Gong Xiubing, Gu Yanan, Jiang Xiangyue, Dou Qingli
Department of Emergency, Baoan District People's Hospital, Shenzhen 518000, Guangdong, China. Gong Xiubing is working on the Department of Critical Care Medicine, Qingyuan People's Hospital, Qingyuan 511500, Guangdong, China. Corresponding author: Dou Qingli, Email:
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2024 Mar;36(3):266-272. doi: 10.3760/cma.j.cn121430-20231009-00851.
To explore the value of cardiodynamicsgram (CDG) obtained from electrocardiogram (ECG) data by radial basis functionradial basis function (RBF) neural network in early diagnosis of patients with acute coronary syndrome (ACS).
Retrospective analysis method was used. Patients with chest pain as the main initial symptom in the emergency department of Baoan District People's Hospital of Shenzhen from October 2021 to September 2022 were enrolled. Baseline data were collected, including gender, age, smoking history, family history of coronary heart disease and history of hypertension, diabetes, hyperlipidemia, and atherosclerosis. The first 12-lead ECG was recorded after admission to the emergency department, and electrocardiodynamics analysis was performed to generate CDG. Receiver operator characteristic curve (ROC curve) was plotted to analyze the value of CDG and ECG in the early diagnosis of ACS and non-ST segment elevation ACS (NSTE-ACS). Sensitivity, specificity, area under the ROC curve (AUC), and 95% confidence interval (95%CI) were calculated. CDG and coronary angiography results of 3 patients with ACS with normal ECG were observed and analyzed. Non-ACS patients with normal ECG but positive CDG were followed for 30 days for adverse cardiovascular events.
A total of 384 patients with chest pain were included, including 169 patients with ACS and 215 patients without ACS. The proportion of male (87.0% vs. 53.0%), smoking history (37.9% vs. 12.1%), hypertension (46.2% vs. 22.3%), diabetes (24.3% vs. 7.9%), hyperlipidemia (55.0% vs. 14.0%) and history of atherosclerosis (22.5% vs. 2.3%) in ACS group were significantly higher than those in non-ACS group (all P < 0.05). The ROC curve showed that the AUC of CDG diagnosis of ACS was higher than that of ECG [AUC (95%CI): 0.88 (0.66-0.76) vs. 0.71 (0.84-0.92)], the sensitivity was 92.8%, 78.6%, and the specificity was 83.3%, 64.2%, respectively. The AUC of CDG diagnosis of NSTE-ACS was higher than that of ECG [AUC (95%CI): 0.85 (0.80-0.90) vs. 0.63 (0.56-0.69)], the sensitivity was 87.1%, 61.3%, and the specificity was 83.3%, 64.2%, respectively. CDG of 3 patients with ACS with normal ECG showed disordered state, and coronary angiography showed ≥70% stenosis of major coronary branches. Of 215 non-ACS patients, 20 had a normal ECG but positive CDG, and 3 developed ST segment elevation myocardial infarction (STEMI) within 30 days, and 2 developed unstable angina (UA) within 30 days.
CDG has high value in early diagnosis of ACS patients and is expected to become an important means of early diagnosis of ACS in emergency.
探讨通过径向基函数（RBF）神经网络从心电图（ECG）数据中获取的心动力图（CDG）在急性冠状动脉综合征（ACS）患者早期诊断中的价值。
采用回顾性分析方法。纳入2021年10月至2022年9月在深圳市宝安区人民医院急诊科以胸痛为主要首发症状的患者。收集基线数据，包括性别、年龄、吸烟史、冠心病家族史以及高血压、糖尿病、高脂血症和动脉粥样硬化病史。患者进入急诊科后记录首份12导联心电图，并进行心电动力学分析以生成CDG。绘制受试者工作特征曲线（ROC曲线），分析CDG和ECG在ACS及非ST段抬高型ACS（NSTE-ACS）早期诊断中的价值。计算敏感性、特异性、ROC曲线下面积（AUC）及95%置信区间（95%CI）。观察并分析3例ECG正常的ACS患者的CDG及冠状动脉造影结果。对ECG正常但CDG阳性的非ACS患者随访30天观察不良心血管事件。
共纳入384例胸痛患者，其中169例为ACS患者，215例为非ACS患者。ACS组男性比例（87.0%对53.0%）、吸烟史（37.9%对12.1%）、高血压（46.2%对22.3%）、糖尿病（24.3%对7.9%）、高脂血症（55.0%对14.0%）及动脉粥样硬化病史（22.5%对2.3%）均显著高于非ACS组（均P<0.05）。ROC曲线显示，CDG诊断ACS的AUC高于ECG [AUC（95%CI）：0.88（0.66 - 0.76）对0.71（0.84 - 0.92）]，敏感性分别为92.8%、78.6%，特异性分别为83.3%、64.2%。CDG诊断NSTE-ACS的AUC高于ECG [AUC（95%CI）：0.85（0.80 - 0.90）对0.63（0.56 - 0.69）]，敏感性分别为87.1%、61.3%，特异性分别为83.3%、64.2%。3例ECG正常的ACS患者的CDG呈紊乱状态，冠状动脉造影显示主要冠状动脉分支狭窄≥70%。215例非ACS患者中，20例ECG正常但CDG阳性，3例在30天内发生ST段抬高型心肌梗死（STEMI），2例在30天内发生不稳定型心绞痛（UA）。
CDG在ACS患者早期诊断中具有较高价值，有望成为急诊科ACS早期诊断的重要手段。
