运动试验诱发ST段抬高对冠心病诊断的临床意义

目的 探讨平板运动试验诱发ST段抬高对冠心病诊断的临床意义.方法 比较平板运动试验中ST段抬高组与ST段压低组患者的冠状动脉造影结果.结果 ST段抬高组与ST段压低组冠状动脉造影结果显示,阳性率、血管狭窄程度以及受累支数均有显著差异(P＜0.05).结论 平板运动试验诱发的ST段抬高是冠状动脉严重狭窄或痉挛所致心肌局部...     

平板运动试验诱发ST段抬高对冠状动脉病变部位定位诊断的意义

目的探讨平板运动试验诱发ST段抬高对冠心病的诊断价值及对冠状动脉病变部位定位诊断的意义。方法分析8例无心肌梗死而运动诱发ST段抬高的运动心电图及冠状动脉造影检查结果。结果8例患者冠脉造影均显示有程度不等的血管狭窄(50%￣100%);ST段抬高导联与缺血相关血管有良好对应关系。结论无心梗患者运动诱发心电图ST段抬高是冠脉痉挛或冠脉严重狭窄所致心肌局部缺血的标志,且对预测冠状动脉病变部位有一定意义。     

活动平板运动试验诱发ST段抬高的临床意义

为探讨活动平板运动试验诱发ST段抬高的临床意义 ,分析了 9例无心肌梗死 (简称心梗 )而运动诱发ST段抬高的静息心电图、运动试验及冠状动脉 (简称冠脉 )造影检查结果。结果 :5 0 5 5例行平板运动试验者中 ,有 11例未患心肌梗死而运动诱发心绞痛伴ST段抬高 ,发生率 0 .2 2 %。其中 ,8例患者作了进一步检查 ,冠脉造影显示均有程度不等的血管病变 ,缺血相关血管的狭窄达到 5 0 %～ 10 0 %。ST段抬高导联与缺血相关血管有良好对应关系。另有 1例患者于运动试验 1周后死于心脏性猝死。结论 :无心梗患者运动诱发心电图ST段抬高是冠脉痉挛或冠脉严重狭窄所致心肌局部缺血的标志。     

平板运动试验恢复期ST段压低对冠心病诊断价值及相关因素分析

目的　评价平板运动试验中恢复期ST段压低的意义。方法　选择2008年7月至2012年12月在我院住院同时接受平板运动试验和选择性冠状动脉造影检查患者,共168例,分成3组：平板运动试验运动中ST段压低组（简称运动中组,n＝90）,男性54例,女性36例,年龄35～80岁;平板运动试验恢复期ST段压低组（简称恢复期组,n＝61）,男性26例,女性35例,年龄45～74岁;平板运动试验结果阴性组（简称平板阴性组,n＝17）,男性11例,女性6例,年龄35～80岁。再根据冠状动脉造影结果将患者分别列入冠状动脉造影阴性组、冠状动脉轻度狭窄组和冠状动脉明显狭窄组。比较各组患者的基本资料、合并症,平板运动试验结果与冠状动脉造影结果之间的联系以及超声心动图资料。结果　运动中组患者年龄偏大,同时糖尿病较多,高密度脂蛋白胆固醇水平低于恢复期组和平板阴性组,而肌酐和胱抑素C水平高于其他两组,差别具有统计学意义（P<0.05）。运动中组冠状动脉明显狭窄的比例高于恢复期组和平板阴性组,恢复期组冠状动脉轻度狭窄比例高于运动中组（P<0.01）。运动中组冠状动脉1支、2支、3支或左主干病变出现概率均高于恢复期组。平板阴性组左心室舒张末期容积小于其他两组,差别具有统计学意义（P<0.05）。结论　运动中ST段压低对诊断冠心病的价值较恢复期ST段压低高。平板运动试验中恢复期出现ST段压低的患者在诊断冠心病时应结合危险因素综合考虑。     

运动试验ST段压低幅度与冠状动脉病变特点的相关性分析

目的:了解运动试验ST段压低不同幅度患者的冠状动脉病变和临床特点,并探讨其相关性。方法:选取114例运动试验阳性和可疑阳性同时行冠状动脉造影的患者为研究对象,按ST段压低幅度分为0.5～0.9mm组、1.0～1.9mm组和≥2.0mm组,比较3组患者冠状动脉病变和临床特点。结果:3组患者间的性别、年龄、心绞痛、高血压、糖尿病和室壁运动障碍人数差异无统计学意义(P0.05),但经皮冠状动脉介入治疗术后的患者人数差异有统计学意义(P=0.032);在冠状动脉病变数目、发生部位方面差异无统计学意义(P0.05);3组患者间血管狭窄90%以上者差异有统计学意义(P=0.035)。经进一步Logistic回归分析发现,血管狭窄90%以上是ST段压低幅度的独立影响因素。结论:运动试验诱发的ST段压低幅度可间接反映冠状动脉病变狭窄程度,且血管狭窄90%以上是ST段压低幅度的独立影响因素。但ST段压低幅度不能反映冠状动脉病变数目和发生部位。     

平板运动试验诱发ST段抬高提示冠状动脉病变部位二例

2例平板运动试验诱发ST段抬高 ,1例为V1 ～V5及Ⅱ、Ⅲ、aVF导联ST段上抬 ,冠状动脉 (简称冠脉 )造影示左前降支和第一对角支狭窄 ;另 1例为V1 ～V3导联ST段抬高 ,造影显示左前降支病变。运动试验诱发ST段抬高提示严重心肌缺血 ,且指示的缺血区域与病变冠脉部位一致。     

平板运动试验诱发ST段抬高对冠心病的诊断价值

目的探讨平板运动试验（TET）诱发ST段抬高对冠心病的诊断价值。方法回顾我院11例无心肌梗死而TET诱发ST段抬高患者,分析其TET心电图及冠状动脉造影（CAG）检查结果。结果 1例CAG未见固定狭窄。10例均有不同程度冠脉病变（其中1例为单支病变,9例为多支病变）,有8例冠状动脉狭窄程度达90%以上。ST段抬高导联与缺血相关冠状动脉有良好的对应关系。结论无心肌梗死者TET诱发的ST段抬高,提示冠脉痉挛或冠脉严重狭窄,且指示的缺血区域与病变冠脉一致。     

平板运动试验恢复期与运动中ST段压低在冠心病中的诊断价值比较

目的 比较平板运动试验恢复期与运动中ST段压低的心电图表现在冠心病中的诊断价值.方法 选择可疑冠心病患者并行平板运动试验结果呈阳性者211例,将其分成运动中ST段压低组（A组,n=178）,恢复期ST段压低组（B组,n=33）,对两组的临床资料和冠状动脉造影结果进行对比分析.结果两组临床资料（除高尿酸）比较,差异均无统计学意义（均P ＞0.05）.两组对冠状动脉造影的阳性预测值相近（ 71.3%vs72.7%,P ＞0.05）,冠状动脉病变部位及单支、三支病变比较,差异无统计学意义（P ＞0.05）;冠状动脉病变重度狭窄率B组高于A组,差异有统计学意义（P＜0.05）.结论 平板运动试验恢复期ST段压低与运动中ST段压低在冠心病诊断中同样重要,可预示冠状动脉的重度病变.     

运动诱发无心肌梗死者ST段抬高的临床意义

目的　报道无心肌梗死运动诱发心电图ST段抬高者 10例 ,探讨其冠状动脉 (冠脉 )病变特点及治疗方法。方法　对无心肌梗死而运动诱发心电图ST段抬高的患者进行静息心电图、运动试验及冠脉造影、左心室造影检查 ,运动试验采用Bruce方案。结果　在 35 6 4例行运动试验检查者中 ,有 10例未患心肌梗死而运动诱发其心电图ST段抬高 ,发生率为 0 2 8%。相应导联ST段抬高 0 1～ 1 0mV ,停止运动后心绞痛症状消失 ,ST段恢复正常。 10例中 ,1例冠状动脉病变轻 (狭窄 <35 % ) ,但于冠状动脉造影后 4周发生急性心肌梗死 ,梗死部位与ST段抬高导联所对应的部位一致 ;余9例冠状动脉均有严重狭窄 (90 %～ 10 0 % ) ,ST段抬高导联与缺血相关血管有良好的对应关系 ,近期内行冠状动脉腔内球囊成形术 (PTCA)效果良好 ,术后症状消失。随访 2 8个月 (8～ 4 8个月 ) ,有 2例分别与出院后 11个月和 2 9个月再次行介入治疗 ,至今无症状生存。结论　无心肌梗死患者运动诱发心电图ST段抬高多提示心肌透壁缺血 ,冠状动脉病变重。少数病人冠状动脉虽无严重病变 ,但预后差 ,应采取积极有效的治疗措施。     

踏板运动试验对评估冠状动脉狭窄严重程度的意义

为明确踏板运动试验与冠状动脉狭窄程度的关系,选取115例冠状动脉造影阳性、且于造影前或造影后1周作踏板运动试验的患者,观察以直径法确定的冠状动脉狭窄程度和范围与踏板运动试验结果对比.结果显示:踏板运动试验中ST段压低出现越早、ST段压低程度越大、持续时间越长、出现ST段压低的导联数目越多,冠状动脉狭窄越重.冠状动脉造影阳性而踏板运动试验阴性者,多为单支或轻度病变.认为踏板运动试验可初步估测冠状动脉狭窄程度.     

Relevance of simultaneous ST segment elevation and depression in an exercise treadmill test

Simultaneous ST segment elevation and depression recorded during an exercise treadmill test and its correlation with coronary angiogram is a new finding that does not find a place in medical literature. We conclude that in the presence of simultaneous ST segment elevation and ST segment depression during exercise treadmill test (1) the localizing value of isolated ST elevation is lost and (2) there is severe triple vessel disease warranting early intervention.     

Short term reproducibility of exercise testing in patients with ST segment elevation and different responses to the dipyridamole test.

The short term reproducibility of exercise testing in 25 patients who had exercise induced ST segment elevation without baseline regional asynergy or a previous myocardial infarction, who had different responses to the dipyridamole test, was assessed. The patients performed a dipyridamole echocardiography test and a second exercise stress test. All underwent coronary arteriography. Seventeen patients had transient regional asynergy after dipyridamole (group 1) and either ST segment elevation (14 patients) or depression (three patients); a second group of eight had no asynergy and no electrocardiographic changes (group 2). The repeated exercise stress test was positive in 16 of the 17 patients of group 1 (11 with ST elevation and five with ST depression) and in two patients of group 2 (both had ST depression and one had coronary artery disease). The dipyridamole echocardiography test was positive in 17 of the 19 patients with coronary artery disease and was negative in all six patients without coronary artery disease. The repeated exercise stress test was positive in 17 of the 19 patients with coronary artery disease and in one patient without. The dipyridamole echocardiography test and a repeated exercise stress test, but not a single exercise stress test, identified coronary artery disease causing exercise induced ST segment elevation.     

Short term reproducibility of exercise testing in patients with ST segment elevation and different responses to the dipyridamole test

The short term reproducibility of exercise testing in 25 patients who had exercise induced ST segment elevation without baseline regional asynergy or a previous myocardial infarction, who had different responses to the dipyridamole test, was assessed. The patients performed a dipyridamole echocardiography test and a second exercise stress test. All underwent coronary arteriography. Seventeen patients had transient regional asynergy after dipyridamole (group 1) and either ST segment elevation (14 patients) or depression (three patients); a second group of eight had no asynergy and no electrocardiographic changes (group 2). The repeated exercise stress test was positive in 16 of the 17 patients of group 1 (11 with ST elevation and five with ST depression) and in two patients of group 2 (both had ST depression and one had coronary artery disease). The dipyridamole echocardiography test was positive in 17 of the 19 patients with coronary artery disease and was negative in all six patients without coronary artery disease. The repeated exercise stress test was positive in 17 of the 19 patients with coronary artery disease and in one patient without. The dipyridamole echocardiography test and a repeated exercise stress test, but not a single exercise stress test, identified coronary artery disease causing exercise induced ST segment elevation.     

Significance of exercise induced ST segment elevation in patients with previous myocardial infarction

In order to determine the significance of exercise induced ST segment elevation in patients with previous myocardial infarction, we have studied 156 patients, 26 months (mean) after myocardial infarction. Each patient underwent 16 lead precordial electrocardiographic mapping before, during, and after exercise and in addition coronary arteriography was performed. There was no significant difference in the extent of coronary disease or abnormalities of left ventricular function between patients with exercise induced ST segment elevation that was noted to occur in leads with Q waves and those with ST segment elevation plus depression or those with ST segment depression alone. Patients without exercise induced ST segment changes had fewer coronary arteries involved than those who developed ST segment changes. Nineteen patients with exercise induced ST segment elevation alone underwent coronary artery bypass surgery; in 11 this resulted in complete abolition of the exercise induced ST segment elevation and was associated with symptomatic relief and patent grafts without alteration of left ventricular function. Thus, exercise induced ST segment elevation in patients with previous myocardial infarction should be considered as important as ST segment depression in terms of underlying myocardial ischaemia, coronary anatomy, and left ventricular function.     

Significance of exercise induced ST segment elevation in patients with previous myocardial infarction.

In order to determine the significance of exercise induced ST segment elevation in patients with previous myocardial infarction, we have studied 156 patients, 26 months (mean) after myocardial infarction. Each patient underwent 16 lead precordial electrocardiographic mapping before, during, and after exercise and in addition coronary arteriography was performed. There was no significant difference in the extent of coronary disease or abnormalities of left ventricular function between patients with exercise induced ST segment elevation that was noted to occur in leads with Q waves and those with ST segment elevation plus depression or those with ST segment depression alone. Patients without exercise induced ST segment changes had fewer coronary arteries involved than those who developed ST segment changes. Nineteen patients with exercise induced ST segment elevation alone underwent coronary artery bypass surgery; in 11 this resulted in complete abolition of the exercise induced ST segment elevation and was associated with symptomatic relief and patent grafts without alteration of left ventricular function. Thus, exercise induced ST segment elevation in patients with previous myocardial infarction should be considered as important as ST segment depression in terms of underlying myocardial ischaemia, coronary anatomy, and left ventricular function.     

Value of the bipolar lead CM5 in electrocardiography.

Only bipolar lead recording are available during ambulatory monitoring. Their sensitivity in detecting ST segment changes in relation to standard electrocardiographic leads is not known. The magnitude and direction of ST segment changes in the bipolar lead CM5 were compared with those in standard electrocardiographic leads in patients during exercise testing and percutaneous transluminal coronary angioplasty. Thirty patients with coronary artery disease were studied during exercise tests in which ST segment depression (greater than 0.5 mm) occurred in one or more standard electrocardiographic leads and 13 patients were studied during angioplasty that resulted in ST segment change in one or more leads (I, II, III, V2, V5, and CM5). Lead CM5 was the most sensitive lead (93%) during exercise testing and also showed the greatest magnitude of ST segment change below the isoelectric line in 93% of the patients. Only two patients, one with ST segment elevation in inferior leads and one with changes restricted to septal leads, had no ST segment depression in lead CM5. When ST segment shift from the baseline electrocardiogram was measured the magnitude of depression was greatest in lead CM5 in only 63% of the patients. During angioplasty of the left anterior descending coronary artery, lead CM5 showed ST segment depression in seven patients, ST segment elevation in two, and a biphasic response in one. Two of the three patients with balloon inflation in right coronary artery developed ST segment elevation in lead CM5. Thus lead CM5 is a reliable lead for detecting subendocardial ischaemia experienced during everyday activities in anginal patients. During total occlusion of coronary arteries (as in variant angina or myocardial infarction) lead CM5 commonly shows ST segment depression and changes due to right coronary artery occlusion may not be detected.     

Value of the bipolar lead CM5 in electrocardiography

Only bipolar lead recording are available during ambulatory monitoring. Their sensitivity in detecting ST segment changes in relation to standard electrocardiographic leads is not known. The magnitude and direction of ST segment changes in the bipolar lead CM5 were compared with those in standard electrocardiographic leads in patients during exercise testing and percutaneous transluminal coronary angioplasty. Thirty patients with coronary artery disease were studied during exercise tests in which ST segment depression (greater than 0.5 mm) occurred in one or more standard electrocardiographic leads and 13 patients were studied during angioplasty that resulted in ST segment change in one or more leads (I, II, III, V2, V5, and CM5). Lead CM5 was the most sensitive lead (93%) during exercise testing and also showed the greatest magnitude of ST segment change below the isoelectric line in 93% of the patients. Only two patients, one with ST segment elevation in inferior leads and one with changes restricted to septal leads, had no ST segment depression in lead CM5. When ST segment shift from the baseline electrocardiogram was measured the magnitude of depression was greatest in lead CM5 in only 63% of the patients. During angioplasty of the left anterior descending coronary artery, lead CM5 showed ST segment depression in seven patients, ST segment elevation in two, and a biphasic response in one. Two of the three patients with balloon inflation in right coronary artery developed ST segment elevation in lead CM5. Thus lead CM5 is a reliable lead for detecting subendocardial ischaemia experienced during everyday activities in anginal patients. During total occlusion of coronary arteries (as in variant angina or myocardial infarction) lead CM5 commonly shows ST segment depression and changes due to right coronary artery occlusion may not be detected.     

Submaximal exercise testing early after myocardial infarction. Prognostic importance of exercise induced ST segment elevation

Seventy four patients (66 men, eight women; mean age 54.3 years) underwent submaximal exercise testing 7-23 days (mean 10.7) after acute myocardial infarction. Follow up was a mean period of 11.3 months. When compared with patients with no exercise induced abnormality, ST segment elevation, ST shift (depression or elevation or both), ST depression, inability to complete five metabolic equivalents, and inadequate blood pressure response to exercise were predictive of subsequent cardiac events (cardiac death, left ventricular failure, recurrent myocardial infarction, angina). When the presence or absence of specific variables was assessed, only ST elevation and ST shift predicted subsequent cardiac events. The presence of exercise induced ST elevation was the only exercise test variable which predicted cardiac death. ST segment elevation was, therefore, the exercise induced abnormality which best predicted the risk of future complications.     

Submaximal exercise testing early after myocardial infarction. Prognostic importance of exercise induced ST segment elevation.

Seventy four patients (66 men, eight women; mean age 54.3 years) underwent submaximal exercise testing 7-23 days (mean 10.7) after acute myocardial infarction. Follow up was a mean period of 11.3 months. When compared with patients with no exercise induced abnormality, ST segment elevation, ST shift (depression or elevation or both), ST depression, inability to complete five metabolic equivalents, and inadequate blood pressure response to exercise were predictive of subsequent cardiac events (cardiac death, left ventricular failure, recurrent myocardial infarction, angina). When the presence or absence of specific variables was assessed, only ST elevation and ST shift predicted subsequent cardiac events. The presence of exercise induced ST elevation was the only exercise test variable which predicted cardiac death. ST segment elevation was, therefore, the exercise induced abnormality which best predicted the risk of future complications.     

Self-predicting stress tests. Predischarge modified stress testing after acute myocardial infarction.

The outcome of 50 consecutive modified predischarge exercise tests after acute myocardial infarction was predicted by three independent observers on the basis of ST segment displacement in the resting pretest 12 lead electrocardiograms. The mean predictive accuracy for the three observers was 82% for a positive test defined as additional ST segment depression or elevation greater than or equal to 0.1 mV, and rose to 94% for a positive test defined as additional ST segment depression greater than or equal to 0.1 mV alone. For the majority of patients, the test result was already apparent in the resting 12 lead electrocardiogram.