平板运动试验心脏变时功能不全对冠心病诊断的价值

目的对照平板运动试验（TET）与冠状动脉造影（CAG）结果，探讨TET心脏变时功能不全对冠心病诊断的价值。方法分析120例在同期内先后接受TET和CAG检查病例的临床和心电图资料，测定心脏变时功能指标最高心率与预测最大心率值之比（rHR）和心率储备率（HRR），并与ST段压低诊断冠心病相比较。结果运动试验无ST段下移但rHR〈85％或HRR〈72％的患者中冠心病发生率达74％。以rHR〈85％或HRR〈72％作为ST标准阴性患者的附加阳性判定标准对冠心病的诊断价值瞰感性85．9％（P〈0．01）、84．7％（P〈0．01），特异性45．7％、45．7％，阳性预测值79．3％、79．1％，阴性预测值57．1％、55．2％]略高于传统的ST标准（敏感性63．5％，特异性62．9％，阳性预测值80．6％，阴性预测值41．5％）。结论运动试验中无ST段下移的变时功能不全患者有较高的冠心病发生率，rHR〈85％或HRR〈72％可以作为运动试验阳性的附加判定标准。

An analysis of the value of coronary heart disease diagnosis in chronotropic incompetence during treadmill exercise

Objective To investigate chronotropic incompetence during treadmill exercise testing and detect coronary artery disease （CAD） diagnosis value through treadmill exercise testing coronary arteriongraphy （CAG） Methods The clinic and electrocardiographic data of 120 patients who underwent treadmill exercise testing and CAG at synchronization were analyzed. The ratios of heart rate reserve （HRR） and the percent maximal age-predicted heart rate achieved （rHR） were measured, and compared with ST Segment depress. Results Without ST segment lowering during the treadmill exercise test but rHR〈85% （or HRR〈72%）, the coronary heart disease incidence rate was 74%. To the diagnostic value of standard coronary artery disease, rHR〈85% （or HRR〈72%） as an additional positive diagnotic criterion of the standard ST-negative patientss （ensitivity were 85.9% （P 〈0.01）, 84.7% （P 〈0.01）, specificity were 45.7%, 45.7%, positive predictive value were 79.3%, 79.1%, negative predictive value were 57.1%, 55.2%） is slightly higher than the ST traditional standard （sensitivity was 63.5%, specificity was 62.9%, positive predictive value was 80.6%, negative predictive value was 41.5%）. Conclusion There is a high CAD incidence in patients with positive rHR （or HRR） but no ST lowering during symptom-limited exercise treadmill tests.