心电图运动试验对急性心肌梗塞后患者残余心肌缺血的评价

５２例急性心肌梗塞后２～１２周患者进行次极量蹬车心电图运动试验，心肌缺血发生率为４４．２％。与冠状动脉造影对比，多支病变者阳性率高于单支病变（Ｐ＜０．０１）；与运动２０１铊心肌显像对比，前者阳性率较低（Ｐ＜０．０１）；心电图运动试验中非梗塞区心肌缺血组阳性率高于梗塞周围缺血组（Ｐ＜０．０２５）；ＳＴ段抬高组左室射血分数低于ＳＴ段正常或压低组（Ｐ＜０．０１）。心电图运动试验对诊断梗塞后残余心肌缺血，特别是非梗塞区心肌缺血有一定价值，运动中ＳＴ段抬高可能预示较差的心功能。     

心电图自行车运动试验对AMI病人心功能的评价

心电图自行车运动试验对ＡＭＩ病人心功能的评价潍坊医学院附属医院心内科冯国勤综述陈景武审校近年来国外以心电图自行车运动试验评价急性心肌梗塞（ＡＭＩ）后病人心脏功能的进展，使这一项临床检测手段在ＡＭＩ病人的治疗、康复中得到进一步应用。ＡＭＩ病人早期（出院...     

心电图运动试验在急性心肌梗死中的应用

心电图负荷试验是心脏负荷试验的起始形式,又是心脏负荷试验的主流.心电图运动试验的目的主要为:测定功能储量、测定运动耐力、观察反映血液动力学改变的血压和心电图改变,判断心血管系统对运动的反应和病情的程度;协助诊断冠心病.鉴别呼吸困难的性质(心脏和肺部病变引起)、提供体力活动受限原因的线索;帮助选择心脏手术患者.运动试验结果是评价患者预后危险的主要指标之一.     

心肌梗死后心电图负荷试验

心肌梗死(MI)发病后4～6周或出院前,施行各种类型的心电图负荷试验,可评价心功能,估计预后,判断疗效,并可指导患者出院后日常活动量或心脏康复锻炼的水平。运动负荷试验 MI后近期,一般施行亚极量运动试验,从低负荷量开始,逐渐升级。鉴于梗死的心脏对运动负荷的适应能力较差,变换负荷量的间隔期不宜短于3分钟;否则后文中有关运动引起的ST段改变或心律失常的意义难以正确判断。MI后心绞痛、高级别室性早搏、心房扑动/颤动、泵衰竭、重度高血压、高龄和静态心电图不稳定等,应列为运动试验禁忌。     

动态心电图与心电图运动试验诊断冠心病的价值比较

<正>近年来因冠状动脉造影技术的发展,使其在诊断冠心病的定性、定位和程度判断上居于主导地位,是目前公认的诊断冠心病的"金标准"。而动态心电图与运动平板试验是两项无创、简单、安全而有效的临     

运动试验验证动态心电图呈现ST-T改变者的意义

目的动态心电图（DCG）出现ST—T改变者做平板运动试验（TET）,探讨ST—T改变的意义。方法对45例患者均先做DCG,然后做TET。结果45例DCG出现ST—T改变者中,有32例TET阳性,占71．1％。结论DCG与TET联合应用可提高冠心病的诊断价值。     

急性心肌梗死恢复期运动试验的价值

29例急性心肌梗死患者恢复期(31—81天)接受症状限制性平板运动试验。23例接受冠脉造影,22例接受左室造影。运动中ST段压低诊断多支病变的敏感性和特异性为60％与92％。低运动负荷结合运动中ST段压低诊断多支病变的敏感性和特异性为100％与67％;运动中收缩压反应异常结合ST段压低诊断多支病变的敏感性和特异性为80％与92％。广泛前壁梗死运动中ST段抬高者显著多于其他部位梗死。10例运动中ST段抬高者6例有室壁瘤形成。运动试验指标与超声心动图测得的左室射血分数无相关性。     

Residual myocardial ischaemia in first non-Q versus Q wave infarction: maximal exercise testing and ambulatory ST-segment monitoring

In a prospective study of 123 consecutive survivors of a firstmyocardial infarction (43 non-Q wave, 80 Q wave), we determinedthe total residual ischaemic burden by use of pre-dischargemaximal exercise testing and post-discharge 36 h ambulatoryST-segment monitoring initiated 11 ± 5 days after theinfarction. The prevalence of exercise-induced ischae-mic manifestations in the infarct types was similar: chest pain 14%vs 16% and ST-segment depression 54% vs 54%. The ischaemic thresholddid not differ either (heart rate at 1 mm of ST-segmnent depression120 ± 27 vs 119 ± 25 beats. min^–1). Duringearly post-discharge daily activities, more patients with non-Qwave infarction demonstrated transient episodes of ST-segmentdepression: 28% vs 14% (ns). Furthermore, ischaemic episodeswere significantly longer (42.5±50.1 vs 22.0 ±20.6 min; p <0.001), and the ischaemic threshold was significantlylower in non-Q wave infarction (heart rate at onset of ST-segmentdepression 84±11 vs 88±9 beats.min^–1; p<0.05). During 3.5±0.9 years of follow-up the proportionof patients with 1 ischaemic event (non-fatal reinfarction,angina pectoris, revascularization) was significantly higherin non-Q wave infarction (51%) as compared to Q wave infarction(31%) (P<005). In both infarct types the presence of ST-segmentdepression on ambulatory recording and exercise testing significantlypredicted the development of future angina pectoris, whereaspatients at increased risk for subsequent non-fatal reinfarctionor cardiac death were not identified.     

Prognostic value of ambulatory ST segment monitoring compared with exercise testing at 1-3 months after acute myocardial infarction

The relative value of ambulatory ST segment monitoring for assessingprognosis following acute myocardial infarction is currentlyuncertain. Ambulatory monitoring was performed in 177 patientsat a mean of 38 days (range 22–93) post-myocardial infarctionand its prognostic value was compared with exercise treadmilltesting (n=170). Cardiac events (myocardial infarction, cardiacdeath or coronary revascularisation) were noted during at least1 year of follow-up. The presence or absence of ST depressionon ambulatory nonitoring did not predict increased fatal ornon-fatal cardiac events although more severe ST depressionhad some predictive power: after adjusting for clinical variablesand coronary prognostic indices, the duration/24 h (P=0·03)and magnitude (P=0·007) of ST depression had independentvalue. ST deviation on exercise testing was associated (P<0·05)with increased events (19/90; 21% vs 7/80; 9%) and in patientswith a positive exercise test ST depression on ambulatory monitoringdid not identify any additional events (8/41; 20% vs 11/49;22%). No factor available from ambulatory monitoring was predictiveof outcome once variables from exercise testing were taken intoaccount. Ambulatory ST segment monitoring performed in the laterecovery phase (1–3 months) after acute myocardial infarctionis inferior to exercise testing for predicting prognosis anddoes not increase the predictive power of an exercise test.Ambulatory monitoring may only be indicated in patients unableto perform an exercise test.     

The influence of thrombolytic therapy on the predictive value of exercise testing 3 weeks after acute myocardial infarction

Abstract. Objectives. To evaluate the prognostic value of exercise testing performed soon after acute myocardial infarction (AMI) in patients treated with thrombolytic therapy. Design. A 1-year prospective follow-up of 185 subjects treated with thrombolytic therapy who survived AMI, and who performed exercise testing 3 weeks after AMI. These patients were compared with 272 patients not receiving thrombolytic therapy during the same period. Subjects. Patients recovering from AMI, without medical contraindications to exercise testing performed 3 weeks after AMI. Main outcome measures. ST-segment deviations during exercise testing 3 weeks post-AMI were related to clinical outcome 1-year post-AMI and to the administration of thrombolytic therapy during the acute phase of infarction. Results. In patients treated with thrombolytic therapy, the only exercise-test-related parameter predicting subsequent cardiac events was ST-segment elevation. In contrast, patients not receiving thrombolytic therapy and demonstrating ST-segment depression of ≥ 1 mm during exercise had more clinical cardiac events than those without this finding (12.3 vs. 3.9%; P < 0.05). Conclusion. This study casts doubt on the ability of exercise testing to select a high-risk population requiring early intervention to prevent recurrent coronary events after thrombolysis for AMI.     

急性心肌梗塞患者出院前的运动心电图试验

急性心肌梗塞（ＡＭＩ）患者出院前作运动心电图试验有临床实际意义。我科自１９９４年６月至１９９６年４月，给５１例病情稳定的ＡＭＩ患者作此检查，男４１例（６３．４±６．４岁）。女１０例（７０．６±６．２岁）试验距发病３０．６±１４．７天（５～５２天），其中有６例广泛性梗塞。结果：（１）多数患者能达到与其年龄相应的运动量；（２）室性心律失常发生率较高（２５％）；（３）患者发生心绞痛、气急、疲劳及血压下降者亦较多（各约１９％）；（４）２６例患者作了冠脉造影（ＣＡＧ），显示运动心电图试验阳性者多为多支冠脉病变；敏感性为８４．６％，特异性达９２．３％。作者认为，只要掌握适应证及试验时间，作好监护急救准备，试验方法适宜，心肌梗塞患者出院前作运动试验基本是安全的。     

Submaximal predischarge exercise testing after myocardial infarction: prognostic value and limitations

The prognostic value of abnormalities resulting from predischargesubmaximal treadmill exercise testing was evaluated in 222 patientsafter myocardial infarction. The presence of the following variables— ST segment depression and elevation, an abnormal bloodpressure response, limited exercise duration, angina pectoris,ventricular arrhythmias — were predictive of subsequentcardiac events (P<0.001) among the 154 patients with oneor more of these abnormalities. When the presence or absenceof specific variables was assessed, only an abnormal blood pressureresponse, limited exercise duration (P<0.001), and ST segmentelevation and shift (P<0.05), were significantly associatedwith cardiac death. Exercise-induced angina was predictive onlyof the development of subsequent angina (P<0.05), and STdepression was associated only with future coronary surgery(P<0.01). Ventricular arrhythmias had no independent prognosticvalue. Markers of left ventricular dysfunction elicited by submaximalexercise testing are therefore valuable in identifying patientsat high risk of death after infarction. Hallmarks of residualreversible myocardial ischaemia are of limited prognostic importance.The test result may be useful in selecting patients for coronaryangiography.     

急性心肌梗塞运动试验的临床价值

目的：研究急性心肌梗塞（AMI）患者平板运动试验的评定心功能、指导康复作用。方法：16例AMI病人（平均56．5岁）在发病4周后按照Bruce方案进行症状限止平板运动试验。结果：VO2max3～12（平均7．3±3．8）METs；HRmax106～186（平均152．7±29．7）次／分；运动试验阳性12例．其中ST段下移、VO2max＜4METs者6例（50％）；ST段抬高、VO2max＜4METs者5例（31．2％）；没有1例发生意外。结论：AMI病人的运动试验对评定心功能、指导康复有较大临床意义；只要掌握适应证、禁忌证，运动中严密监护．AMI病人运动试验是安全的。     

Prognostic significance of silent myocardial ischaemia during maximal exercise testing after a first acute myocardial infarction

Clinical, exercise, and angiographic variables, and long-termfollow-up were compared in patients, who, during maximal Bruceexercise testing after a first acute myocardial infarction (AMI),had positive responses to exercise testing (n = 116, 38% of303) with (n % 23, group I) or without (n = 93, group II) angina.Group I patients more often (52 vs 19%, P < 0.001) had ahistory of pre-infarction angina. Group II had a greater proportion(75 vs 52%, P < 0.05) of inferior wall AMI, whereas groupI had a greater proportion (30 vs 19%, P < 0.01) of non-Qwave AMI. Total exercise duration was significantly (P <0.01) longer in group II (7.6 ± 3.2 vs 5.5 ± 3.1min). Maximal exercise heart rate (144 ± 22 vs 133 ±21, beats . min^–1 P < 0.05 was also higher in groupII. A greater proportion of group II patients (37 vs 9%, P <0.05) had single-vessel disease, whereas multivessel diseasewas more common (91 vs 63% P < 0.03) in group I. Left ventricularfunction was similar in both groups. During follow-up (48 ±22 months) the incidence of cardiac death (group I, 3.3%, groupII, 4.8%), of recurrent infarction (group I, 4.8%, group II3.3%), and of revascularization procedures (group I, 28.5%,group II, 19.8%) were similar in both groups. Although asymptomaticexercise-induced ischaemia was associated with better exerciseperformance and less extensive coronary disease than symptomaticischaemia, it had the same long-term prognostic implications.     

Transient ischaemia after acute myocardial infarction: relationship to exercise ischaemia

To study the implications of transient myocardial ischaemia following acute myocardial infarction we compared ambulatory ST segment monitoring with exercise treadmill testing in 170 patients (mean age 58 years) at 4-8 weeks after admission. Ambulatory monitoring detected transient ischaemia (265 episodes; 249 (94%) silent) in 53/170 patients (31%) which was less frequent than ischaemia during exercise testing (90 patients; 53%) (P less than 0.0001). However, patients displaying transient ambulatory ischaemia (i) achieved less total exercise (248.7 +/- 17.2 vs 318.7 +/- 14.1 s; means +/- SEM) (P less than 0.006), (ii) developed exercise ST deviation earlier (172.4 +/- 14.3 vs 244.8 +/- 16.2 s) (P less than 0.0004) and (iii) had more widespread exercise ischaemia (3.8 +/- 0.3 vs 2.5 +/- 0.2 ECG leads) (P less than 0.005). Positive ambulatory ST segment monitoring was infrequently found (12/80 patients; 15%) in the presence of a negative exercise test but did identify the majority of patients (9/11 patients; 82%) with easily provoked exercise ischaemia and hence strongly positive exercise tests. These data suggest a limited role for routine 24 h ambulatory monitoring after myocardial infarction for the diagnosis of ongoing ischaemia but raise the possibility of an important place for this test in prognosis and risk stratification.     

Cardiac function and maximal exercise capacity early after acute myocardial infarction

The purpose of the study was to assess the relationship betweenleft and right ventricular function measured at rest and maximalexercise capacity in patients with recent acute myocardial infarction(AMI). Forty-three male patients (Killip Class I, n=36; KillipClass II, n=7) with a wide range of left ventricular (LV) functionand size underwent graded bicycle exercise testing less than4 weeks after AMI (mean 21 days, 17–27). None of the patientshad exercise limiting factors other than dyspnoea and fatigue.Left and right ventricular ejection fractions were determinedby a radionuclide ventriculo graphic method which also alloweddetermination of absolute LV volumes and actual LV peak fillingrate. LV ejection fraction had a tt weak association to estimatedmaximal oxygen uptake (VO₂ max) (r=0·37). No associationwas found between LV size, LV stroke volume, or LV peak fillingrate and estimated VO₂ max. Similarly, right ventricular ejectionfraction showed no correlation to estimated VO₂ max. Patientswith well preserved LV function had a higher exercise inducedincrease in systolic blood pressure than patients with reducedLV function, but the increase in systolic blood pressure couldnot be used to estimate LV function with any reasonable accuracy. We conclude that the maximal exercise capacity of patients withrecent AMI is virtually independent of their left and rightventricular function determined at rest, and that exercise testingand radionuclide ventriculography should be regarded as complementaryprocedures in the evaluation of patients with AMI.