动态心电监测在老年高血压无症状心肌缺血诊断中的价值

Objective To explore the diagnostic value of ambulatory electrocardiogram monitoring(AECG) combined with corrected QT interval dispersion(QTcd) and heart rate variability(HRV) indicators for asymptomatic myocardial ischemia(SMI) in elderly hypertensive patients, and to analyze the clinical characteristics and indicator changes related to SMI. Methods A total of 87 elderly hypertensive patients in our hospital from January to December 2024 were selected. All patients underwent AECG, routine electrocardiogram and coronary computed tomography angiography(CCTA), using non-invasive CCTA with precise coronary assessment as the gold standard. The diagnostic efficacy of the two electrocardiogram methods was compared, and the association between clinical characteristics and SMI and the differences in AECG indicators between the two groups were analyzed. Results The sensitivity and accuracy of AECG in diagnosing SMI were significantly better than those of routine electrocardiogram(P<0.05). The incidence of SMI was higher in patients with a hypertension course of ≥ 10 years and those with diabetes(P<0.05). In the SMI group, QTcd was elevated, and partial HRV indicators were decreased, with significant differences in the low frequency/high frequency(LF/HF) ratio and ST segment-related indicators(P<0.05). Conclusion The diagnostic efficacy of AECG combined with QTcd and HRV for SMI in elderly hypertensive patients is superior to that of routine electrocardiogram. A longer course of hypertension and the presence of diabetes are related factors for SMI, and related electrocardiogram indicators can be used as potential diagnostic references, providing support for early and precise clinical diagnosis.