平板运动试验与心脏变时功能不全对冠状动脉病变的诊断价值

目的探讨平板运动试验（treadmill exercise testing，TET）心脏变时功能不全（chronotropic incompetence，CI）对冠心病（CHD）患者的的诊断价值及与冠状动脉病变的临床意义。方法165例临床拟诊CHD患者，先后行TET和冠状动脉造影（CAG）检查，对传统指标、CI及两项联合指标诊断CHD的敏感性、特异性、准确率进行比较；并根据CAG结果分CHD组和非CHD组，分析比较两组间心脏变时功能（chronotropic response，CR）：运动中心率变化的各项指标和心脏变时指数（chronotropic responseindex，CRI）。结果（1）单纯以CI指标诊断冠状动脉病变的敏感性、特异性与传统指标相比，无统计学意义（P〉0．05），准确率高于传统指标（P〈0．05）；两项联合指标诊断CHD的敏感性、特异性及准确率均显著高于传统指标（P〈0．01）。（2）CHD组运动CR明显低于非CHD组（P〈0．01）。CHD组3支冠脉病变者CR明显低于1、2支冠脉病变者（P〈0．01）。CRI与冠脉病变分支数目（r=-0．699，P〈0．01）呈负性相关。（3）右冠支、回旋支病变的CR均低于前降支病变（P〈0．05）。结论CI指标是诊断CHD的重要价值的指标，可以提高TET对CHD的诊断率。CHD患者CI可以预测心肌缺血程度，预测自主神经功能受损情况，提示窦房结发生供血不足的可能性，为临床早期诊治提供更快捷的准确信息。

Clinical study on chronotropic incompetence of treadmill exercise testing and coronary artery disease

Objective To study the diagnostic value of chronotropic incompetence(CI)in coronary heart disease(CHD),and clinical relationship of CI of coronary artery disease.Methods 165 patients who underwent the electrocardiogram treadmill exercise test(TET)and coronary angiography(CAG)were included in this study.CAG was used as the standard of diagnosing CHD.The sensitivity,specificity,and accuracy of CI were compared with the traditional index of TET.And then they were put in two groups according to CAG:CHD group an...