| Objective To collect the early repolarization(ER)population,analyze the clinical data of different Antzelevitch types group,and evaluate the potential clinical value of twenty-four hours dynamic electrocardiogram(Holter),transthoracic echocardiography(TTE)and other related indicators for risk stratification of ER population,so as to provide help for further assessment of the risk degree of ER population.Methods By accessing the medical record management system and electrocardiogram(ECG)registration system of Gansu Provincial People’s Hospital,443 inpatients with ER by ECG from January 2019 to June 2022 were screened by inclusion and exclusion criteria,and169 eligible Antzelevitch types groups were included(54 cases in type 1 group distributed in anterolateral leads,75 cases in type 2 group distributed in inferior leads,40 cases in type 3group distributed in inferior + lateral leads),and 60 healthy subjects in the same period were selected as the control group,and 229 subjects were finally included in the study.The common data,ECG parameters,heart rate variability(HRV)index,number of ventricular premature beat,TTE indicators and the incidence of severe cardiac events was followed up to analyze whether there were differences in these indexes among the four groups.Results1.Detection rate of ER: There were 319649 inpatients,and 443 cases of ER were detected,with a detection rate of 0.14%.2.Distribution characteristics of ER:(1)The gender distribution of ER is mainly male(73.37%);(2)The age distribution of ER is mainly from 51 to 60 years old(31.36%);(3)ECG characteristic distribution of ER:(1)J wave morphology: slur accounted for 55.62%,and notch accounted for 44.38%.(2)J wave amplitude: < 0.2 m V accounted for 73.37%,and ≥ 0.2m V accounted for 26.63%.(3)The morphology of the ST segment after J wave: ascending ST segment accounted for 79.88%,and horizontal or descending ST segment accounted for20.12%.(4)J wave distribution: anterolateral leads accounted for 31.95%,inferior leads accounted for 44.38% and all leads accounted for 23.67%.3.Comparison of common data: There was no significant difference in age,sex,smoking history,hypertension history,diabetes history,total cholesterol(TC),and triglycerides(TG),and other indicators among the four groups(P>0.05).4.Comparison of ECG parameters: There was no significant difference in heart rate,PR interval and QRS duration between the four groups(P>0.05).The QTc interval among the four groups was statistically significant(P<0.05),and the results of pairwise comparison showed that types 1,2 and 3 were lower than the control group,with statistically significant differences(P<0.05).5.Comparison of HRV time domain indexes: There was significant difference in HRV time domain indexes among the four groups(P<0.05),and the results of pairwise comparison showed that the type 1 group was lower than the type 2 group,the type 1 group was lower than the type 3 group,the type 2 group was lower than the type 3 group,the control group was lower than the type 3 group,with statistically significant differences(P<0.05).There was no significant difference between the type 1 group and the control group(P>0.05).6.Comparison of the number of ventricular premature beat: There was significant difference among the four groups(P<0.05),and the results of pairwise comparison showed that the type 1 group was lower than the type 2 group,the type 1 group was lower than the type 3 group,the type 2 group was lower than the type 3 group,the control group was lower than the type 3 group,with statistically significant differences(P<0.05).There was no significant difference between the type 1 group and the control group(P>0.05).7.Comparison of TTE indexes: There was no significant difference in left atrial diameter(LAD),aortic diameter(AOD),and other indicators among the four groups(P>0.05).8.Follow-up: None of the study subjects had a serious cardiac event of sudden cardiac death(SCD),ventricular fibrillation(VF),or sustained ventricular tachycardia(VT).Conclusion1.The ER population is predominantly male,middle-aged and elderly,and the ECG distribution is dominated by slur type,amplitude < 0.2 m V,ascending ST segment,and inferior leads.2.There was significant difference in HRV among ER population with different Antzelevitch types,and the type 3 group is abnormal,followed by the type 2 group,and there was no significant difference between the type 1 group and the control group.3.Holter detection of HRV-related indicators helps to distinguish benign and malignant forms of ER,while TTE has no specificity in distinguishing benign and malignant forms of ER.4.ER population have autonomic abnormalities and imbalances and are at increased risk of malignant arrhythmias,and the possibility of arrhythmia in type 3 group was higher than that in type 2 and type 1.The risk degree should be carefully evaluated and the prognosis should be followed up,and intervention should be given if necessary. |
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