探讨运动试验中单纯恢复期ST段压低的意义

目的　探讨受试者在心电图运动试验中其单纯恢复期ST段压低的意义。方法　对经运动试验诱发ST段压低者 2 14例进行分析 ,其中仅在运动停止后的恢复期出现ST段压低者共 3 4例 (Ⅰ组 ) ,在运动期出现ST段压低者 (包括运动中ST段压低并持续到恢复期者 )共 180例 (Ⅱ组 ) ,比较两组的临床特征及运动试验参数。结果　Ⅰ组中高血压的患病率明显高于Ⅱ组 (67.64 %vs 2 3 .89% ,P <0 .0 5 ) ;运动试验中 ,Ⅰ组的ST段压低程度明显小于Ⅱ组 ,Ⅰ组的冠状动脉造影阳性率也明显低于Ⅱ组 (P <0 .0 5 )。结论　与运动期出现ST段压低者比较 ,单纯恢复期ST段压低多见于高血压患者 ,冠状动脉造影检出这些患者大血管病变程度较轻。     

心电图动态改变对不典型胸痛伴ST-T改变的诊断价值

目的：探讨心电图有无动态改变对不典型胸痛伴ST—T改变的诊断价值。方法：对53倒不典型胸痛伴ST—T改变患者静息与胸痛发作时心电图与冠脉造影结果进行分析。结果：冠脉造影证实有冠心病者为A组，占77．36％(41／53)，胸痛发作时心电图ST段水平型下移加深且有动态改变者占95．12％(39/41)，无动态改变者占4．88％(2／41)；冠状动脉正常者为B组，占22．64％(12／53)，胸痛发作时ST段抬高，无痛时ST段下降者占25％(3/12)，均为心肌桥；无动态改变占75％(9／12)，其中3倒为心尖肥厚型心肌病，4倒为高血压性心脏病。2例为老年心律失常患者。结论：不典型胸痛伴ST—T改变患者误诊率较高，确诊应作冠脉造影；胸痛时心电图ST段水平型下移加深且有动态改变对诊断冠心病有一定的参考价值，胸痛时ST段抬高，无痛时ST段下降者注意鉴别冠脉痉事或心肌桥。     

平板运动试验对冠心病的诊断价值

目的探讨平板运动试验 (TET)诊断冠状动脉粥样硬化性心脏病 (冠心病 )的临床意义。方法选择发作性胸闷、胸痛的患者 3 6例。同期 (1～ 2周内 )进行冠状动脉造影 (CAG)和记录TET心电图变化。冠状动脉狭窄≥ 5 0 %的为冠心病组 ,冠状动脉狭窄 <5 0 %或正常冠状动脉为对照组 ,将两组检查的结果进行对照分析。结果TET检出冠心病的敏感性 95 .45 % (2 1/ 2 2 ) ,特异性 71.42 % (10 / 14) ,准确度 86.11% (3 1/ 3 6)。运动时间、ST段下移幅度及峰心率冠心病组与对照组比较差异显著 (P <0 .0 5 ,P <0 .0 1)。运动试验早期低运动量时出现的心肌缺血提示 2、3支病变。结论利用TET诊断冠心病简便易行、准确高度 ,综合多项参数可初步推测其病变程度     

平板运动试验与冠状动脉造影对冠心病危险分层的意义

目的评估平板运动试验在心肌缺血诊断、危险分层方面的价值和意义。方法对均进行平板运动试验及冠状动脉造影两项检查的52例患者进行观察和分析,对平板试验阳性者28例、平板试验阴性者24例与各自的冠状动脉造影对比,评判平板运动试验对胸痛、胸闷等不同症状患者心肌缺血程度初步估测,进行危险评估。结果活动平板运动试验检测心肌缺血的灵敏度为96%,特异性88%,预测阳性值为89%,ST段的下移形态、程度及导联数是评估的重要指标。对冠状动脉造影中血管狭窄85%以上、平板运动试验阳性的18例中的8例(强阳性)行PTCA术,其余10例用药物治疗,疗效满意。结论活动平板运动试验对缺血性心脏病的诊断价值是可以肯定的,对冠心病进行危险分层及选择治疗、评估预后有重要意义。     

178例拟诊冠心病患者心电图与冠状动脉造影结果分析

目的评价静息心电图ECG对冠心病诊断和预后的价值。方法对178例患者拟诊为冠心病患者的静息ECG与冠状动脉造影结果进行回顾性分析。其中男109例、女69例。平均62.5(61.5±11.1)岁。均有发作性胸闷、胸痛症状,并有一项以上危险因素(高血压、糖尿病、高脂血症)。静息ECG心肌缺血诊断标准为ST段自J点后80ms处水平型或下斜型下降≥0.1mV。CAG冠心病诊断标准为至少有1支主要冠状动脉或其主要分支内径狭窄程度≥50%。结果99例有静息ECG心肌缺血(ECG阳性组);79例无心肌缺血表现(ECG阴性组)。静息ECG阳性与阴性组患者,CAG阳性率差异无统计学意义(54.5%vs59.5%,P>0.05);但静息ECG阳性组多支病变率明显高于ECG阴性组(66.7%vs44.7%,P=0.029);而静息ECG阴性组单支病变率明显高于ECG阳性组(33.3%vs55.3%,P=0.026)。静息ECG阳性组高血压患病率明显高于ECG阴性组(64.8%vs42.6%,P=0.042)。结论静息ECG阳性对诊断冠心病的特异性和敏感性低,对多支、多危险因素的高危冠心病患者具有一定的提示意义。     

平板运动试验致心电图ST段抬高的分析

目的进一步探讨平板运动试验诱发心电图ST段抬高的临床意义。方法总结分析5例非心肌梗死而运动中诱发ST段抬高病人的静息心电图、运动试验及冠状动脉造影检查结果。结果7912例平板运动试验病人中，有5例病人运动中诱发心电图卯段抬高伴有不同程度的心绞痛，冠状动脉造影显示不同程度的血管病变。结论非心肌梗死患者运动诱发心电图ST段抬高是冠状动脉严重狭窄或痉挛所致心肌局部严重缺血的表现。     

运动平板试验对冠心病诊断价值的研究

目的探讨运动平板试验(TET)对冠心病诊断的临床应用价值。方法回顾性分析清华大学玉泉医院及阜外医院2016年1月至2017年8月收治的有胸闷、胸痛症状拟诊为冠心病、进行平板运动试验及冠状动脉造影(CAG)的208例患者,计算平板运动试验诊断冠心病的敏感性、特异性、准确性。分析运动平板试验真阳性患者冠脉病变严重程度及累及支数。并对TET发生ST段压低的导联与冠状动脉病变部位的关系进行对比。结果 (1)TET阳性110例患者中,CAG阳性73例,阴性37例。TET阴性98例患者中,CAG阳性15例,阴性83例。TET诊断冠心病的敏感性为83.0%,特异性为69.2%,准确性为75.0%;TET的敏感性、准确性较高,但特异性较低。(2)TET真阳性患者中冠状动脉为中重度病变的人数显著多于轻度病变(P0.05)。(3)TET真阳性患者中冠状动脉多支病变的人数显著多于单支病变(P0.05)。(4)胸前导联V4~V6导联ST段改变者,CAG前降支病变率明显高于其他导联ST段改变者(P0.05);下壁导联Ⅱ、Ⅲ、aVF导联ST段改变者,CAG右冠脉病变率明显高于其他导联ST段改变者(P0.05)。结论 TET对评价冠心病具有较高的敏感度,可对冠状动脉病变部位和病变程度进行一定的预判。     

非ST段抬高型急性冠状动脉综合征患者胸痛时间、肌钙蛋白水平及心电图ST段下移的诊断价值

目的:探讨非ST段抬高型急性冠状动脉综合征(ACS)患者胸痛时间、肌钙蛋白水平及心电图ST段下移的临床诊断价值。方法:收集自2008-06—2008-12,在急诊科因急性胸痛拟诊不稳定性心绞痛(UA)及非ST段抬高心肌梗死(NSTEMI)收入院且记录资料完整的54例患者。仔细询问病史、体检,据胸痛持续时间分成3组(0.5h,0.5～2h,≥2h),并完成常规18导联心电图检查,将患者入院时心电图ST段下移幅度分成3组(1mV,1～2mV,≥2mV),同时抽静脉血做肌钙蛋白I(TnI)检测。据TnI水平将患者分成3组(TnI0.02μg/L,0.02μg/L～0.04μg/L,≥0.04μg/L),根据冠状动脉造影结果诊断急性心肌梗死。结果:随着胸痛发生时间延长或肌钙蛋白水平升高,心肌梗死的发病率显著升高。随着ST段下移幅度加深,心肌梗死的发病率没有升高。结论:胸痛时间及TnI水平对非ST段抬高的ACS患者的预测均有重要价值,但心电图的ST段变化对于非ST段抬高的ACS患者的预测价值有待进一步探讨。     

冠状动脉心肌桥静息心电图及运动试验心电图特征

目的:探讨心肌桥的冠状动脉造影特点与心电图、运动试验之间的关系。方法:回顾性分析经冠状动脉造影证实的98例单纯性心肌桥的冠状动脉造影和心电图的特点。结果:冠状动脉造影单纯性心肌桥均位于左前降支,且大部分位于中远端,按Nobel分级,I级58例(59.1%),Ⅱ级27例(27.6%),Ⅲ级13例(13.3%)。心肌桥深度:浅表型70例(68.6%),深在型28例(31.4%),深在型缺血性ST段和T波改变的发生明显高于浅表型。心肌桥患者静息心电图主要表现为V3-V6导联ST段压低,T波低平或倒置;部分病例呈早期复极样改变。36例行运动试验,阳性18例(50%),可疑阳性11例(31.6%)。结论:冠状动脉心肌桥可能导致ST段、T波改变,部分患者运动试验阳性或可疑阳性心肌缺血,但是有多种方案治疗的。     

心电图与冠状动脉造影63例对照分析

心电图是诊断冠心病的基本方法之一 ,而冠状动脉造影被认为是诊断冠心病的金标准 ,本文对照分析 63例静息心电图及冠状动脉造影结果 ,旨在探讨常规心电图诊断冠心病的临床价值。1　资料和方法1 1　对象　 63例住院病人 ,男 5 1例 ,女 12例 ;年龄 3 3～ 76岁 ,平均 62 4岁 ,临床均有胸痛、胸闷症状 ,拟诊冠心病。1 2　方法　心电图检查 :记录静息状态下 12导联心电图 ,必要时加做相应导联。本文阳性标准 :ＳＴ段水平形或下垂形下移≥ 0 .1ｍｖ和Ｔ波倒置 ,损伤性ＳＴ段抬高、病理性Ｑ波。冠状动脉造影采用Ｊｕｄｋｉｎｓ方法 ,在多个投射角…     

心电图运动试验对高血压患者冠心病的诊断价值

目的 探讨心电图运动试验对心电图无左室肥厚高血压患者冠心病的诊断价值。方法 以冠状动脉造影为对照 ,分析高血压组与非高血压组运动试验的敏感性和特异性。结果 高血压组与非高血压组运动试验的敏感性相似 (81.8 %对85.7% ) ,但高血压组的特异性显著低于非高血压组 (42.8 %对81.8 % ,P<0.05)。结论 心电图运动试验对高血压患者的冠心病诊断价值有限。     

Adenosine echocardiography — an alternative to dynamic stress echocardiography

Dynamic exercise echocardiography is sensitive and specific in detection and evaluation of coronary artery disease. Frequently, however, patients cannot achieve maximum exercise because of various factors. The aims of this study were to compare usefulness of adenosine infusion and dynamic exercise to induce myocardial ischemia detected with 2-D echocardiography and standard electrocardiography; to determine the sensitivity of the adenosine echo test; and to evaluate the safety and tolerability of adenosine infusion. In 31 men with clinical diagnosis of stable angina pectoris, myocardial ischemia was induced by: a) symptom-limited exercise test on a bicycle, and b) intravenous adenosine infusion. The two tests were performed with an average interval of 24 hours. Coronary angiography was performed in 29 of 31 patients and significant coronary artery disease (diameter narrowing >50%) was documented in 26 of these (12 single, 6 two- and 8 three-vessel disease). The criterion for echo positivity was a transient impairment of contraction as compared to the baseline examination in any of 10 segments, with an increase of left ventricular score index of 0.3 or more. ECG positivity was considered as ST₆₀ segment depression of 0.1 mV or more from the reference level in any lead. Adenosine echo test was positive in 22 out of 26 patients and exercise echo in 19 (sensitivity 85% and 73%, respectively, p=NS). Adenosine ECG test was positive in 14 of 26 patients and exercise ECG test in 21 (sensitivity 54% and 81% respectively, p= NS). In three patients with normal coronary arteriography adenosine echo was negative in all three, exercise echo, adenosine ECG and exercise ECG in two. Side effects due to adenosine infusion were always minor, well tolerated by the patients and disappeared within seconds after termination of infusion. The present study suggests that adenosine test is at least as useful as exercise echo test in the provocation of myocardial ischemia in patients with coronary artery disease and stable angina pectoris.     

The diagnostic significance of reciprocal ST segment depression in acute myocardial infarction

The relationship between reciprocal ST-segment depression, the result of an early submaximal exercise ECG, and the anatomy of coronary artery disease was explored in 142 patients with acute myocardial infarction. Reciprocal ST-segment depression was observed in 65 per cent of 79 patients with inferior infarction and 57 per cent of 63 with anterior infarction. Thirty-three of the 52 patients with reciprocal ST-segment depression had a significant stenosis of the coronary artery supplying the reciprocal ST-segment territory (63 per cent), and 31 of the 46 patients with a positive exercise test had a significant stenosis of the coronary artery supplying the ischaemic territory (67 per cent). Forty-one of the patients with reciprocal ST-segment depression (79 per cent) and 35 of the patients with positive exercise tests (76 per cent) were found to have multivessel coronary artery disease. The study showed that reciprocal ST-segment depression was associated with stenosis of the coronary artery supplying the territory opposite the infarct in nearly two-thirds of the patients and with multivessel coronary artery disease in almost four-fifths of them. Reciprocal ST-segment depression after infarction was as accurate as a positive submaximal exercise test at predicting the presence of multivessel coronary artery disease.     

The Diagnostic Significance of Reciprocal ST Segment Depression in Acute Myocardial Infarction

The relationship between reciprocal ST-segment depression, theresult of an early submaximal exercise ECG, and the anatomyof coronary artery disease was explored in 142 patients withacute myocardial infarction. Reciprocal ST-segment depression was observed in 65 per centof 79 patients with inferior infarction and 57 per cent of 63with anterior infarction. Thirty-three of the 52 patients withreciprocal ST-segment depression had a significant stenosisof the coronary artery supplying the reciprocal ST-segment territory(63 per cent), and 31 of the 46 patients with a positive exercisetest had a significant stenosis of the coronary artery supplyingthe ischaemic territory (67 per cent). Forty-one of the patientswith reciprocal ST-segment depression (79 per cent) and 35 ofthe patients with positive exercise tests (76 per cent) werefound to have multivessel coronary artery disease. The study showed that reciprocal ST-segment depression was associatedwith stenosis of the coronary artery supplying the territoryopposite the infarct in nearly two-thirds of the patients andwith multivessel coronary artery disease in almost four-fifthsof them. Reciprocal ST-segment depression after infarction wasas accurate as a positive submaximal exercise test at predictingthe presence of multivessel coronary artery disease.     

Exercise thallium-201 scintigraphy in the localization of myocardial ischaemia

Summary. We performed a retrospective study in order to study the ability of thallium-201 exercise scintigraphy to detect and to localize coronary artery perfusion defects (in comparison with a recent coronary angiogram). We studied 81 patients (67 males); their average age was 52.3 years (men 50.5 and women 54.1 years). They performed a pulse-conducted cycle exercise test, and 2 min before end of exercise 75 MBq of thallium-201 was infused intravenously, and tomographic images were reconstructed by using a Siemens-Rota SPECT gamma camera immediately and 4 h after exercise. The thallium-201 uptake defects were attributed to different coronary arteries, and the results were compared with a coronary angiogram made afterwards in 48 patients. The groups of one-, two- and three-vessel disease were 27, 21, and 21 patients, and only 12 patients did not have significant (over 50%) stenoses. The latter had the highest ejection fraction and working capacity. Sensitivity of thallium-201 exercise scintigraphy was 65%, whereas that of exercise ECG was 41% in patients with a low ejection fraction, while in the whole material the sensitivity of thallium-201 scintigraphy was 91% and that of exercise ECG was 54%. A stenosis in the right coronary artery was best localized by the thallium-201 scintigram (86% correctly); a stenosis in the left anterior descending artery was localized correctly in 75% of the cases, but a stenosis in left circumflex artery was localized correctly only in 44%. We conclude that exercise thallium-201 scintigraphy is a useful method not only in detecting but also in localizing coronary artery disease.     

Ambulatory ST-recording has no additional value to exercise test for identification of severe coronary lesions after an episode of unstable coronary artery disease in men

One month after an episode of unstable coronary artery disease, 95 male patients performed coronary angiography, 48 hours ambulatory ST-recording and also an exercise test. ST-depression occurred in 29.5% during the ST-recording and in 44.2% during the exercise test (p<0.05). In patients with ST-depression at ambulatory monitoring, 79% demonstrated the same finding at the exercise test. A high risk response at the exercise test — defined as either ST-depression in ≥ 3 leads, ST-depression in 1–2 leads with a maximal work load below the 60th percentile or a maximal work load below the 30th percentile regardless of the ECG reaction — occurred in 56.8%. Severe coronary lesions — defined as three vessel disease, left main stenosis or proximal left anterior descending artery stenosis as part of two vessel disease — was observed in 46.3%. Patents with a high risk exercise test response and patients with ST-depression during ST-recording had severe coronary lesions in 67% and 64% respectively. However, a high risk exercise test response occurred in 82%, while ST-depression at ambulatory monitoring was observed only in 41% of the patients with severe coronary lesions (p < 0.001). Thus, ambulatory ST-recording one month after an episode of unstable coronary artery disease in men adds no further information to a symptom limited exercise test in order to identify patients with severe coronary lesions.     

Chronic stable angina pectoris. Risk stratification and treatment.

Workup of stable angina patients begins with careful history taking and evaluation of various risk factors, physical examination, and a resting electrocardiogram (ECG). A noninvasive exercise stress test is valuable for risk stratification. Abnormalities on a resting ECG or equivocal results on a stress test warrant an exercise test combined with thallium scintigraphy, which is more sensitive and specific. Cardiac catheterization is advisable for patients with chest discomfort and multiple risk factors, even if results of thallium testing are negative. Patients with severe or progressive angina or congestive heart failure should also have cardiac catheterization. Nitrates, beta-adrenergic blockers, and calcium channel blockers are cornerstones of medical therapy. Revascularization with coronary artery bypass graft is recommended for patients with left main coronary artery disease, left ventricular dysfunction, or severe proximal three-vessel coronary artery disease. Percutaneous transluminal coronary angioplasty (PTCA) is a good alternative for one- or two-vessel disease. Three-vessel PTCA can be accomplished, but its real role still remains to be established.     

Evaluation of the patient with angina pectoris

All patients with chronic stable angina presumed to be due to coronary artery disease should undergo exercise stress testing early in evaluation for evidence of high-risk coronary disease. If the exercise stress test shows early positive findings, patients should undergo cardiac catheterization to exclude left main coronary vessel disease and three-vessel disease with concomitant left ventricular dysfunction. Patients with unstable angina who are subsequently stabilized on medical therapy should undergo a limited exercise stress test before discharge from the hospital to identify those at high risk. An ambulatory ECG is also helpful in evaluating for evidence of silent ischemia in these patients.     

A Prospective Study of Heart Disease in Diabetes Mellitus

Six hundred and twenty-five patients with diabetes mellituswere studied by standardised clinical methods, resting andexerciseelectrocardiography (ECG) and digitised echocardio-graphy todetermine the prevalence of coronary and non-coronary heartdisease. Clincial evidence of coronary artery disease (anginaand infarction) was present in 110 (18 per cent) normotensivepatients. Hypertension (blood pressure >165/95 mmHg) waspresent in 172 (27 per cent) of whom 32 had cardiac symptoms.Heart failure or left ventricular dilatation was seen in 18of whom 11 had either hypertension or coronary artery diseaseand six asymptomatic patients had unexplained ventricular hypertrophy. Echocardiograms in 245 of 290 asymptomatic patients with normalECG showed that relaxation was prolonged (p<0.001) and mitralvalve opening delayed (p<0.001) from normal especially inthose with severe microangiopathy (proliferative retinopathyand/or heavy proteinuria). The peak rates of cavity dimensionincrease and posterior wall thinning were reduced from normal(both p<0.001) and patients with severe microangiopathy hadthe most marked changes. Redivision of these 245 diabetics byabnormalities of left ventricular function showed that 147 hadnormal function in whom only one of23 (random 15 per cent sample)had a positive exercise ECG. Prolonged relaxation or delayedmitral valve opening alone (anon-specific abnormality) was presentin 41 and only three of 28 had a positive exercise ECG. Thirty-onehad delayed mitral valve opening with inco-ordinate relaxation(abnormalities very suggestive of coronary artery disease) ofwhom 20 of 29 had a positive exercise ECG. Twenty-six had delayedmitral valve opening with slow cavity dimension increase orwall thinning (without hypertrophy) of whom 21 of 25 had a negativeexercise ECG. This is a relatively specific abnormality similarto that found in left ventricular hypertrophy. Coronary artery disease is common in symptomatic and asymptomaticforms in diabetes mellitus. Non-coronary left ventricular diseases,such as dilation and hypertrophy, are probably no more commonin diabetics than non-diabetics. A small number of diabeticswith severe microangiopathy had abnormal relaxation and reducedpeak rate of dimension increase or wallthinning which may representleft ventricular disease due to microangiopathy.     

老年人冠心病无创性检查与冠状动脉造影的比较

目的 探讨老年人冠心病无创性检查的诊断价值.方法 在选择性冠状动脉造影的住院患者中,对无创性检查(常规心电图、运动试验、动态心电图)进行冠心病诊断价值的分析比较,并使用Spss 11.0统计软件分析包对数据进行R×C表χ2检验.结果 三种检查方法 的敏感性最高为常规心电图(ECG),达83.17%(P=0.001),运动试验(TET)最低,为66.67%(P=-0.001).特异性最高为TET,达79.17%,ECG最低,为46.46%.结论 ECG可作为冠心病筛选检查的首选方法 ;TET的诊断价值最高,尤其是对无症状性心肌缺血,更具有实用价值;动态心电图(Holter)的敏感性及特异性与ECG相近,用于发现院外及日常生活中的心肌缺血,是其他检查方法 无法替代的.