Suryanarayana Prakash Goutham, Kandala Jagdesh, Marcus Frank I
Division of Cardiology, Sarver Heart Center, University of Arizona, Tucson, AZ, United States.
Division of Cardiology, Sarver Heart Center, University of Arizona, Tucson, AZ, United States.
J Electrocardiol. 2017 Nov-Dec;50(6):884-888. doi: 10.1016/j.jelectrocard.2017.06.004. Epub 2017 Jun 9.
We have observed electrocardiographic (ECG) changes primarily in women during tilt table testing.
We reviewed 12 lead ECGs during tilt studies between 2012 and 2016 for changes in ST segments and T waves during tilt table testing. Patients with distinctly abnormal baseline ECGs were excluded.
Of the 180 tilt studies, 117 (65%) were in women. There were 32 patients with ECG changes during tilting. Of these, 28 (87.5%) were in women with an average age of 45years. None had a history of CAD or exertional chest pain. Echocardiograms were available in 21 of the 28 women with tilt induced ECG changes and all were normal. ECG changes during tilt table testing were found in 4/64 (6.25%) of men. The occurrence of ST-T wave changes during tilt testing was significantly higher among women compared to men, with a p value of 0.008. Of the 28 women with ECG changes during tilt, 11 had T wave inversions alone. ST segment depression alone was noted in 7 women. There were 10 women who had both ST segment depression and T wave inversions. Changes occurred immediately upon tilting in 6. In the remaining, they occurred at an average of 4.8±4min after tilting. The slight increase in heart rate in patients with ECG changes was similar to that in the patients without new ECG changes. The ECG changes were not related to the presence of syncope.
ECG changes during the testing was observed at a relatively high incidence primarily in women. The clinical significance of these repolarization changes during tilt testing is unknown. These ECG changes during tilt testing may correlate with the high incidence of false positive ECGs in women during exercise testing but do not necessarily indicate the presence of ischemic coronary disease. Additional research is needed to explain this phenomenon.
我们在倾斜试验中主要观察到女性心电图（ECG）的变化。
我们回顾了2012年至2016年倾斜研究期间的12导联心电图，以观察倾斜试验期间ST段和T波的变化。排除基线心电图明显异常的患者。
在180例倾斜研究中，117例（65%）为女性。有32例患者在倾斜过程中出现心电图变化。其中，28例（87.5%）为女性，平均年龄45岁。无一例有冠心病或劳力性胸痛病史。28例倾斜诱发心电图变化的女性中有21例可获得超声心动图检查结果，且均正常。在男性中，64例中有4例（6.25%）在倾斜试验期间出现心电图变化。与男性相比，女性在倾斜试验期间ST-T波变化的发生率显著更高，p值为0.008。在28例倾斜时出现心电图变化的女性中，11例仅有T波倒置。7例女性仅有ST段压低。有10例女性既有ST段压低又有T波倒置。6例在倾斜后立即出现变化。其余患者平均在倾斜后4.8±4分钟出现变化。心电图有变化的患者心率略有增加，与无新心电图变化的患者相似。心电图变化与晕厥的发生无关。
试验期间观察到的心电图变化主要发生在女性中，发生率相对较高。倾斜试验期间这些复极变化的临床意义尚不清楚。倾斜试验期间的这些心电图变化可能与女性运动试验中心电图假阳性的高发生率相关，但不一定表明存在缺血性冠状动脉疾病。需要进一步研究来解释这一现象。
