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。     

运动诱发ST段抬高者的冠状动脉病变特点及治疗探讨

目的 :观察无心肌梗死 (MI)运动诱发心电图ST段抬高者 6例 ,探讨其冠状动脉 (冠脉 )病变特点及治疗方法。方法 :对无MI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检查 ,运动试验采用Bruce方案。结果 :在 2 86 4例行运动试验检查者中 ,有 6例未患MI而运动诱发心绞痛伴心电图ST段抬高 ,发生率为 0 .2 1%。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。 6例中 ,1例冠脉病变轻 (狭窄 <35 % ) ,但于冠脉造影后 4周发生急性MI ,梗死部位与ST段抬高导联所对应的部位一致 ;余 5例冠脉均有严重狭窄 (90 %～ 10 0 % ) ,ST段抬高导联与缺血相关血管有良好的对应关系 ,近期内行冠脉腔内球囊成形术效果良好 ,术后症状消失 ,多次复查运动试验 ,结果均阴性。结论 :无MI患者运动诱发心电图ST段抬高多提示心肌透壁缺血 ,冠脉病变重 ,预后差 ,应采取积极的治疗措施。     

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。     

运动诱发ST段抬高的意义

目的观察运动诱发心电图ST段抬高的无心肌梗死（MI）者6例,探讨其冠状动脉（冠脉）病变特点。方法对无MI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检查,运动试验采用Bruce方案。结果在3002例行运动试验检查者中,有6例未患MI而运动诱发心绞痛伴心电图ST段抬高,发生率为0．2％。相应导联ST段抬高0．1～0．6mV,停止运动后心绞痛症状消失,ST段恢复正常。6例中,1例冠状动脉正常;余5例冠脉均有严重狭窄（70％～95％）,ST段抬高导联与缺血相关血管有良好的对应关系,近期内行冠脉介入治疗效果良好,术后症状消失。多次复查运动试验,结果均阴性。结论无MI者运动诱发心电图ST段抬高多提示心肌透壁缺血,冠脉病变重,应采取积极的治疗措施。     

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。     

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。     

平板运动试验致ST段抬高的临床意义

目的平板运动试验诱发ST段抬高的临床意义。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段抬高组和ST段压低组患者冠状动脉造影显示的血管狭窄程度及血管受累支数有显著差异(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和痉挛所致心肌严重缺血损伤的表现。     

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...     

QT离散度对运动试验中无胸痛或ST段下移患者冠脉狭窄的诊断价值

为了探讨 QT离散度 (QTd)在运动试验中无诱发胸痛或ST段下移患者冠脉狭窄的诊断价值 ,2 0 0 1年 1月至 2 0 0 2年3月 ,我们对运动试验中无诱发胸痛或 ST段下移患者行冠脉造影检查 ,并与 QTd结果进行比较。现报告如下。临床资料 :同期住院的 15 0例胸痛患者 ,年龄 (5 5± 10 )岁 ;男 10 6例 ,女 4 4例。所有患者按照 Bruce方案进行限制性试验 ,15 0例患者运动中无诱发胸痛或心电图 ST段下移 86例。运动试验后 [(7± 4 )天 ]行选择性冠脉造影 ,依照美国AHA标准分类 ,冠脉直径狭窄 >75 %被认为有意义的狭窄。试验前 2天停服β受体阻滞剂…     

平板运动试验致ST段抬高与继发室性心律失常和心肌梗死关系探讨(附29例分析)

目的:分析无陈旧性心肌梗死患者运动诱发的ST段抬高现象,比较ST段抬高和继发室性心动过速、心肌梗死的关系,找出预警指标。方法:对9 900例疑似冠心病者行平板运动试验检查,阳性人数3 002例。同时检出ST段抬高者29例,并对其行冠状动脉造影检查,比较ST抬高程度、冠状动脉狭窄、T波顶峰后宽度(TaTe)、T波顶峰后宽度/QT间期(TaTe/QT)、QT离散度(QTd)、修正的QT离散度(QTcd)、室性期前收缩(RONT,室早)和症状之间存在的内在联系。结果:发现9 900例检查者中阳性率30.32%;ST段抬高发生率为0.29%。4例并发心肌梗死,5例并发室性心动过速。同时发现,ST段抬高程度、形态、冠状动脉狭窄、伴发的室性心动过速、心肌梗死、TaTe、TaTe/QT、QTd、QTcd、RONT及症状之间存在正向关系,室性心动过速时TaTe/QT与无心律失常组比较差异有统计学意义(P<0.001)。结论:无心肌梗死者运动诱发心电图ST段抬高,提示冠状动脉存在严重固定狭窄或/并痉挛,并与心肌梗死、室性心动过速有并行关系,尤其TaTe/QT比值,是最有预警可能发生室速的重要价值。     

非心肌梗死冠心病患者运动致ST段抬高的临床意义

目的 研究运动致ST段抬高在非心肌梗死患者中发生率及其临床意义。方法 2004年6月至2006年6月共有4601例患者接受了运动平板试验,其中有15例非心肌梗死患者出现ST段抬高,对这15例患者的临床特点与冠状动脉造影结果进行分析。结果 15例（3．2‰）运动致ST段抬高患者中,男性13例,女性2例,年龄40-75岁。单支病变者6例（40％）,2支病变者6例（40％）,3支病变者3例（20％）;12例（80％）累及前降支,1例（6．6％）累及左主干,7例累及右冠状动脉,在累及前降支及左主干13例患者中有8例为重度狭窄病变（狭窄程度为90％-100％）,所有ST段抬高的导联均与病变血管的供血部位一致。结论 运动致ST段抬高在非心肌梗死患者中发生率非常低,多因冠状动脉有严重的固定性狭窄,特别是前降支,可根据出现ST段抬高的导联判断缺血心肌的部位。     

Prediction of infarct-related coronary artery of patients with acute inferior myocardial infarction by a predischarge exercise test index

The predictive accuracy of electrocardiographic markers in identifying the infarct-related artery of myocardial infarctions has been a subject of extensive investigation. The present study was designed to test whether the index L II/L III ratio adapted to exercise electrocardiograms could be utilized as a marker to distinguish right coronary and left circumflex arteries as culprit coronaries in acute inferior myocardial infarctions. For this purpose, 82 patients with a positive-symptom-limited and/or submaximal treadmill exercise test with modified Bruce protocol after an acute inferior myocardial infarction were studied. Those patients with ST segment elevation during the stress test were included in the study. ST segment index was defined as the ratio of exercise-induced ST elevation amplitude in L II/L III. Patients were classified as having an index > 1 (n=24) and < 1 (n=58), and the findings were compared with the findings on coronary angiography. The groups were comparable with respect to age, gender, peak exercise level, and double products achieved. Circumflex artery was the infarct-related one in the majority (21/24; 88%) of patients with an index > 1, whereas most (51/58; 88%) patients with an index < 1 had the culprit lesion in their right coronary artery (p<0.001). The ratio of exercise-induced ST elevations in leads L II and L III has a significantly high ability to discriminate the infarct-related coronary artery in patients with uncomplicated inferior myocardial infarction. Considering the prognostic importance of the type of coronary involvement, this index could be a part of predischarge evaluation in this patient group.     

Value of lead V4R in exercise testing to predict proximal stenosis of the right coronary artery

To assess the value of lead V4R during exercise testing for predicting proximal stenosis of the right coronary artery, 107 patients were studied. In all patients, a Bruce exercise test with the simultaneous recording of leads I, II, V4R, V1, V4 and V6 was followed by coronary angiography. Apart from registering ST segment changes in the conventional leads, all patients were classified according to absence or presence of an ST segment deviation of 1 mm or greater in lead V4R. Seventy-nine of the 107 patients were studied because of inadequate control of angina pectoris. Seven patients had had myocardial infarction before 40 years of age. Twenty-one patients were analyzed because of severe cardiac arrhythmias. In the 46 patients who had a previous myocardial infarction, the infarct location was inferior in 28 and anterior in 18. Seven of the 14 patients without myocardial infarction and significant proximal stenosis in the right coronary artery showed an ST segment deviation of 1 mm or greater in lead V4R during exercise. This was also observed in 11 of 18 patients with an old inferior wall infarction and proximal occlusion of the right coronary artery. None of the 53 patients without significant proximal stenosis in the right coronary artery showed exercise-related ST segment changes in lead V4R. Exercise-related ST segment deviation in lead V4R had a sensitivity of 56%, a specificity of 96% and a predictive accuracy of 84% in recognizing proximal stenosis in the right coronary artery. These observations indicate that the recording of lead V4R is of value for predicting or excluding proximal stenosis in the right coronary artery.     

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.     

Positive treadmill stress tests post myocardial infarction in patients with single-vessel coronary disease

To investigate the possibility that patients with single-vessel coronary artery disease (CAD) and recent myocardial infarction (MI) can have ST segment depression on post infarction treadmill testing due to ischemia, we studied 16 such patients who underwent cardiac catheterization and exercise testing after MI. Of the 11 patients with ST segment depression on treadmill testing, 10 failed to increase their ejection fraction and nine had a focal worsening of wall motion during exercise radionuclide ventriculography. Seven of these 11 patients had hypokinesis or normokinesis in the suspected area of infarction. In contrast, four of the five patients without ST segment depression on treadmill stress testing had an increase in ejection fraction with stress which was significantly greater than that seen in patients with ST depression (7.2% vs 0%, p less than 0.05). Short-term follow-up (1.1 years) revealed continued post infarction angina in 10 of the 11 patients with positive treadmill stress tests. Four of these patients underwent either percutaneous transluminal angioplasty or surgery. We conclude that positive post infarction treadmill tests due to exercise-induced ischemia may occur in patients with single-vessel CAD and may be associated with continued angina that requires surgical intervention.     

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.