活动平板运动试验avR导联ST段抬高对左冠状动脉病变的诊断价值

目的:探讨活动平板运动试验avR导联ST段抬高对左冠状动脉病变的诊断价值.方法:选择82例活动平板运动试验阳性的冠心病病人,根据是否伴有avR导联ST段抬高≥0.01 mV分为2组,其中ST段抬高组42例,无ST段抬高组40例,所有病人同时进行冠状动脉造影(CAG).结果:ST段抬高组CAG阴性3例,阳性39例;无ST段抬高组CAG阴性4例,阳性36例.ST段抬高组左前降支近端发生率为58.97％,高于无ST段抬高组的33.33％(P<0.05);而左前降支远端病变发生率为5.13％,低于无ST段抬高组的50.00％(P<0.01).ST段抬高组左主干、右冠状动脉和三支病变发生率与无ST段抬高组差异均无统计学意义(P>0.05).avR导联ST段抬高组CAG阳性时对左主干病变阳性预测值为70.00％;如将左主干与左前降支近端合并,则阳性预测值为90.91％.结论:活动平板运动试验阳性并伴avR导联ST段抬高≥0.01 mV,对左冠状动脉病变有较高的诊断价值.

The value of the ST-segment elevation in lead avR of treadmill exercise test in the diagnosis of left coronary artery lesions

Objective:To explore the value of the ST-segment elevation in lead avR of treadmill exercise test in the diagnosis of left coronary artery lesions.Methods:Eighty-two coronary artery disease patients with the positive treadmill exercise test were divided into the ST-segment elevation group(42 cases)and non-ST-segment elevation group(40 cases)according to the ST-segment elevation(≥0.01 mV).The coronary angiography(CAG)in two groups was examined.Results:Three cases of negative CAG and 39 cases of positive CAG in ST-segment elevation group,and 4 cases of negative CAG and 36 cases of positive CAG in non-ST-segment elevation group were identified.The incidence rate of proximal left anterior lesion in ST-segment elevation group(58.97％)was higher than that in non-ST-segment elevation group(33.33％)(P<0.05),but the incidence rate of distal left anterior lesion in ST-segment elevation group(5.13％)was lower than that in non-ST-segment elevation group(50.00％)(P<0.01).The differences of the incidence rates of left main branch,right coronary artery and three-branch lesions between two groups were not statistically significant(P>0.05).The positive predictive value of left main branch lesion was 70.00％under the condition of positive ST-elevation in lead avR,and the positive predictive value was 90.91％under the condition of combination of left main branch with proximal left anterior branch.Conclusions:The positive treadmill exercise test combined with ST-segment elevation ≥0.01 mV in lead avR has high diagnostic values in left coronary artery lesions.