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目的评估aVR四步法、Vereckei四步法及Brugada四步法对宽QRS波心动过速(WQRST)诊断的灵敏度(Se)、特异度(Sp)、阳性预测值(PPV)、阴性预测值(NPV)。方法选择2006年3月～2009年6月在北京大学人民医院就诊的WQRST78例[室速(VT)66例,室上速(SVT)12例],已行心内电生理检查证实并行导管消融术,由2位电生理医生在不知道确切诊断的情况下依据aVR四步法、Vereckei四步法及Brugada四步法对以上患者的体表心电图进行诊断,分别计算3种方法诊断VT的Se、Sp、PPV、NPV,并应用3个率的卡方检验比较3种方法有无统计学差异。结果aVR导联四步法诊断室速的Se、Sp、PPV、NPV分别是97%、50%、91.4%、75%,Vereckei四步法分别是89.4%、25%、81.9%、50%,Brugada四步法分别是90.9%、33.3%、88.2%、40%。3种方法诊断VT的Se差异无显著性(p=0.22),Sp差异无显著性(p=0.57),PPV差异无显著性(p=0.23),NPV差异亦无显著性(p=0.35)。3种方法对VT及SVT的诊断符合率差异无显著性(p=0.195)。结论aVR四步法、Vereckei四步法与Brugada四步法诊断室速的Se、Sp、PPV、NPV没有显著性差异;但仅用aVR导联的四步法更为简单、合理、方便,更适用于临床较紧急的情况。
Objective To assess the sensitivity, specificity, SpV, PPV, and negative predictive value (WVS) of four-step aVR, Vereckei four-step and Brugada four- NPV). Methods A total of 78 WROs (66 VTs and 12 SVTs) were enrolled in Peoples Hospital of Peking University from March 2006 to June 2009 and their cardiac catheterization ablation Surgery, two electrophysiologists do not know the exact diagnosis of the case according to aVR four-step method, Vereckei four-step method and Brugada four-step method for the diagnosis of body surface ECG in patients with three methods were calculated VT Se Se , Sp, PPV and NPV. Three methods were used to compare the three methods with or without chi square test. Results The ventricular tachyarrhythmia rates of SeV, Sp, PPV and NPV were 97%, 50%, 91.4% and 75%, respectively. The Verekei four-step method was 89.4%, 25%, 81.9% and 50% Brugada four-step method is 90.9%, 33.3%, 88.2%, 40% respectively. There was no significant difference between the three methods (P = 0.22), Sp (P = 0.57), PPV (P = 0.23), NPV (P = 0.35) . There was no significant difference between the three methods in the diagnosis of VT and SVT (p = 0.195). Conclusions There is no significant difference between aVR four-step method, Vereckei four-step method and Brugada four-step method for diagnosing ventricular septum Se, Sp, PPV, NPV. However, the four-step method using only aVR leads is more simple, reasonable and convenient For more urgent clinical situation.