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。     

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...     

食管心房调搏负荷试验联合平板运动试验对男性冠心病患者的诊断价值

目的 探讨食管心房调搏负荷试验联合平板运动试验对男性冠心病患者的诊断价值.方法 选择拟诊冠心病的男性患者82例,入选病例全部行冠状动脉造影,且造影前或后1个月行食管心房调搏负荷试验和平板运动试验,观察对比直径法确定的冠状动脉狭窄程度和范围与食管心房调搏负荷试验和平板运动试验结果.结果 以冠状动脉造影结果为标准,食管心房调搏负荷试验联合平板运动试验诊断冠心病的敏感度为72.9％,特异度为52.6％,阳性预测价值为90.4％,阴性预测价值为78.7％,食管心房调搏负荷试验及平板运动试验显示冠状动脉狭窄支数越多,ST段压低出现越早、压低程度越大、持续时间越长（P＜0.001）.冠状动脉造影阳性而食管心房调搏负荷试验、平板运动试验阴性者,多为单支病变或病变较轻.结论 简便易行且无创的食管心房调搏负荷试验联合平板运动试验能提高冠心病的诊断率,并可初步估测冠状动脉狭窄程度.     

活动平板试验对冠状动脉狭窄侧支循环尚好常规心电图正常的临床意义

目的为了明确活动平板试验与冠状动脉狭窄程度以及形成侧支循环的关系。方法选择冠状动脉造影阳性且造影1周前后作活动平板试验者80例,冠状动脉造影以通用直径法确定冠状动脉抉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段下移出现越早,下移程度越大,持续时间越长,冠状动脉狭窄程度越重;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,多为单支或轻度病变,或因侧支循环形成支数多。结论活动平板运动试验可估计冠状动脉狭窄程度,对门诊常规心电图正常但已有冠脉狭窄的患者可预防或减少院外猝死的发生。     

冠心病患者运动试验时无症状性心肌缺血的意义

本文评价运动试验时无症状性心肌缺血的诊断和预后意义,并与运动试验时出现心绞痛者进行比较.2982例资料取自冠状动脉外科研究登记处.经冠状动脉造影检查:1583例左主干狭窄(内径缩小≥50%)或某主支狭窄(内径缩小≥70%),为明显冠状动脉病变(CAD);1117例非明显CAD;282例无CAD.造影后一个月内按标准或修订的Bruce方案进行活动平板试验,凡ST段水平型或下垂型(较静息时)压低≥1mm且持续≥0.08S,或者出现心绞痛,为阳性.各例逐年随访达7年(至少5年),99%病例完成随访.明显CAD者根据运动试验结果分组:424例(组Ⅰ)缺血性ST段压低组无心绞痛;232例(组Ⅱ)出现心绞痛但无缺血性ST段压低;456例(组Ⅲ)兼有缺血性ST段压低和心绞痛;471例(组Ⅳ)既无ST段压低也无心绞痛.     

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ST段压低幅度与冠状动脉病变特点的相关性分析

目的:了解运动试验ST段压低不同幅度患者的冠状动脉病变和临床特点,并探讨其相关性。方法:选取114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ST段压低幅度分为0.5～0.9mm组、1.0～1.9mm组和≥2.0mm组,比较3组患者冠状动脉病变和临床特点。结果:3组患者间的性别、年龄、心绞痛、高血压、糖尿病和室壁运动障碍人数差异无统计学意义(P0.05),但经皮冠状动脉介入治疗术后的患者人数差异有统计学意义(P=0.032);在冠状动脉病变数目、发生部位方面差异无统计学意义(P0.05);3组患者间血管狭窄90%以上者差异有统计学意义(P=0.035)。经进一步Logistic回归分析发现,血管狭窄90%以上是ST段压低幅度的独立影响因素。结论:运动试验诱发的ST段压低幅度可间接反映冠状动脉病变狭窄程度,且血管狭窄90%以上是ST段压低幅度的独立影响因素。但ST段压低幅度不能反映冠状动脉病变数目和发生部位。     

平板运动试验恢复期与运动中ST段压低在冠心病中的诊断价值比较

目的 比较平板运动试验恢复期与运动中ST段压低的心电图表现在冠心病中的诊断价值.方法 选择可疑冠心病患者并行平板运动试验结果呈阳性者211例,将其分成运动中ST段压低组（A组,n=178）,恢复期ST段压低组（B组,n=33）,对两组的临床资料和冠状动脉造影结果进行对比分析.结果两组临床资料（除高尿酸）比较,差异均无统计学意义（均P ＞0.05）.两组对冠状动脉造影的阳性预测值相近（ 71.3%vs72.7%,P ＞0.05）,冠状动脉病变部位及单支、三支病变比较,差异无统计学意义（P ＞0.05）;冠状动脉病变重度狭窄率B组高于A组,差异有统计学意义（P＜0.05）.结论 平板运动试验恢复期ST段压低与运动中ST段压低在冠心病诊断中同样重要,可预示冠状动脉的重度病变.     

血管造影证实为冠状动脉心脏病患者的分级运动试验

活动平板运动试验的应用日益普遍,但迄今尚乏冠状动脉造影资料以证实病变的存在及程度。本文对650例经冠状动脉造影检查的患者,观察运动试验的结果与临床症状、血管造影及血液动力学之间的关系。方法:应用分级活动平板运动试验,每级持续运动3分钟,并鼓励患者运动至极量。在12个标准导联中任何一个导联出现ST段水平压低或抬高0.1毫伏(间期≥O.08秒)者为阳性。休息时心电图中有洋地黄效应或非特异性ST-T波改变时,则ST段需较对照压低0.2毫伏。如达到最大心率的85％后     

平板运动试验恢复期ST段压低对冠心病诊断价值及相关因素分析

目的　评价平板运动试验中恢复期ST段压低的意义。方法　选择2008年7月至2012年12月在我院住院同时接受平板运动试验和选择性冠状动脉造影检查患者,共168例,分成3组：平板运动试验运动中ST段压低组（简称运动中组,n＝90）,男性54例,女性36例,年龄35～80岁;平板运动试验恢复期ST段压低组（简称恢复期组,n＝61）,男性26例,女性35例,年龄45～74岁;平板运动试验结果阴性组（简称平板阴性组,n＝17）,男性11例,女性6例,年龄35～80岁。再根据冠状动脉造影结果将患者分别列入冠状动脉造影阴性组、冠状动脉轻度狭窄组和冠状动脉明显狭窄组。比较各组患者的基本资料、合并症,平板运动试验结果与冠状动脉造影结果之间的联系以及超声心动图资料。结果　运动中组患者年龄偏大,同时糖尿病较多,高密度脂蛋白胆固醇水平低于恢复期组和平板阴性组,而肌酐和胱抑素C水平高于其他两组,差别具有统计学意义（P<0.05）。运动中组冠状动脉明显狭窄的比例高于恢复期组和平板阴性组,恢复期组冠状动脉轻度狭窄比例高于运动中组（P<0.01）。运动中组冠状动脉1支、2支、3支或左主干病变出现概率均高于恢复期组。平板阴性组左心室舒张末期容积小于其他两组,差别具有统计学意义（P<0.05）。结论　运动中ST段压低对诊断冠心病的价值较恢复期ST段压低高。平板运动试验中恢复期出现ST段压低的患者在诊断冠心病时应结合危险因素综合考虑。     

活动平板运动试验诱发ST段抬高的临床意义

为探讨活动平板运动试验诱发ST段抬高的临床意义 ,分析了 9例无心肌梗死 (简称心梗 )而运动诱发ST段抬高的静息心电图、运动试验及冠状动脉 (简称冠脉 )造影检查结果。结果 :5 0 5 5例行平板运动试验者中 ,有 11例未患心肌梗死而运动诱发心绞痛伴ST段抬高 ,发生率 0 .2 2 %。其中 ,8例患者作了进一步检查 ,冠脉造影显示均有程度不等的血管病变 ,缺血相关血管的狭窄达到 5 0 %～ 10 0 %。ST段抬高导联与缺血相关血管有良好对应关系。另有 1例患者于运动试验 1周后死于心脏性猝死。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。     

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。     

平板运动试验心率校正的ST段压低参数对冠心病诊断价值的探讨

探讨心率校正的ST段压低参数诊断冠状动脉 (简称冠脉 )病变的准确性 ,12 8例患者接受次极量平板运动试验和冠脉造影。观察各例患者运动中心率相关的ST段压低最大速度即最大ST段 /心率斜率 ,最大心率时ST段与静息时ST段压低值之差除以最大心率与静息心率之差即ΔST/HR指数 ,以及ST段压低 ,观察值与阳性判断标准比较。结果显示 ,最大ST/HR斜率诊断冠心病的敏感性、特异性及诊断符合率最高 ,分别为 94.1%、92 .3%、94.5 % ,ST段压低诊断冠心病的敏感性、特异性及诊断符合率最低 ,分别为 74.5 %、6 9.2 %、73.4%。最大ST/HR斜率在冠脉不同程度病变间无重叠 ,其它参数虽与冠脉病变程度有平行关系 ,但有较大程度的重叠。结论 :心率校正的ST段压低参数显著提高了对冠心病的诊断价值 ,其中最大ST/HR斜率对冠脉病变支数有定量诊断价值     

平板运动试验中室性早搏ST段下移诊断冠状动脉病变的价值

探讨平板运动试验中室性早搏(VPCs)ST段下移程度对反映冠状动脉(简称冠脉)病变的价值。将休息和平板运动试验中均发生VPCs并且在3个月内进行冠脉造影的92例患者按冠脉造影结果分成冠心病组和非冠心病组,比较两组VPCsST段下移程度,下移程度与冠脉狭窄程度的关系以及VPCsST段下移诊断冠心病的价值。结果:冠心病组运动中VPCsST段下移及ST/R均大于非冠心病组。其中ST/R>10%对冠心病诊断灵敏度为91%,特异度为75%;对单支、2支、3支血管病变诊断灵敏度分别为84%、91%、100%。冠脉狭窄≥90%组运动中VPCsST段下移和ST/R大于狭窄为50%~69%组。结论:运动试验中VPCsST段下移可作为诊断冠心病的有效参考指标,其下移程度可能与冠脉狭窄程度有关。     

The effect of resting ST segment depression on the diagnostic characteristics of the exercise treadmill test

OBJECTIVES: The aim of this study is to demonstrate the effect of resting ST segment depression on the diagnostic characteristics of the exercise treadmill test. BACKGROUND: Previous studies evaluating the effect of resting ST segment depression on the diagnostic characteristics of exercise treadmill test have been conducted on relatively small patient groups and based only on visual electrocardiogram (ECG) analysis. METHODS: A retrospective analysis of data collected prospectively was performed on consecutive patients referred for evaluation of chest pain. One thousand two hundred eighty-two patients without a prior myocardial infarction underwent standard exercise treadmill tests followed by coronary angiography, with coronary artery disease defined as a 50% narrowing in at least one major epicardial coronary artery. Sensitivity, specificity, predictive accuracy and area under the curve of the receiver operating characteristic (ROC) plots were calculated for patients with and without resting ST segment depression as determined by visual or computerized analysis of the baseline ECG. RESULTS: Sensitivity of the exercise treadmill test increased in 206 patients with resting ST segment depression determined by visual ECG analysis compared with patients without resting ST segment depression (77 +/- 7% vs. 45 +/- 4%) and specificity decreased (48 +/- 12% vs. 84 +/- 3%). With computerized analysis, sensitivity of the treadmill test increased in 349 patients with resting ST segment depression compared with patients without resting ST segment depression (71 +/- 6% vs. 42 +/- 4%) and specificity decreased (52 +/- 9% vs. 87 +/- 3%) (p < 0.0001 for all comparisons). There was no significant difference in the area under the curve of the ROC plots (0.66-0.69) or the predictive accuracy (62-68%) between the four subgroups. CONCLUSIONS: The diagnostic accuracy and high sensitivity of the exercise treadmill test in a large cohort of patients with resting ST segment depression and no prior myocardial infarction support the initial use of the test for diagnosis of coronary artery disease. The classification of resting ST segment depression by method of analysis (visual vs. computerized) did not affect the results.     

Diagnosis of important fixed coronary stenosis in patients with variant angina by exercise tests after treatment with calcium antagonists.

A 12 lead electrocardiogram was recorded during treadmill exercise in 57 patients with variant angina in whom coronary angiography was performed. Thirty six patients performed exercise tests with and without calcium antagonists, and 21 performed them only with calcium antagonists. In 55 patients calcium antagonists had prevented spontaneous attacks of variant angina for more than two days before the test. The other two patients were given a single dose of diltiazem (90 mg) two hours before the test. Exercise testing without calcium antagonists induced ST segment elevation with chest pain in nine patients, ST segment depression in 10 (nine with chest pain), and no important shift of the ST segment in 17. Five patients had severe coronary stenosis (greater than or equal to 75%) and all of them showed positive response. Thirty one patients had no important coronary stenosis and 14 of them showed positive response. The sensitivity of the exercise test in detecting a coronary stenosis greater than or equal to 75% was 100% without calcium antagonists but the specificity was low (55%). When the exercise test was done in patients taking calcium antagonists, only two (specificity 96%) of 48 patients without severe coronary stenosis showed positive response (elevation of ST segment in one and depression in another) whereas all nine patients with severe coronary stenosis had a positive response (depression of ST segment in six and elevation in three (sensitivity 100%). It is concluded that exercise testing with calcium antagonists may be a useful method for detecting severe coronary stenosis in patients with variant angina.     

Diagnosis of important fixed coronary stenosis in patients with variant angina by exercise tests after treatment with calcium antagonists

A 12 lead electrocardiogram was recorded during treadmill exercise in 57 patients with variant angina in whom coronary angiography was performed. Thirty six patients performed exercise tests with and without calcium antagonists, and 21 performed them only with calcium antagonists. In 55 patients calcium antagonists had prevented spontaneous attacks of variant angina for more than two days before the test. The other two patients were given a single dose of diltiazem (90 mg) two hours before the test. Exercise testing without calcium antagonists induced ST segment elevation with chest pain in nine patients, ST segment depression in 10 (nine with chest pain), and no important shift of the ST segment in 17. Five patients had severe coronary stenosis (greater than or equal to 75%) and all of them showed positive response. Thirty one patients had no important coronary stenosis and 14 of them showed positive response. The sensitivity of the exercise test in detecting a coronary stenosis greater than or equal to 75% was 100% without calcium antagonists but the specificity was low (55%). When the exercise test was done in patients taking calcium antagonists, only two (specificity 96%) of 48 patients without severe coronary stenosis showed positive response (elevation of ST segment in one and depression in another) whereas all nine patients with severe coronary stenosis had a positive response (depression of ST segment in six and elevation in three (sensitivity 100%). It is concluded that exercise testing with calcium antagonists may be a useful method for detecting severe coronary stenosis in patients with variant angina.     

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。