Diagnostic value of dynamic electrocardiogram parameters combined with serum myocardial injury markers in silent myocardial ischemia in coronary atherosclerotic heart disease

ZHOU Hongle; JING Xigai; KONG Shuangyan

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Diagnostic value of dynamic electrocardiogram parameters combined with serum myocardial injury markers in silent myocardial ischemia in coronary atherosclerotic heart disease

Clinical Research | 更新时间：2026-01-06

- Diagnostic value of dynamic electrocardiogram parameters combined with serum myocardial injury markers in silent myocardial ischemia in coronary atherosclerotic heart disease
- J Clin Electrocardiol Vol. 34, Issue 6, Pages: 445-449(2025)
- 作者机构：
  
  467000 河南平顶山，平顶山市第一人民医院心电图室（周红乐，孔双燕），急诊科（静喜改）
- 作者简介：
- 基金信息：
- DOI：
  CLC： R541.4
- Received：01 September 2025，
  
  Accepted：21 November 2025，
  
  Published：28 December 2025
- 稿件说明：
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周红乐, 静喜改, 孔双燕. 动态心电图参数联合血清心肌损伤标志物在冠状动脉粥样硬化性心脏病无症状心肌缺血诊断中的价值分析[J]. 临床心电学杂志, 2025, 34(6): 445-449.

ZHOU Hongle,JING Xigai,KONG Shuangyan..Diagnostic value of dynamic electrocardiogram parameters combined with serum myocardial injury markers in silent myocardial ischemia in coronary atherosclerotic heart disease[J].J Clin Electrocardiol,2025,34(06):445-449.
周红乐, 静喜改, 孔双燕. 动态心电图参数联合血清心肌损伤标志物在冠状动脉粥样硬化性心脏病无症状心肌缺血诊断中的价值分析[J]. 临床心电学杂志, 2025, 34(6): 445-449. DOI：

ZHOU Hongle,JING Xigai,KONG Shuangyan..Diagnostic value of dynamic electrocardiogram parameters combined with serum myocardial injury markers in silent myocardial ischemia in coronary atherosclerotic heart disease[J].J Clin Electrocardiol,2025,34(06):445-449. DOI：

摘要

目的

探讨动态心电图参数联合血清心肌损伤标志物在冠状动脉粥样硬化性心脏病（Coronary Atherosclerotic Heart Disease，CHD）无症状心肌缺血（Silent Myocardial Ischemia，SMI）诊断中的价值。

方法

选取2021年8月~2024年7月本院接收的126例无症状心肌缺血的CHD患者作为研究对象，均进行冠状动脉造影（CAG）检查、动态心电图检查和血清心肌损伤标志物［肌钙蛋白I（cTnI）、氨基末端B型脑钠肽前体（NT-proBNP）］检测。以CAG结果为金标准，分为阳性组（

=90）和阴性组（

=36），比较两组一般资料、动态心电图参数、血清cTnI、NT-proBNP水平。ROC分析血清cTnI、NT-proBNP诊断的SMI的截断值，Kappa一致性分析动态心电图、血清cTnI、NT-proBNP及联合诊断SMI的一致性。

结果

两组患者性别、年龄、基础疾病等一般资料结果差异无统计学意义（

0.05）；阳性组血清cTnI、NT-proBNP水平及心肌缺血发作持续时间均明显高于阴性组差异具有统计学意义（

0.05）；阳性组与阴性组ST段压低发作时间分布差异无统计学意义（

0.05）。以血清cTnI、NT-proBNP最佳截断值为诊断临界值，血清cTnI水平

0.16 ng/mL为阳性，126例无心肌缺血症状的CHD患者中共77例阳性，49例阴性；血清NT-proBNP

656.53 pg/ml为阳性，126例无症状心肌缺血的CHD患者中共83例阳性，43例阴性；动态心电图诊断结果为68例阳性，58例阴性；三者联合共91例阳性，35例阴性。Kappa一致性分析显示，联合诊断的敏感度明显高于单独诊断（

0.05），且联合诊断的Kappa值明显高于单独诊断（

0.05）。

结论

动态心电图参数联合血清心肌损伤标志物在CHD中无症状心肌缺血有更高的诊断效能，可显著提高敏感度，且有较高的特异度和准确度，有较高的临床应用价值。

Abstract

Objective To explore the diagnostic value of dynamic electrocardiogram parameters combined with serum myocardial injury markers in silent myocardial ischemia (SMI) in coronary atherosclerotic heart disease (CHD). Methods A total of 126 CHD patients without myocardial ischemia symptoms in the hospital were enrolled as the research objects between August 2021 and July 2024. All underwent coronary angiography (CAG)

dynamic electrocardiogram examination and detection of serum myocardial injury markers [cardiac troponin I (cTnI)

N-terminal pro brain natriuretic peptide (NT-proBNP)

]

. Taking CAG results as the golden standard

patients were divided into positive group

(

=90) and negative group (

=36)

general data

dynamic electrocardiogram parameters

levels of serum cTnI and NT-proBNP in the two groups were compared. The cut-off values of serum cTnI and NT-proBNP in the diagnosis of SMI were analyzed by ROC curves

the consistency of dynamic electrocardiogram

serum cTnI

NT-proBNP and combined detection in the diagnosis of SMI was analyzed by Kappa consistency analysis. Results There was no significant difference in general data (gender

age

underlying diseases) between the two groups (

0.05). The levels of serum cTnI and NT-proBNP

and duration of myocardial ischemia onset in positive group were significantly higher than those in negative group (

0.05)

but there was no significant difference in onset duration of ST segment depression between the two groups (

0.05). Taking the best cut-off values of serum cTnI and NT-proBNP as the diagnostic critical values

when level of serum cTnI

0.16 ng/mL was considered as positive

there were 77 positive cases and 49 negative cases. When level of serum NT-proBNP

656.53 pg/ml was considered as positive

there were 83 positive cases and 43 negative cases. The diagnosis results of dynamic electrocardiogram showed that there were 68 positive cases and 58 negative cases. The combined detection showed that there were 91 positive cases and 35 negative cases. Kappa consistency analysis showed that sensitivity of combined detection was significantly higher than that of single index (

0.05)

and Kappa value was also significantly greater than that of single index (

0.05). Conclusions Dynamic electrocardiogram parameters combined with serum myocardial injury markers have higher diagnostic efficiency for SMI in CHD

which can significantly improve sensitivity

with higher specificity

accuracy and clinical application value.

关键词

Keywords

references

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