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。     

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.     

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。     

平板运动试验诱发ST段抬高提示冠状动脉病变部位二例

2例平板运动试验诱发ST段抬高 ,1例为V1 ～V5及Ⅱ、Ⅲ、aVF导联ST段上抬 ,冠状动脉 (简称冠脉 )造影示左前降支和第一对角支狭窄 ;另 1例为V1 ～V3导联ST段抬高 ,造影显示左前降支病变。运动试验诱发ST段抬高提示严重心肌缺血 ,且指示的缺血区域与病变冠脉部位一致。     

踏板运动试验对评估冠状动脉狭窄严重程度的意义

为明确踏板运动试验与冠状动脉狭窄程度的关系,选取115例冠状动脉造影阳性、且于造影前或造影后1周作踏板运动试验的患者,观察以直径法确定的冠状动脉狭窄程度和范围与踏板运动试验结果对比.结果显示:踏板运动试验中ST段压低出现越早、ST段压低程度越大、持续时间越长、出现ST段压低的导联数目越多,冠状动脉狭窄越重.冠状动脉造影阳性而踏板运动试验阴性者,多为单支或轻度病变.认为踏板运动试验可初步估测冠状动脉狭窄程度.     

平板运动试验aVR导联ST段抬高对冠状动脉左主干病变的诊断价值

目的探讨平板运动试验aVR导联ST段抬高对冠状动脉左主干病变及前降支近段病变诊断价值。方法选取18例平板运动试验阳性并伴aVR导联ST段抬高者,2周内行冠状动脉造影(CAG),以冠状动脉内径狭窄≥50%者为CAG阳性。结果左主干病变13例,前降支近段病变3例,右冠状动脉中段狭窄1例,冠状动脉造影阴性1例。平板运动试验阳性并伴aVR导联ST段抬高对左主干病变的阳性预测值为72.22%(13/18);对冠状动脉左主干及前降支近段病变的预测值为88.89%(16/18)。结论平板运动试验阳性并aVR导联ST抬高≥0.1mv对诊断冠状动脉左主干及前降支近段病变有较高的阳性预测价值。     

平板运动试验诱发ST段抬高对冠心病的诊断价值

目的探讨平板运动试验（TET）诱发ST段抬高对冠心病的诊断价值。方法回顾我院11例无心肌梗死而TET诱发ST段抬高患者,分析其TET心电图及冠状动脉造影（CAG）检查结果。结果 1例CAG未见固定狭窄。10例均有不同程度冠脉病变（其中1例为单支病变,9例为多支病变）,有8例冠状动脉狭窄程度达90%以上。ST段抬高导联与缺血相关冠状动脉有良好的对应关系。结论无心肌梗死者TET诱发的ST段抬高,提示冠脉痉挛或冠脉严重狭窄,且指示的缺血区域与病变冠脉一致。     

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.     

Short term reproducibility of exercise testing in patients with ST segment elevation and different responses to the dipyridamole test.

The short term reproducibility of exercise testing in 25 patients who had exercise induced ST segment elevation without baseline regional asynergy or a previous myocardial infarction, who had different responses to the dipyridamole test, was assessed. The patients performed a dipyridamole echocardiography test and a second exercise stress test. All underwent coronary arteriography. Seventeen patients had transient regional asynergy after dipyridamole (group 1) and either ST segment elevation (14 patients) or depression (three patients); a second group of eight had no asynergy and no electrocardiographic changes (group 2). The repeated exercise stress test was positive in 16 of the 17 patients of group 1 (11 with ST elevation and five with ST depression) and in two patients of group 2 (both had ST depression and one had coronary artery disease). The dipyridamole echocardiography test was positive in 17 of the 19 patients with coronary artery disease and was negative in all six patients without coronary artery disease. The repeated exercise stress test was positive in 17 of the 19 patients with coronary artery disease and in one patient without. The dipyridamole echocardiography test and a repeated exercise stress test, but not a single exercise stress test, identified coronary artery disease causing exercise induced ST segment elevation.     

Short term reproducibility of exercise testing in patients with ST segment elevation and different responses to the dipyridamole test

The short term reproducibility of exercise testing in 25 patients who had exercise induced ST segment elevation without baseline regional asynergy or a previous myocardial infarction, who had different responses to the dipyridamole test, was assessed. The patients performed a dipyridamole echocardiography test and a second exercise stress test. All underwent coronary arteriography. Seventeen patients had transient regional asynergy after dipyridamole (group 1) and either ST segment elevation (14 patients) or depression (three patients); a second group of eight had no asynergy and no electrocardiographic changes (group 2). The repeated exercise stress test was positive in 16 of the 17 patients of group 1 (11 with ST elevation and five with ST depression) and in two patients of group 2 (both had ST depression and one had coronary artery disease). The dipyridamole echocardiography test was positive in 17 of the 19 patients with coronary artery disease and was negative in all six patients without coronary artery disease. The repeated exercise stress test was positive in 17 of the 19 patients with coronary artery disease and in one patient without. The dipyridamole echocardiography test and a repeated exercise stress test, but not a single exercise stress test, identified coronary artery disease causing exercise induced ST segment elevation.     

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。     

乙酰胆碱诱发冠状动脉痉挛时的心电图改变及其与血管内皮功能关系

目的探讨血管内皮细胞功能紊乱与乙酰胆碱试验诱发冠状动脉痉挛时心电图ST段变化与缓慢型心律失常的关系。方法选择以静息性胸痛为主要临床表现、接受乙酰胆碱激发试验的患者为研究对象,根据是否发生冠状动脉痉挛分为阳性组和阴性组,冠状动脉痉挛发作时心电图变化分为ST段抬高和非ST段抬高组以及缓慢型心律失常和无缓慢型心律失常组,测定其血浆一氧化氮和内皮素1浓度,比较各组一氧化氮和内皮素1水平以及痉挛血管的分布。结果ST段抬高组一氧化氮水平显著低于阴性组,而内皮素1显著高于阴性组(P<0.01),非ST段抬高组一氧化氮水平亦显著低于阴性组,但高于ST段抬高组(P<0.05),而内皮素1显著高于阴性组但低于ST段抬高组(P<0.05);缓慢型心律失常组和无缓慢型心律失常组的血浆一氧化氮和内皮素1水平以及痉挛血管的分布差异无统计学意义(P>0.05)。结论乙酰胆碱试验诱发的冠状动脉痉挛以及ST段变化与血管内皮细胞功能紊乱有关,乙酰胆碱试验中的缓慢型心律失常与血管内皮细胞功能或痉挛血管的分布无关。     

Clinical significance of exercise-induced ST segment elevation. Correlative angiographic study in patients with ischaemic heart disease.

We have examined the relation between electrocardiographic ST elevation during treadmill exercise (greater than or equal to 1 mm, using the conventional 12 leads), the severity of coronary artery disease, and left ventricular wall motion abnormalities in 680 patients. They were divided into three groups: (1) 218 patients with clinically significant coronary artery disease, (2) 178 patients with clinically significant coronary artery disease, and (3) 284 patients with clinically significant coronary artery disease and previous myocardial infarction. ST elevation during exercise (predominantly in lead V2) was seen in two patients (1%) in group 1, three patients (2%) in group 2, and 147 patients (52%) in group 3. Coronary artery disease (number of vessels involved and severity of stenoses) was comparable in groups 2 and 3. All the patients in group 1 showed a normal left ventricular contraction pattern; 64% of the patients in group 2 showed wall motion abnormalities (predominantly hypokinesia) and 95% of group 3 (mainly akinesia, dyskinesia, or aneurysm). A strongly positive correlation was seen between the ST elevation and left ventricular dysfunction in patients belonging to group 3. The overall sensitivity and the specificity of the stress test in detecting wall motion abnormalities was 55% and 100% respectively. The sensitivity increased with deterioration in left ventricular function, reaching 81% and 90% in patients with dyskinesia and aneurysm, respectively. Maximal ST elevation (greater than or equal to 3 mm) was confined to the patients with dyskinesia or aneurysm. The incidence of ST elevation during exercise was also related to the location of previous infarction, showing a positive response in 85% of patients with anterior myocardial infarction and in only 33% with inferior myocardial infarction. We conclude that ST segment elevation during exercise in patients with previous myocardial infarction is a sensitive and a specific indicator of advanced left ventricular asynergy. The ST segment response during exercise in patients with previous infarction and with angiographically demonstrated myocardial asynergy appears to be a continuous spectrum. A normal ST segment response or elevation alone usually signifies involvement of only one vessel supplying the infarcted myocardium, ST elevation with concomitant ST depression indicates additional coronary artery disease, and ST depression alone indicates overwhelming myocardial ischaemia resulting from multiple vessel disease. The employment of multiple leads is essential to obtain this information.     

Significance of exercise induced ST segment elevation in patients with previous myocardial infarction

In order to determine the significance of exercise induced ST segment elevation in patients with previous myocardial infarction, we have studied 156 patients, 26 months (mean) after myocardial infarction. Each patient underwent 16 lead precordial electrocardiographic mapping before, during, and after exercise and in addition coronary arteriography was performed. There was no significant difference in the extent of coronary disease or abnormalities of left ventricular function between patients with exercise induced ST segment elevation that was noted to occur in leads with Q waves and those with ST segment elevation plus depression or those with ST segment depression alone. Patients without exercise induced ST segment changes had fewer coronary arteries involved than those who developed ST segment changes. Nineteen patients with exercise induced ST segment elevation alone underwent coronary artery bypass surgery; in 11 this resulted in complete abolition of the exercise induced ST segment elevation and was associated with symptomatic relief and patent grafts without alteration of left ventricular function. Thus, exercise induced ST segment elevation in patients with previous myocardial infarction should be considered as important as ST segment depression in terms of underlying myocardial ischaemia, coronary anatomy, and left ventricular function.     

Angiographic documented coronary arterial spasm in absence of critical coronary artery stenoses in a patient with variant angina episodes during exercise and dobutamine stress echocardiography

Dobutamine stress echocardiography is widely performed as a useful diagnostic tool in patients with known or suspected coronary artery disease. Dobutamine induced myocardial ischaemia is frequently associated with ST segment depression. ST segment elevation is uncommon and is almost always associated with prior myocardial infarction or transient total coronary occlusion. Dobutamine induced ST segment elevation in absence of significant coronary artery disease is a rare condition and is supposed to be a consequence of severe coronary artery spasm. The case of a 58 year old man with variant angina episodes at rest, during exercise test, and dobutamine stress echocardiography is reported, in whom coronary spasm without significant coronary artery stenoses was documented angiographically.


Keywords: coronary spasm; variant angina; Prinzmetal angina; dobutamine stress echocardiography; exercise test