食管心房调搏诱发阵发性房颤的心房电生理特性

为了探讨食管心房调搏对阵发性房颤检查的临床价值。回顾食管心房调搏诱发２５例阵发性房颤的心房电生理特性。其结果；程序刺激，分级起搏诱发１１例房颤，均有明确的房颤 史，猝发电脉冲诱发的１４例中１０例有明确的房颤史。房颤组２５例与正常对照组２５例相比心房有效不应期缩短，相对不应期区域扩大，最大房间传导时间延长，房间传导延缓更显著，这些可能是食管心房调搏诱发房颤的重要电生理基础。认为食管心房调搏对确定临床     

经食管心房调搏诱发房颤诊断阵发性房颤30例体会

阵发性房颤是临床较常见的一种心律失常.通常心电图就可明确,但初发阵发性房颤,24h动态心电图监测不易捕捉.为探索此病的有效诊断方法,本文对明确诊断阵发性房颤者与正常对照组各30例经食管心房调搏(TEAP)诱发房颤报道如下.材料和方法 阵发性房颤30例,男25例,女5例,年龄47—72(平均56)岁.病程3天—4.5年,平均1.9年.其中冠心病13例,原发性心肌病2例,高血压性心脏病3例,病态窦房结综合征2例,甲亢性心脏病3例,不明原因7例.对照组30例,男18例,女12例,年龄44—     

食管心房调搏对室上性心动过速诊断的准确性评价

评价食管电生理检查对室上性心动过速诊断的准确性。方法 比较102例室上性心动过速经心内和食管电生理检查的结果。结果 102例室上性心动过速101例分型诊断一致：房室折返性心运过速（AVRT）58例,房室结折返性心运过速（AVNRT）37例,房内折返性心动过速（IART）5例,窦房结折返性心动过速（SART）1例,房性自律性心动过速（AAT）1例。6例房性心动过速（IART5例,AAT1例）起源于右房还是左房和57例房室折返性心动过速的旁路位于右侧还是左侧,两种检查结果完全一致。结论 食管心房调搏对室上性心动过速的分型诊断和初步定位诊断具有很高的准确性,这对选择射频消融术病例和简化消融术程序具有重要意义。     

食管心房调搏在阵发性心动过速电生理检查中的地位

为评价食管心房调搏(TEAP)在阵发性心动过速电生理检查中的地位,用TEAP检查273例阵发性心动过速,其中267例室上速诱发266例(99.3%),2例室速(2/6)复制成功;所诱发持续性心动过速均被终止.经与心内标测和射频消蚀对照,结果:(1)检出室上速264例(诊断阳性率98.2%),单旁道184例(阳性率100%),双旁道4例(阳性率57.1%).(2)86例隐(?)性旁道术前左右定位的符合率100%,其中41例正确地预测了旁道的具体部位.提示:除多发性旁道外,TEAP对室上速检查的准确率与心内标测相近,其结果对射频消蚀病例选择和术中指导均有意义.     

食管心房调搏对预激综合征房室旁道电生理特性的研究

用食管心房调搏结合多导联同步描记技术测得69例预激征房室旁道的前向不应期为362.8±234.2ms。不应期≤280ms 者占40.6%,≥600ms 者占11.6%。不应期与旁道传导能力呈显著负相关;性别、年龄及预激分型对不应期无明显影响;基础心率增快时多数病人不应期有所缩短,旁道传导能力有所提高,但并不尽然。作者认为旁道不应期及传导能力测定是对高危预激综合征病人有价值的筛选指标。     

经食管心房调搏终止阵发性室上速方法分析

经食管心房调搏终止阵发性室上速方法分析海军总医院心内科（１０００３７）田慧生，石湘芸临床上阵发性室上速（ＰＳＶＴ）较常见，发病急，需尽快处理，经食管心房调搏（ＴＥＡＰ）终止发作见效快、安全，患者易耐受，现就我院对４３例ＰＳＶＴ患者用ＴＥＡＰ终止成功几...     

经食管心房调搏对阵发性室上性心动过速的诊断价值

目的 探讨经食管心房调搏对阵发性室上性心动过速的分型及定位诊断价值。方法 回顾性分析食管心房调搏对193例阵发性室上性心动过速分型及定位诊断结果，并与心内电生理检查诊断结果比较。结果 经食管心房调搏对慢-快型AVNRT及顺向性AVRT的诊断敏感性、特异性、准确性均较高，对少见型AVNRT的诊断敏感性低(25％)。结论 阵发性室上性心动过速发作时食管与体表心电图P^-波起始与极性是诊断阵发性室上性心动过速的关键。经食管心房调搏对心动过速旁道定位误诊原因主要是心动过速时体表心电图P^-波往往与T波融合，导致V1、I导联P^-波极性及V1导联P^-波起始部形态改变。     

食管心房调搏对儿童室上性心动过速的诊断

３４例阵发性室上性心动过速（室上速）患儿经食管心房调搏检查，诊断为房室结折返１３例。快慢径有效不应期分别为３３７±５９．４６ｍｓ和２７８±７１．２４ｍｓ（Ｐ＜０．０５）；传导时间分别为２２０±５０ｍｓ和３０８±５８．０９ｍｓ（Ｐ＜０．０５）。旁室旁道折返１９例，其中６例为隐性，旁道前向有效不应期２００～３２０ｍｓ，与年龄呈正相关，但无显著性。自律性房住心动过速２例。儿童ＳＶＴ以房室折返为主，测定ＰＶ１－ＰＥ时距及ＲＰＥ间期有助于鉴别折返性室上速的类型及旁道位置。房室结折返ＰＶ１－ＰＥ时距近于零，房室折返为３４．２９±８．５ｍｓ．左侧旁道为正值，右侧为负值。但ＰＶ１有时辨认不满意，有局限性。房室结折返ＲＰＥ间期＜７０ｍｓ．而旁路折返则＞７０ｍｓ。     

短P—R间期食管心房调搏的电生理探讨

对21例体表ECG记录的正常QRS波、短P-R间期患者作经食管心房调搏术,从其电生理特性进行探讨。资料和方法1.病例选择男性10例,女性11例,年龄26—50岁,(平均37±57岁)。常规12导联ECG 记录,选最长的P-R 导联测量P-R 间期,P-R 间期均<0.12s。2.仪器刺激仪用苏州产XD-2A 型心脏电生理诊疗仪。记录仪用日本产6511型心电图机。     

平板运动试验假阳性相关因素的分析

目的 探讨活动平板运动试验假阳性相关影响因素,调整观察参数,提高心电图活动平板运动试验评估冠脉病变的价值.方法 收集整理2012年1月至2014年6月因疑似冠心病在苏州九龙医院心脏中心接受活动平板运动试验、结果阳性的94例患者,所有患者均在平板运动试验后1w内行冠脉造影检查.根据造影结果将其分为真阳性组(A组)和假阳性组(B组),对比分析两组各项临床资料及活动平板试验数据.结果 真阳性组和假阳性组在性别、最大运动耐量(Mets)、运动峰值、心率收缩压乘积方面有显著差异(p＜0.05),A组平板运动试验中最大心率与运动终止后2 min心率的差值显著低于B组;A组平板运动试验终止后3 min收缩压与运动终止1 min收缩压的比值、包含2个以上冠心病危险因子的例数明显大于B组(p＜0.05).结论 活动平板试验参数结合相关的临床资料、血流动力学相关参数,能提高冠脉病变的诊断准确性,对临床诊断冠心病、评估治疗效果和预后等方面可提供有价值的参考.     

头胸导联、常规导联心电图诊断冠心病的比较——与冠脉造影结果对照

同步记录72例拟诊冠心病患者头胸导联(HC)及常规导联(wilson)心电图(ECG),并与冠脉造影结果对照。结果:HC与Wilson导联ECG对冠心病诊断的敏感性分别为88.9％与81.5％,特异性33.3％与27.8％,准确性75％与68.1％;二组导联对比无明显差异(P>0.05);对右心室梗塞、缺血及左心室后壁缺血.HC导联的敏感性(91.7％)及准确性(94.4％)均显著高于Wilson导联(12.5％、70.8％,P<0.01),并与冠状动脉病变程度呈高度正相关。HC导联优于Wilson导联。     

Analysis of multiple noninvasive test procedures for the diagnosis of coronary artery disease

All noninvasive tests used for the diagnosis of coronary artery disease are imperfect, both in sensitivity and in specificity. Accordingly, we evaluated the accuracy of four different diagnostic tests in various combinations in a population of 43 patients undergoing coronary angiography to determine if accuracy could be improved by multiple testing. These tests included stress electrocardiography for evaluation of exercise-induced ST-segment depression, stress cardio-kymography (CKG) for detection of exercise-induced precordial regional left ventricular dysfunction, stress ²⁰¹thallium scintigraphy for assessment of exercise-induced regional myocardial hypoperfusion, and cardiac fluoroscopy for detection of coronary artery calcification. A total of 46 (27%) of the 172 test responses observed were incorrect relative to angiography. These “false” responses were uniformly distributed over the four test procedures (12 ECG, 11 CKG, 10 ²⁰¹thallium, 13 fluoroscopy). Thus, a single test had a limited predictive accuracy for the detection or exclusion of coronary artery disease. The greater the number of abnormal responses observed in a given patient the greater the predictive accuracy for disease, especially multi-vessel disease. Analysis of various combinations of these procedures revealed substantial differences both in cost of testing and net diagnostic yield. These data suggest that the four procedures employed are functionally independent and highly accurate relative to the diagnosis of coronary artery disease when used in combination. Cost-effectiveness of diagnostic testing might be improved with the use of combinations of the less expensive and more accurate of these tests.     

A comparison of treadmill scores to diagnose coronary artery disease

Background: Recently, several treadmill scores have been proposed as means for improving the diagnostic accuracy of the exercise treadmill test (ETT). Questions remain regarding the diagnostic accuracy of treadmill scores when applied to a different patient population than that from which they were derived; furthermore, many treadmill scores have not been compared with one another in the same population. Hypothesis: The diagnostic accuracy of treadmill scores may not be the same. Methods: A retrospective analysis of data collected prospectively was performed on consecutive patients referred for evaluation of chest pain. All patients underwent a standard ETT followed by coronary angiography. Using angiographic evidence of coronary artery disease (CAD) as a reference, the area under the curve (AUC) of receiver operator characteristic (ROC) plots of the ST response alone, the Duke Treadmill Score (DTS), the Morise score, the Detrano score, the VA score, and a Consensus score consisting of the Morise, Detrano, and VA scores together were calculated and compared. The predictive accuracies of the DTS and the Consensus score to stratify patients for the likelihood of CAD were calculated and compared. Results: In all, 1,282 patients without a prior myocardial infarction had an ETT and coronary angiography. The AUC (± standard error) was 0.67 ± 0.01 for the ST response, 0.73 ± 0.01 for DTS, 0.76 ± 0.01 for Detrano score, 0.77 ± 0.01 for Morise score, 0.78 ± 0.01 for VA score, and 0.78 ± 0.01 for Consensus score. The AUC for each treadmill score was significantly higher (z‐score > 1.96) than for the ST response alone. The AUC of DTS was significantly lower than all other treadmill scores (z‐score > 1.96). The predictive accuracy (± 95% confidence interval) of the DTS to risk stratify patients into high and low likelihood for CAD was 71 (65‐77)%, versus 80 (74‐86)% for the Consensus score (p < 0.0001). Conclusion: In this population, the DTS remains useful for diagnosing CAD and stratifying for the likelihood of CAD, although it is less accurate than other treadmill scores.     

Predictive treadmill score to identify coronary artery disease

Background Exercise treadmill testing(ETT) is widely used for the diagnosis of coronary artery disease(CAD).The high false-positive and false-negative rates hamper its clinical application.Hypothesis:We examined a hypothesis that combined ETT and risk-factors of CAD to develop an easily applied predictive treadmill score(PTS) and the superiority of the novel score over the conventional ETT criteria was tested.This score can improve the diagnostic accuracy of treadmill testing for Chinese patients with suspected CAD and plan management strategies for such patients.Methods The present study comprised a retrospective analysis of 300 ETTs of Chinese patients with chest pain referred to suspected CAD who also had coronary angiography within one month after ETT.Clinical characteristics and ETT results of those with and without angiographic CAD were compared.A logistic regression model was used to construct a PTS that could accurately predict clinically significant CAD,defined as the presence of at least one 70 % angiographic stenosis in a major epicardial coronary artery.The accuracy of the new PTS was compared to conventional criteria of ETT for CAD diagnosis.Results The study included 185 patients with clinically significant CAD(61.6 %) and 115(38.4 %) without CAD.Patients with significant CAD were older,more cigarettes smokers,and had higher prevalence of hypercholesterolemia,diabetes mellitus and serum CRP concentration.The PTS for CAD was derived from the logistic regression equation:Y(-1,1) =-6.94 + 0.07Age + 0.56Smoking + 0.7DM + 0.6TC /HDL + 0.6ST + 3.5Symptom-0.01HR.According to the derived Y value,the study subjects were classified as low,intermediate and high risk CAD groups,if Y -1,-1 ≤ Y ≤ 1,and Y 1 respectively.The area under the curve(AUC) of our PTS on the receiver operating curve(ROC) was 0.863.Using the PTS,the specificity,false-positive rate and the predictive accuracy for CAD detection were significantly improved compared to conventional ETT diagnostic criteria(73.6% vs.56.9%;26.4% vs.43.1%;77.6% vs.71.8%,P 0.05).Conclusions A new predictive treadmill score for CAD diagnosis was validated and found superior to the conventional criteria of ETT for the diagnosis of CAD in Chinese patients presenting with chest pain.     

平板运动试验后心率恢复情况对冠心病的诊断价值

目的评价平板运动试验后心率恢复的意义及其对冠心病的诊断价值。方法76例拟诊冠心病患者行平板运动试验,根据冠状动脉造影结果分为冠心病组和非冠心病组。计算运动后1、2、3、4、5、7min心率恢复值并比较,利用运动后心率恢复异常作为诊断冠心病标准与传统的ST段压低法比较。结果冠心病组的患者运动后各时段心率恢复值均低于非冠心病组。以运动后1、2min心率恢复异常作为诊断冠心病的标准,与传统的ST段压低法相比,其敏感性无差别,特异性较高。结论冠心病组与非冠心病组比较表明,运动后心率恢复存在明显差异,且运动后心率恢复异常可以作为诊断冠心病的方法之一。     

平板运动试验评分与冠状动脉病变的关系

目的探讨平板运动试验评分即Duke评分(DTS)与冠状动脉病变严重程度之间的相关性。方法分析219例在同期内先后接受平板运动试验(TET)和冠状动脉造影(CAG)检查病例的临床和心电图资料,揭示不同程度和范围的冠状动脉病变和Duke评分的相关性。结果Duke评分与冠心病高危因素(高血压、糖尿病、高脂血症)呈明显相关性(P<0.05)。Duke评分与冠脉病变的严重程度和范围呈明显相关性(P<0.001)。低危Duke评分组47例无>75%狭窄,8例1支血管>75%狭窄,13例2支血管>75%狭窄或前降支病变,2例3支血管>75%狭窄或左主干病变;中危Duke评分组22例无>75%狭窄,13例1支血管>75%狭窄,51例2支血管>75%狭窄或前降支病变,9例3支血管>75%狭窄或左主干病变;相比而言,高危Duke评分组1例无>75%狭窄,2例1支血管>75%狭窄,18例2支血管>75%狭窄或前降支病变,33例3支血管>75%狭窄或左主干病变。结论Duke评分综合了临床资料、冠状动脉解剖及左室射血分数等预测因素,可作为预测有意义的冠脉病变的一个独立因素。该评分方法除了提供准确的预后评价,而且可以预测冠脉病变严重程度。     

Effects of coronary artery narrowing,collaterals, and left ventricular function on the pattern of myocardial perfusion

We evaluated effects of the degree of diameter narrowing of the coronary arteries (50–69%, 70–89%, ≥90%); extent of coronary disease [one-vessel disease (1VD), two-vessel (2VD), three-vessel (3VD)]; collaterals; and left ventricular function on the pattern of exercise thallium-201 perfusion in 121 patients; 30 patients with normal coronary angiograms, 37 with 1VD, 24 with 2VD, and 30 with 3VD. Fifteen patients had Q waves on ECG, 29 patients had akinetic segments on the left ventriculogram, and 46 patients had collaterals. The results suggest the following: 1) Patients with 59–69% narrowing of one vessel have normal exercise perfusion. 2) All patients with 1VD have abnormal exercise perfusion if the degree of narrowing is ≥90%, unless the right coronary artery (RCA) is the vessel involved. 3) Patients with 2VD and 3VD generally have abnormal exercise perfusion unless all the narrowings are <90%, or the RCA is the only vessel with ≥90% narrowing, or the stress is submaximal. 4) Collaterals do not protect against development of abnormal exercise perfusion; they feed the most severely narrowed vessel, and perfusion abnormalities are ordinarily seen in the distribution of such severely narrowed vessels. 5) Neither the presence of Q waves on the ECG nor an akinetic segment on the left ventriculogram correlates with defects in the redistribution images; residual defects may be seen in the delayed images despite the absence of prior myocardial infarction, and normal images may be seen despite the presence of akinetic segments in the left ventriculogram.     

平板运动试验诊断冠心病阳性指标的比较研究

目的：探讨ST、ST／HR及QTd在平板运动试验试验中的变化及对冠心病心肌缺血的诊断价值。方法：56例临床诊断或疑诊为冠心病的病人先后行平板运动试验及冠状动脉造影检查，并进行比较分析。结果：ST、ST／HR、QTd及ST ST／HR QTd诊断冠心病的准确性分别为：52％、64％、66％、84％。结论：运动试验中诊断冠心病心肌缺血的敏感性和准确性最高的指标为ST ST／HR QTd。     

Anomalous origin of the right coronary artery from the left anterior descending: Angiographic diagnosis in a patient with coronary artery disease

The coronary angiographic findings of an individual whose right coronary artery originates from the proximal left anterior descending coronary artery are described.