动态心电图Lorenz散点图与冠状动脉慢性完全闭塞病变预后的相关性分析OA

Objective To investigate the prognostic significance of dynamic electrocardiogram(DCG)Lorenz scatter plot in patients with coronary artery chronic total occlusion(CTO).Methods A total of 100 patients diagnosed with CTO via coronary angiography were selected from the hospital from December 2018 to December 2020.All patients underwent coronary angiography,percutaneous coronary intervention(PCI),and stent implantation upon admission,followed by routine pharmacological therapy.Holter monitoring was con-ducted prior to PCI.Patients were followed up for one year and categorized into good prognosis and poor prog-nosis groups based on the occurrence of cardiovascular adverse events.The study compared parameters inclu-ding mean heart rate(HR),heart rate variability(HRV),atrial premature beats,ventricular premature beats,atrioventricular block,atrial fibrillation,ventricular tachycardia,and Lorenz scatter plots between the two groups.The diagnostic value of the Lorenz scatter plot and HRV Standard Deviation of Normal-to-Normal In-tervals(SDNN)in predicting the prognosis of CTO patients was evaluated using receiver operating character-istic(ROC)curve analysis.Results Among the 100 patients,58 exhibited a favorable prognosis while 42 had an unfavorable prognosis.In the favorable prognosis group,the incidence of atrial fibrillation was 15.51%,with(364.81±195.03)ventricular premature beats,(0.21±0.11)episodes of ventricular tachycardia,and(1.63±1.18)episodes of atrioventricular block per 24 hours.In contrast,in the poor prognosis group,the in-cidence of atrial fibrillation was 19.05%,with(2 093.86±1 732.20)ventricular premature beats,(0.82±0.14)episodes of ventricular tachycardia,and(3.21±1.83)episodes of atrioventricular block per 24 hours.There was no statistically significant difference in the incidence of atrial fibrillation between the two groups(P>0.05).However,the frequencies of ventricular premature beats,ventricular tachycardia,and atrioventric-ular block were significantly lower in the favorable prognosis group compared to the poor prognosis group.The Lorenz plot analysis revealed that 86.2%of patients in the favorable prognosis group exhibited a comet shape,which was significantly higher than the 31.0%observed in the poor prognosis group(P<0.001).Ad-ditionally,the incidences of four-distribution and irregular distribution in the favorable prognosis group(3.5%and 1.7%,respectively)were lower than those in the poor prognosis group(19.0%and 23.8%,respective-ly),with statistically significant differences(P<0.05).These findings suggested that scatter plot distribution could serve as a valuable reference for predicting patient prognosis.Furthermore,the morphology of the Lorenz scatter plot was identified as a graded variable with an area under the curve(AUC)of 0.795(P=0.050,95%CI 0.698-0.893),while SDNN,a continuous variable,had an AUC of 0.747(P=0.054,95%CI 0.641-0.852).Both the Lorenz scatter plot morphology and the SDNN-derived heart rate variability AUC ex-ceeded 0.5,indicating their potential diagnostic value in prognostic prediction.Conclusion The distribution characteristics of the Lorenz scatter plot derived from Holter monitoring are associated with the prognosis of CTO,and can serve as a valuable tool for evaluating CTO prognosis.