Electrocardiogram Indexes Changes Of HRV,Frontal QRS-T Angle And PtfV1 And The Prognostic Value In Patients With Acute Coronary Syndrome

Objective: The purpose of this study was to study the electrocardiogram parameters changes of Heart rate variability(HRV),frontal plane QRS-T angle and P wave terminal force in lead V1(PtfV1)in different risk stratification with acute coronary syndrome(ACS)patients,the relationship between their changes and the major adverse cardiovascular events(MACEs)was analyzed,and to investigate the prognostic value of the electrocardiogram indexes changes of HRV,frontal QRS-T angle and PtfV1 in patients with ACS.Methods: 120 patients of ACS who visited the emergency department of Bao Gang hospital from October 2019 to November 2020 were selected.The data of patients,routine surface 12/18 ECG at admission and Holter monitoring results within 3 hours after admission were collected,global registry of acute coronary events(GRACE)at admission was calculated,and the patients were divided into low-risk group,intermediate-risk group and high-risk group;the standard deviation of normal RR intervals(SDNN)was used as the analysis parameter of HRV,SDNN was defined as70 ms,frontal QRS-T angle was defined as 90 °,and PtfV1 was defined as-0.04 mm.s,and to observe the changes of ECG parameters HRV,frontal QRS-T angle and PtfV1 in different risk strata;after 3 months of follow-up,MACEs(including sudden cardiac death,recurrent non-fatal myocardial infarction,acute heart failure,unstable angina and occurrence of serious arrhythmia)in patients was recorded,and the relationship between the changes of HRV,frontal QRS-T angle and PtfV1 and the MACEs in ACS patients was analyzed using logistic regression to investigate the role of the three ECG parameters in the prognostic evaluation of ACS patients.Results: 1.Comparison results of baseline data,the age,heart rate at admission,creatinine,c Tn I,and Killip class ≥ II accounted for a higher proportion in the high-risk group than in the intermediate-risk and low-risk groups,and the age,heart rate at admission,creatinine,c Tn I,and Killip class ≥ II accounted for a higher proportion in the intermediate-risk group than in the low-risk group;the systolic blood pressure at admission was lower in the high-risk group than in the intermediate-risk and low-risk groups,and the systolic blood pressure at admission was lower in the intermediate-risk group than in the low-risk group(P < 0.05).2.The SDNN value of the high-risk group was lower than the intermediate-risk and low-risk groups,and the SDNN value of the intermediate-risk group was lower than the low-risk group;the frontal QRS-T angle and negative values of PtfV1 of the high-risk group were higher than the intermediate-risk and low-risk groups,and the frontal QRS-T angle and negative values of PtfV1 in the intermediate-risk were higher than the low-risk group(P < 0.05).In the high-risk group,the probability of SDNN ≤ 70 ms,frontal QRS-T ≥90 ° and PtfV1 ≤-0.04 mm.s were higher than medium risk group and low risk group.In the medium risk group,the probability of SDNN ≤ 70 ms,frontal QRS-T ≥90 ° and PtfV1 ≤-0.04 mm.s were higher than low risk group(P < 0.05).3.According to the follow-up results,the age,GRACE score,Gensini score,frontal plane QRS-T angle and negative PtfV1 level of patients in the MACE group were higher than those in the non-MACE group,and the SDNN level was lower than that in the non-MACE group(P < 0.05).4.The logistic regression analysis showed that SDNN,frontal QRS-T angle or PtfV1 were the risk factors for the development of3-month MACEs in ACS patients.(P < 0.05).5.Plotting the ROC curve yielded that the area under the curve of SDNN,frontal QRS-T angle,and PtfV1 value was 0.822,0.791,0.798(P<0.05),the sensitivity was 0.743,0.714,0.686,the specificity respectively was 0.812,0.765,0.812 respectively;the area under the curve of SDNN combined with frontal QRS-T angle,SDNN combined with PtfV1,and frontal QRS-T angle combined with PtfV1 was 0.857,0.864,0.841(P < 0.05),the sensitivity was0.771,0.800,0.714,and the specificity respectively was 0.835,0.776,0.847 respectively.Conclusion: 1.The abnormal decrease of HRV,the abnormal increase of frontal QRS-T angle and the abnormal increase of negative values of PtfV1 are all related to the occurrence of MACEs in ACS patients;2.The predictive value of any two of HRV frontal QRS-T angle and PtfV1 for the occurrence of MACEs in ACS patients is higher than that of a single index,and the combination of HRV and PtfV1 has the highest value in predicting the prognosis of ACS patients.