospondin type 1 motifs (ADAMTS-1) and high sensitive C reactive protein (hs CRP) with Gensini score and Ambrose classification in patients with coronary heart disease,and to investigate the correlations of IL-6R,ADAMTS-1 and hsCRP levels with unstable coronary atherosclerotic plaques.Methods 328 patients undergoing coronary angiography were admitted,and 272 patients were diagnosed as coronary heart disease including 105 cases with acute myocardial infarction (AMI),126 cases with unstable angina peetoris (UA) and 41 cases with stable angina pectoris (SA).The 56 cases with no coronary artery stenosis were selected as control group.We detected the levels of IL-6R,ADAMTS 1 and hs-CRP in all patients,and then evaluated their Gensini scores by coronary angiography,and appraised the character of the plaque by Ambrose classification.Results The serum levels of IL 6R and ADAMTS-1 were higher in AMI and UA groups than in SA and normal control groups (all P＜0.05).The level of hsCRP was higher in AMI group than in UA,SA and control groups (all P＜0.05).The levels of IL-6R,ADAMTS 1 and hs-CRP were higher in complex lesion group evaluated by Ambrose classification than in simple lesion group and normal control group (all P＜0.05).ADAMTS-1 level was higher in simple lesion group than in normal control group (P＜0.05).The level of IL 6R was positively correlated with ADAMTS-1 levels (r=0.70,P＜0.05),while the serum IL-6R,ADAMTS-1 and hsCRP levels had no relationship with Gensini score in patients with coronary heart disease (all P＞ 0.05).Conclusions The IL-6R,ADAMTS-1 and hs-CRP levels can be the indexes for evaluating the plaque stability in patients with coronary heart disease,but have no relationships with the severity of coronary artery stenosis.
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Objective To explore the effects of fentanyl combined with ischemic post-processing on the pro-tein active concentration of superoside dismutase ( SOD) and the concentration of manlondialdehyde ( MDA) in rab-bits after myocardial ischemia and reperfusion injury.Methods The left anterior descending coronary artery were li-gated for 30 minutes and then reperfusion for 120 minutes to establish myocardial ischemia-reperfusion model of rab-bit.32 Japanese white rabbits were randomly divided into four groups by randomized block method(8 rabbits in each group):Sham-operated group(group S):seperate LAD without ligation;ischemia-reperfusion group(group I/R):re-store reperfusion directly;ischemic post conditioning group( group IPOC):restore reperfusion after ischemic post con-ditioning (filling for 30s/ischemia for 30s,three rounds);combination of fentanyl and ischemic post conditioning group( group F+IPOC):fentanyl post conditioning by ear marginal vein after ischemia 28 minutes,the dose was 5μg/kg, and after 30min,the rabbits was given ischemic post conditioning and then restored reperfusion.Then the differences in the protein active concentration of SOD and in the concentration of MDA were detected.Results The concentra-tion of MDA in the group F+IPOC were lower than that in the group IPOC[(3.52 ±0.45)mmol/mL vs (4.42 ± 0.47)mmol/mL,F =81.619,P <0.01].But the protein active concentration of SOD increased significantly [(178.38 ±20.32)U/mL vs (130.18 ±20.44)U/mL,F=59.359,P<0.01].Conclusion Fentanyl combined with ischemic post-processing can reduce the concentration of MDA and increase the protein active concentration of SOD significantly,which has the effect to decrease the myocardial ischemia and reperfusion injury.
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Objective To observe the dynamic changes of endothelial progenitor cells (EPC)and vascular endothelial growth factor (VEGF) in the patients with acute myocardial infarction (AMI)after percutaneous transluminal coronary intervention (PCI). Methods The level of VEGF before and after PCI in 50 cases with AMI were determined by fluorescence immunoassay and enzyme-linked immunosorbnent assay (ELISA),and the ratio of EPC in flood was checked by flow cytometry.Results The level of EPC was higher after PCI than before PCI [(4.15 ± 0.22)％ vs.(0.59 ±0.02) ％,P＜0.01],and there were positive correlations between EPC and number of coronary artery disease (r=0.45,P ＜ 0.05 ),coronary artery lesions ( r =0.76,P ＜ 0.01 ),left ventricular enddiastolic diameter (r=0.68,P＜0.01),ejection fraction (r=0.75,P＜0.01).The VEGF levels after PCI was increased [(506± 120)μg/L vs.(204±98)μg/L,P＜0.01],and its level was positively related with coronary lesions (r=0.66,P＜0.01),left ventricular ejection fraction(r=0.90,P＜0.01).There was association between rising rates of EPC and VEGF in a short time after PCI within 24 h period (r=0.56,P＜0.01). Conclusions The clinical efficacy and prognosis can be assessed by the changes of VEGF level and EPC ratio before and after PCI operation in AM1 patients.