Angiographic correlates of the high-risk criteria for conventional exercise testing and the Duke treadmill score]

OBJECTIVE: To compare the sensitivity, the specificity, the positive and negative predictive value and the predictive accuracy of the Duke Treadmill Score, the Spanish Society of Cardiology (SEC) and American College of Cardiology/American Heart Association (ACC/AHA) high-risk criteria for exercise testing in the detection of left main disease, three vessel disease and two vessel disease involving the proximal left anterior descending artery. PATIENTS AND METHOD: A cohort of 199 patients (age 75 years) consecutively admitted to hospital for unstable angina was studied. All patients underwent an exercise stress test and coronariography. RESULTS: The SEC high-risk Criteria showed a sensitivity of 69.2% and a specificity of 49.0%. The ACC/AHA high-risk Criteria demonstrated a sensitivity of 98.1% and a specificity of 23.8% and the Duke Treadmill Score presented a sensitivity of 30.8% and a specificity of 90.5%. In patients with moderate risk in the Duke Treadmill Score we found a sensitivity of 62.9% and a specificity of 39.8% for the SEC high-risk criteria, while the ACC/AHA high-risk Criteria presented a sensitivity of 100.0% and a specificity of 5.8%. CONCLUSIONS: The ACC/AHA high-risk Criteria showed a higher sensitivity while the Duke Treadmill Score presented a higher specificity for the detection of left main disease, three vessel disease and two vessel disease involving the proximal left anterior descending artery. The ACC/AHA and SEC high-risk Criteria were found to be very useful in the group of patients with moderate risk in the Duke Treadmill Score.     

156例平板运动试验与冠状动脉造影结果对照分析

目的将平板运动试验的结果与冠状动脉造影（CAG）的结果对照，探讨平板运动试验与冠状动脉病变的相关关系。方法选择临床拟诊冠心病（CHD）患者156例，2周内行平板运动试验与CAG检查。将平板运动试验的结果与CAG的结果对照分析。结果①156例患者中，平板运动试验阳性67例，其中CAG阳性50例，CAG阴性17例。平板运动试验阴性89例，其中CAG阴性75例，CAG阳性14例。平板运动试验检出CHD的敏感性为75．3％（67／89），特异性为81．5％（75／92），阳性预测值74．6％（50／67），阴性预测84.3％（75／89），预测准确性80．1％（125／156），假阳性率为25．4％（17／67），假阴性率为15．7％（14／89）。②平板运动试验阳性率与冠状动脉病变支数有关；平板运动中ST段下移程度、出现时间及持续时间与冠状动脉狭窄程度有关。③女性平板运动试验假阳性率高于男性（P〈0．05）。结论平板运动试验是目前诊断冠心病较理想的非创伤性的检查方法，并可估测冠状动脉病变程度，适合临床广泛应用。     

Are the American College of Cardiology/American Heart Association guidelines for exercise testing for suspected coronary artery disease correct?

BACKGROUND: Recently published American College of Cardiology (ACC)/American Heart Association (AHA) guidelines state that patients with suspected coronary disease and an intermediate pretest probability are appropriate candidates for exercise ECG, while those with low or high pretest probability are not. METHODS: From 5,103 consecutive patients with symptoms of suspected coronary disease, we evaluated 872 patients who underwent coronary angiography following exercise ECG. Differences in test performance were determined using receiver operating characteristic curve area analysis. A score using age, gender, symptoms, and risk factors was used to classify patients into low, intermediate, and high pretest probability groups. RESULTS: When patients with inadequate exercise tests were excluded, overall sensitivity and specificity were 70% and 66%, respectively. Only the intermediate pretest probability group demonstrated significant incremental value: pretest vs posttest intermediate, 70 +/- 3 vs 79 +/- 3 (p < 0.0001); low, 71 +/- 6 vs 76 +/- 7 (p = 0.39); and high, 69 +/- 8 vs 75 +/- 7 (p = 0.12). From the low- to the high-probability groups, there was a progressive increase in positive predictive value (21%, 62%, and 92%) and decrease in negative predictive value (94%, 72%, and 28%), respectively. The frequencies of abnormal exercise ECGs were lower in the unselected groups compared with the angiography groups (low, 13% vs 36%; intermediate, 22% vs 53%; high, 36% vs 63%). CONCLUSIONS: Based on the information added by exercise testing to clinical data, these results confirm the ACC/AHA guideline assignments for test selection. However, despite these guidelines, patients with a low pretest probability can be selected for exercise testing with the knowledge that a positive result is infrequent and a negative result carries a very high negative predictive value. Intermediate-probability patients on average carry a significant false-negative rate, suggesting that exercise ECG alone may not be a sufficient screening test in all intermediate-probability patients. Because of poor negative predictive value and a large percentage of negative tests, high-probability patients should undergo coronary angiography as the initial strategy, unless the goal of exercise testing is to assess prognosis.     

227例平板运动试验与冠状动脉造影结果对照分析

目的将平板运动试验的结果与冠状动脉造影(CAG)的结果对照,探讨心电图平板运动试验反映冠状动脉病变的价值。方法选择临床拟诊冠心病(CAD)患者227例,二周内行平板运动试验与CAG检查。将平板运动试验的结果与CAG的结果对照分析。结果227例患者中,平板运动试验阳性99例,其中CAG阳性75例,CAG阴性24例。平板运动试验阴性128例,其中CAG阴性109例,CAG阳性19例。平板运动试验检出CAD的敏感性为83.9%(99/118),特异性为82.0%(109/133),阳性预测值75.8%(75/99),阴性预测值85.2%(109/128),预测准确性81.1%(184/227),假阳性率为24.2%(24/99),假阴性率为14.8%(19/128)。总运动时间、峰运动METs、S-T段压低出现的导联数、峰运动收缩压、S-T段压低持续时间,CAG阳性组与CAG阴性组比较差异有统计学意义(P<0.05)。平板运动试验阳性率,CAG阳性组与CAG阴性组比较差异有统计学意义(P<0.05)。女性平板运动试验假阳性率高于男性组(P<0.05)。结论平板运动试验是诊断CAD的无创性检查方法之一。它操作简单、经济、实用,适合临床广泛应用。     

A survey of exercise testing: methods, utilization, interpretation, and safety in the VAHCS

BACKGROUND: Healthcare organizations are being graded in terms of their adherence to practice guidelines. The authors sought information on practice patterns of exercise testing within the Veterans Affairs Health Care System (VAHCS) to determine how well current practice patterns adhere to current guidelines. In addition, we sought to update past surveys to determine methods, indications, utilization of alternative diagnostic modalities, criteria for interpretation, safety, and physician supervision of exercise testing within the VAHCS. METHODS: Questionnaires were sent to 72 of the largest Veterans Affairs Medical Centers with cardiology divisions. The centers were queried regarding volume and type of exercise testing (standard, nuclear, and echocardiographic), indications, safety, protocols used, and criteria for interpretation. RESULTS: Seventy-one questionnaires were returned, comprising a total of 75,828 exercise tests performed within the last year. Virtually all indications for exercise testing fit the American Heart Association/American College of Cardiology (AHA/ACC) guidelines Class I criteria; 46% of patients were tested for the evaluation of chest pain; 14% were tested to evaluate patients at high risk for coronary artery disease; 10% were preoperative evaluations; and 8% were post-myocardial infarction evaluations. The most commonly used diagnostic test was the standard exercise electrocardiogram; a patient was five times more likely to undergo a standard exercise electrocardiogram or nuclear exercise test than an exercise or pharmacologic echocardiogram. The largest proportion of centers (49%) used 1.0-mm horizontal or downsloping ST depression as a criterion for an abnormal test, although 22% considered 1.5-mm upsloping ST depression to be abnormal, and 25% relied on a treadmill score. Seventy-eight percent of respondents used the treadmill, and of these, 82% used the Bruce or modified Bruce protocol. Four major cardiac events were reported (three myocardial infarctions, one sustained ventricular tachycardia) representing an event rate of 1.2/10,000. A physician was present during 73% of all standard exercise tests; 21% of respondents reported that a physician was required to be present "only for high-risk patients." CONCLUSION: Indications for exercise testing are in close agreement with the AHA/ACC guidelines; thus, the test continues to have an important role in diagnosis and prognosis among patients with or suspected of having coronary artery disease. The exercise test is an extremely safe procedure, with an event rate similar to other recent surveys. However, a great deal of variation exists in terms of criteria for abnormal results and whether physician presence is required during exercise testing.     

Comparison of the chronotropic response to exercise and heart rate recovery in predicting cardiovascular mortality.

BACKGROUND: Both an impaired capacity to increase heart rate during exercise testing (chronotropic incompetence), and a slowed rate of recovery following exercise (heart rate recovery) have been shown to be associated with all-cause mortality. It is, however, unknown which of these responses more powerfully predicts risk, and few data are available on their association with cardiovascular mortality or how they are influenced by beta-blockade. METHODS: Routine symptom-limited exercise treadmill tests performed on 1910 male veterans at the Palo Alto Veterans Affairs Medical Center from 1992 to 2002 were analyzed. Heart rate was determined each minute during exercise and recovery. Chronotropic incompetence was defined as the inability to achieve > or =80% of heart rate reserve, using a population-specific equation for age-predicted maximal heart rate. An abnormal heart rate recovery was considered to be a decrease of <22 beats/min at 2 min in recovery. Cox proportional hazards analyses including pretest clinical data, chronotropic incompetence, heart rate recovery, the Duke Treadmill Score (abnormal defined as <4), and other exercise test responses were performed to determine their association with cardiovascular mortality. RESULTS: Over a mean follow-up of 5.1+/-2.1 years, there were 70 deaths from cardiovascular causes. Both abnormal heart rate recovery and chronotropic incompetence were associated with higher cardiovascular mortality, a lower exercise capacity, and more frequent occurrence of angina during exercise. Both heart rate recovery and chronotropic incompetence were stronger predictors of risk than pretest clinical data and traditional risk markers. Multivariately, chronotropic incompetence was similar to the Duke Treadmill Score for predicting cardiovascular mortality, and was a stronger predictor than heart rate recovery [hazard ratios 3.0 (95% confidence interval 1.9-4.9), 2.8 (95% confidence interval 1.7-4.8), and 2.0 (95% confidence interval 1.1-3.5) for abnormal Duke Treadmill Score, chronotropic incompetence, and abnormal heart rate recovery, respectively]. Having both chronotropic incompetence and abnormal heart rate recovery strongly predicted cardiovascular death, resulting in a relative risk of 4.2 compared with both responses being normal. Beta-blockade had minimal impact on the prognostic power of chronotropic incompetence and heart rate recovery. CONCLUSION: Both chronotropic incompetence and heart rate recovery predict cardiovascular mortality in patients referred for exercise testing for clinical reasons. Chronotropic incompetence was a stronger predictor of cardiovascular mortality than heart rate recovery, but risk was most powerfully stratified by these two responses together. The simple application of heart rate provides powerful risk stratification for cardiovascular mortality from the exercise test, and should be routinely included in the test report.     

平板运动试验与动态心电图联合检测对冠状动脉病变的预测价值

目的 为明确平板运动试验与动态心电图联合检测对冠状动脉病变的预测意义。方法 选取冠状动脉造影患者、且造影前或造影后2月内作平板运动试验和动态心电图者185例,冠状动脉造影以通用直径法确定冠状动脉狭窄程度和范围,并与平板运动试验和动态心电图结果对比观察。结果 95例平板运动试验和动态心电图结果均阳性者,94例存在冠状动脉病变,7例仅动态心电图阳性者6例有冠状动脉病变而53例仅平板运动结试验阳性者42例有冠状动脉病变,30例动态心电图和平板运动结试验均阴性者仅1例有轻度冠状动脉病变。结论 平板运动试验与动态心电图联合检测可初步估测冠状动脉狭窄。     

Risk stratification after successful coronary revascularization: the lack of a role for routine exercise testing.

OBJECTIVE: The objective of this study was to evaluate the American College of Cardiology/American Heart Association (ACC/AHA) guidelines for exercise testing (EXT) after successful coronary revascularization (CR) using the Bypass Angioplasty Revascularization Investigation experience. BACKGROUND: The ACC/AHA guidelines state that EXT within three years of successful CR is not useful. METHODS: The 1,678 patients randomized to CR by either angioplasty or bypass surgery were required to take symptom-limited treadmill tests one, three and five years after revascularization. RESULTS: Patients who took the test at each specified time had a much lower subsequent two-year mortality than those who did not (1.9% vs. 9.4%, 3.5% vs. 12.6% and 3.3% vs. 11.0% at one, three and five years, respectively, after CR [p < 0.0001 for each]). Exercise parameters at the one- and three-year test did not improve a multivariable model of survival after including clinical parameters. Exercising to Bruce stage 3 or generating a Duke score >-6 were independently predictive of two-year survival after the five-year test. ST depression on the one-year test was associated with more revascularizations (relative risk = 1.6; p < 0.001). CONCLUSIONS: Patients with stable multivessel coronary disease who took a protocol-mandated exercise test at one, three and five years after revascularization were at low risk for mortality in the two years subsequent to each test. Exercise parameters did not improve prediction of mortality in the two years after the one- and three-year tests. The ACC/AHA guidelines on exercise testing after CR (no value for routine testing in stable patients for three years after revascularization) are supported by these results.     

平板运动试验QRS波改变对女性冠心病的预测价值

目的 探讨平板运动试验(TET)QRS波改变对诊断女性冠心病(CHD)的预测价值.方法选择临床可疑女性CHD患者382例,1周内相继完善TET与选择性冠状动脉造影(CAG)检查.对TET的QRS波改变与CAG的结果进行分析.结果 TET的QRS时限延长检出女性CHD的敏感性为89.1%,特异性为65.48%,阳性预测值48.13%,阴性预测值94.36%,预测准确性为71.73%.TET的QRS积分检出女性CHD的敏感性为88.46%,特异性为76.62%,阳性预测值58.60%,阴性预测值94.67%,预测准确性为79.84%.结论 TET的QRS波改变是目前诊断女性CHD较理想的无创性检查方法.     

Use of routine functional testing after percutaneous transluminal coronary angioplasty: results from the ROSETTA Registry

BACKGROUND: The American College of Cardiology (ACC)/American Heart Association (AHA) guidelines for exercise testing suggest that only selected groups of high-risk patients should undergo routine functional testing after percutaneous transluminal coronary angioplasty (PTCA) for the detection of restenosis. OBJECTIVES: Our purpose was (1) to document the patterns of use of post-PTCA functional testing and (2) to determine whether the choice of functional testing strategy is related to clinical characteristics of patients or whether physicians use a similar strategy for all their patients. METHODS: The Routine Versus Selective Exercise Treadmill Testing After Angioplasty (ROSETTA) Registry is a prospective study examining the use of functional testing among 788 patients at 13 centers in 5 countries. RESULTS: During the 6-month period after a successful PTCA, 49% of patients underwent functional testing (range among centers 10%-81%). Among patients who underwent functional testing, 39% had a clinical indication and 61% had functional testing as a routine follow-up. The first functional test was performed a median of 7 weeks after PTCA, with 13% of patients having second tests at a median of 14 weeks and 4% having additional tests at a median of 20 weeks. Univariate and multivariate analyses demonstrated that the chief determinant of the use of routine functional testing was clinical center. Aside from age (P <.0001), no baseline clinical or procedural characteristics were consistently associated with the use of routine functional testing after PTCA. CONCLUSIONS: Physicians do not appear to be adhering to the ACC/AHA guidelines for exercise testing regarding the routine use of post-PTCA functional testing. None of the clinical characteristics identified by the ACC/AHA guidelines were associated with the routine use of post-PTCA functional testing, and the primary determinant of functional testing was the location of the center at which the patient had the PTCA.     

活动平板试验对冠心病诊断及介入疗效的评价作用

目的探讨活动平板试验对冠心病诊断及介入疗效评价的作用。方法对比分析213例疑诊或临床诊断冠心病患者的运动平板试验和选择性冠状动脉造影结果，并对其中49例接受介入治疗的病例对比分析治疗前后的运动平板试验结果。结果以选择性冠状动脉造影结果为标准，活动平板试验敏感性为66．7％，特异性为87．6％，阳性预测值为77．8％，阴性预测值为80．1％。冠心病介入治疗后活动平板试验的阳性率降低（P〈0．01），总运动代谢当量和运动开始至达到阳性诊断标准的时间较冠心病介入治疗前增加（P均〈0．05）。结论简便、易行及无创的活动平板试验是诊断冠心病的重要手段，并为客观评价冠心病介入治疗效果提供依据。     

运动平板试验Duke评分预测冠状动脉病变程度的价值

目的:评价平板运动试验Duke评分(DTS)对冠心病冠状动脉病变程度的临床价值。方法: 选择169例运动试验阳性和可疑阳性同时行冠状动脉造影的患者为研究对象,按Duke评分分为DTS低危组（Duke≥+5分,n=35）、中危组(DTS:(-10~+4)分,n=77)和DTS高危组(DTS≤-11分,n=57),比较3组患者冠状动脉病变和临床特点。分析DTS预测冠状动脉病变程度的价值。结果: 在DTS高危组和中危组中限制性心绞痛发作例数、ST段偏移≥1 mm例数、运动时ST改变涉及导联数目、ST段偏移值均明显高于DTS中低危组（P＜0.05,P＜0.01）;而运动持续时间和运动最大心率明显低于DTS中低危组 （P＜0.05,P＜0.01）。随冠状动脉病变严重程度的加重DTS高危组病例数显著增多。3组间两两相比差异均有统计学意义(均P＜0.05)。相关分析发现,3组患者的DTS与冠状动脉病变Gensini积分呈负相关（r=-0.74,P＜0.05）。结论: 运动试验DTS与冠状动脉病变狭窄程度高度相关,应用该评分可以更好地对临床中怀疑心肌缺血的患者进行明确诊断及预后的判断。     

An update on exercise stress testing

Exercise stress testing is the most commonly used noninvasive method to evaluate for coronary artery disease in men and women. Although emphasis has been placed on the diagnostic value of ST-segment depression, the exercise stress test provides other valuable diagnostic and prognostic data, beyond ST-segment depression. The value of these variables, which include exercise capacity, chronotropic response, heart rate recovery, blood pressure response, and the Duke Treadmill Score, are reviewed in this article. In addition, the gender differences seen with these exercise testing variables are reviewed. In this modern era of exercise stress testing, making use of all the information from a stress test and creating a comprehensive stress testing report are recommended in the evaluation of patients with suspected coronary artery disease who undergo exercise stress testing.     

活动平板试验对评估冠状动脉狭窄程度的预测价值

目的 为了明确活动平板试验与冠状动脉狭窄程度的关系。方法 选取冠状动脉造影阳性且造影1周前后作活动平板试验115例,冠状动脉造 通用直径法确定冠状动脉狭窄程度并与活动平板试验中心电活动改变对比观察。结果 平板运动中ST下移出现越早,ST段下移程度越大,持续时间越长冠状动脉狭窄越重,相反ST段下移出现晚,下移程度小,提示冠状动脉病变程度轻。冠状动脉造影阳性而平板运动试验阴性者,多为单支或轻度病变。结论 活动平板运动试验可估测冠状动脉狭窄程度。     

Evaluation of pretest and exercise test scores to assess all-cause mortality in unselected patients presenting for exercise testing with symptoms of suspected coronary artery disease

OBJECTIVES: To determine how well recently developed multivariables scores assess for all-cause mortality in patients with suspected coronary disease presenting for exercise electrocardiography (ExECG). BACKGROUND: Recently revised American College of Cardiology/American Heart Association guidelines for ExECG have suggested that ExECG scores be used to assist in management decisions in patients with suspected coronary artery disease. Recently developed scores accurately stratify patients according to angiographic disease severity. METHODS: To determine how well these scores assess for all-cause mortality, we utilized 4,640 patients without known coronary disease who underwent ExECG to evaluate symptoms of suspected coronary disease between 1995 and 2001. Previously validated pretest and exercise test scores as well as the Duke treadmill score were applied to each patient. All-cause mortality was our end point. RESULTS: Overall mortality was 3.0% with 2.8 +/- 1.6 years of follow-up. All three scores stratified patients into low-, intermediate-, and high-risk groups (p < 0.00001). No differences were seen when patients were evaluated as subgroups according to gender, diabetes, beta-blockers, or inpatient status. Low-risk patients defined by the Duke treadmill score had consistently higher mortality and absolute number of deaths compared with low-risk patients using other scores. In addition, the Duke treadmill score had less incremental stratifying value than the new exercise score. CONCLUSIONS: Simple pretest and exercise scores risk-stratified patients with suspected coronary disease in accordance with published guidelines and better than the Duke treadmill score. These results extend to diabetics, inpatients, women, and patients on beta-blockers.     

平板运动试验结合多层螺旋CT冠状动脉成像对冠心病的诊断价值

目的 探究平板运动试验（TET）结合多层螺旋CT（MSCT）对冠心病的诊断价值.方法 选择临床拟诊冠心病（CAD）的患者200例,2周内先后进行平板运动试验、多层螺旋CT冠状动脉成像及冠状动脉造影（CAG）检查.以冠状动脉造影为＂金标准＂,分析平板运动试验、多层螺旋CT冠状动脉成像及两者结合对冠心病检出率的有关指标.结果 平板运动试验、多层螺旋CT冠脉成像及两者结合诊断冠心病的敏感性、特异性、阳性预测值、阴性预测值、准确性分别为81.3%（74/81）、70.6%（77/109）、69.8%（74/106）、81.9%（77/94）和75.5%（151/200）;83.5%（76/91）、84.4%（92/109）、82.6%（76/92）,85.2%（82/108）和84.0%（168/200）;98.0%（53/57）,100%（143/143）、100%（53/53）、97.3%（143/147）和98.0%（196/200）.结论 平板运动试验结合多层螺旋CT冠状动脉成像能明确诊断或排除冠心病.     

Utilization of coronary angiography and revascularization after acute myocardial infarction in men and women risk stratified by the American College of Cardiology/American Heart Association guidelines

OBJECTIVES: We sought to determine whether men and women are equally likely to receive coronary angiography and revascularization after acute myocardial infarction (AMI) when they are risk stratified according to American College of Cardiology/American Heart Association (ACC/AHA) practice guidelines for post-MI care. BACKGROUND: Several previous studies have suggested that women may undergo angiography and revascularization procedures less frequently than men. METHODS: In 439 consecutive patients admitted to a public hospital with AMI, rates of coronary angiography and revascularization were compared in men and women categorized, according to ACC/AHA practice guidelines, as having strong (class I or IIa) or weaker (class IIb) indications for angiography. RESULTS: Women were older and more likely to be diabetic or hypertensive, but men and women were equally likely to meet class I/IIa criteria for post-MI angiography (both 51%). Angiography rates were nearly identical in men and women overall (63% vs. 64%), as well as in patients in class I/IIa (80% vs. 82%) and class IIb (46% vs. 46%) (all p > 0.80, with >80% power to detect important differences); the only multivariate predictors of post-MI angiography were age and ACC/AHA class. Significant coronary artery disease was equally prevalent in men and women undergoing angiography, and men and women were equally likely to undergo revascularization, whether they were in class I/IIa (both 55%, p = 0.90) or class IIb (59% vs. 58%, p = 0.88). No significant differences in mortality were noted between men and women. CONCLUSIONS: Despite being older and having more risk factors than men, women were equally likely to undergo coronary angiography and revascularization procedures after AMI, and they had in-hospital clinical outcomes that were at least as favorable.     

Duke评分预测胸痛患者冠脉病变程度的价值

目的探讨胸痛合并三个及以上心血管病危险因素患者Duke评分预测冠状动脉病变程度的价值。方法选择2008年2月至2013年5月在北京大学人民医院接受平板运动试验并完成冠脉造影检查的胸痛患者118例，依据合并的危险因素数量将患者分为危险因素≥3个和危险因素〈3个两组，分析两组患者Duke评分与冠脉病变的相关性，并分别分析两组中不同年龄亚组（〈65、≥65岁）的Duke评分与冠状动脉评分的相关性。结果危险因素数量t≥个或〈3个的患者中，Duke评分与冠状动脉ACC评分均呈负相关（r=-0．538，p〈0．001；r=-0．482，p〈0．001）。危险因素数量≥3组，年龄〈65岁患者和年龄≥65岁的老年患者其Duke评分与冠状动脉ACC评分均负相关（r=-0．392，p=0．01；r=-0．805，p=0．002）；在危险因素数量〈3组，年龄〈65岁患者的Duke评分与冠状动脉ACC评分负相关（r=-0．578，p〈0．001），而年龄≥65岁的老年患者Duke评分与冠状动脉ACC评分不相关（p=0．786）。结论平板运动试验Duke评分对冠状动脉病变程度的预测不受患者合并的危险因素数量的影响。在合并较多危险因素（≥3个）时，平板运动试验Duke评分对冠状动脉病变程度的预测不受年龄因素的影响。     

运动平板试验与冠状动脉造影结果对比研究

目的分析运动平板试验与冠脉造影的结果,评价无创TET在冠心病诊断中的价值。方法比较分析2009年1月—2010年5月在我院行运动平板试验及冠脉造影检查的147例患者的检查结果。结果本组患者运动平板试验检出冠心病的敏感性84%,特异性64%,运动平板试验阳性患者的冠状动脉病变严重。结论运动平板试验操作简单、安全、无创,诊断冠心病有较高的敏感性和特异性。     

Primary care management of chronic stable angina and asymptomatic suspected or known coronary artery disease: a clinical practice guideline from the American College of Physicians

In 1999, the American College of Physicians (ACP), then the American College of Physicians-American Society of Internal Medicine, and the American College of Cardiology/American Heart Association (ACC/AHA) developed joint guidelines on the management of patients with chronic stable angina. The ACC/AHA then published an updated guideline in 2002, which ACP recognized as a scientifically valid review of the evidence and background paper. This ACP guideline summarizes the recommendations of the 2002 ACC/AHA updated guideline and underscores the recommendations most likely to be important to physicians seeing patients in the primary care setting. This guideline is the second of 2 that provide guidance on the management of patients with chronic stable angina. This document covers treatment and follow-up of symptomatic patients who have not had an acute myocardial infarction or revascularization procedure in the previous 6 months. Sections addressing asymptomatic patients are also included. Asymptomatic refers to patients with known or suspected coronary disease based on a history or electrocardiographic evidence of previous myocardial infarction, coronary angiography, or abnormal results on noninvasive tests. A previous guideline covered diagnosis and risk stratification for symptomatic patients who have not had an acute myocardial infarction or revascularization procedure in the previous 6 months and asymptomatic patients with known or suspected coronary disease based on a history or electrocardiographic evidence of previous myocardial infarction, coronary angiography, or abnormal results on noninvasive tests.