Internal Medicine B, Tel-Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Wizman 6, Tel Aviv, Israel.
Sci Rep. 2023 Aug 2;13(1):12510. doi: 10.1038/s41598-023-39803-1.
Holter electrocardiography (ECG) assists in the diagnosis of arrhythmias. Its use in the inpatient setting has been described solely for the evaluation of stroke and syncope. Our aim was to assess its diagnostic value for other conditions in the internal medicine department. We included all hospitalized patients between 2018 and 2021 in a tertiary referral center. The primary outcome was a diagnostic Holter recording a new arrhythmia that led to a change in treatment. Overall, 289 patients completed a 24-h inpatient Holter ECG for conditions other than syncope or stroke, with 39 (13%) diagnostic findings. The highest diagnostic value was found in patients admitted for pre-syncope (19%), palpitations (18%), and unexplained heart failure exacerbation/dyspnea (17%). A low diagnostic yield was found for the evaluation of chest pain (5%). Heart failure with preserved ejection fraction (adjusted OR 2.3, 95% CI 1.1-5.4, p = 0.04), and baseline ECG with either a bundle branch block (AOR 4.2, 95% CI 1.9-9.2, p < 0.01) or atrioventricular block (first or second degree, AOR 5, 95% CI 2.04-12.3, p < 0.01) were among the independent predictors for a diagnostic test. Inpatient Holter ECG monitoring may have value as a diagnostic tool for selected patients with conditions other than syncope or stroke.
动态心电图（ECG）有助于心律失常的诊断。其在住院患者中的应用仅用于评估中风和晕厥。我们的目的是评估其在内科的其他疾病中的诊断价值。我们纳入了 2018 年至 2021 年在三级转诊中心住院的所有患者。主要结局是诊断性动态心电图记录新的心律失常，导致治疗方式改变。共有 289 例患者因晕厥或中风以外的疾病完成了 24 小时住院动态心电图检查，有 39 例（13%）有诊断发现。在因预晕厥（19%）、心悸（18%）和不明原因心力衰竭加重/呼吸困难（17%）入院的患者中，诊断价值最高。胸痛评估的诊断效果较低（5%）。射血分数保留的心力衰竭（调整后的 OR 2.3，95%CI 1.1-5.4，p=0.04）和基线心电图有束支传导阻滞（AOR 4.2，95%CI 1.9-9.2，p<0.01）或房室传导阻滞（一度或二度，AOR 5，95%CI 2.04-12.3，p<0.01）是诊断性检查的独立预测因素。住院患者动态心电图监测可能对除晕厥或中风以外的特定疾病患者具有诊断价值。
