心肌缺血总负荷对老年患者冠状动脉病变的预测价值

目的探讨12导联动态心电图(DCG)诊断心肌缺血总负荷(TIB)对老年患者冠状动脉病变程度的预测价值。方法连续入选行DCG检查的835例患者,进行TIB阳性评价。对可疑冠心病的150例患者行冠状动脉造影检查,并根据诊断分为糖尿病组69例和非糖尿病组81例;又根据病变支数分为单支病变组47例和多支病变组103例。用Gensini方法计算冠状动脉积分。分析TIB诊断冠心病的灵敏性、特异性、符合率、阳性预测值、阴性预测值,并进行相关性分析。结果 835例老年患者中,116例提示TIB阳性。TIB诊断冠心病的敏感性为77.5%,特异性为68.6%,符合率为73.3%,阳性预测值为83.8%,阴性预测值为63.2%。糖尿病组Gensini积分明显高于非糖尿病组(P0.01)。多支病变组TIB值和Gensini积分均明显高于单支病变组(P0.01)。TIB值与Gensini积分呈正相关(r=0.4095,P0.01)。结论 TIB阳性老年患者中,随着TIB值的增加,冠状动脉病变程度可能越严重。糖尿病可能影响T1B的阳性诊断率。

The value of total ischemia burden for predicting the severity of coronary artery lesions of aged patients

Objective To evaluate the value of total ischemia burden (TIB) diagnosed by 12-lead dynamic electrocardiography for predicting the severity of coronary artery lesions in aged patients. Methods A total of 835 patients were enrolled and underwent dynamic electrocardiography which was used to evaluate the TIB.Coronary angiography(CAG) was performed in 150 cases who had been suspected to have coronary heart disease (CHD) in clinic.They were divided into diabetes mellitus group(DM,69 cases) and non-diabetes mellitus group(non-DM 81 cases). They were also divided into multi-branch lesions group(Group Ⅰ) and single branch lesion group (Group Ⅱ) according to their CAG.Gensini cumulative index(GCI) of coronary artery was evaluated. The sensitivity,specificity,coincidence,positive predictive value and negative predictive value of TIB for diagnosis of CHD were analyzed.The correlation of TIB to coronary artery lesions was also evaluated.Results 116 of 835 cases reached the criterion of TIB.The sensitivity of TIB for diagnosis of CHD was 77.5%,specificity was 68.6%,coincidence was 73.3%.The positive predictive value was 83.8% and negative predictive value was 63.2%.The average GCI was obviously higher in DM group than in non-DM group (P < 0.01).Group Ⅰ was significantly higher in TIB and GCI compared with Group Ⅱ (P < 0.01).There was a positive correlation between TIB and GCI (r = 0.4095,P < 0.01).Conclusion TIB may indicate CHD of aged patients.With increase in TIB level,the lesions of coronary artery may be more severe.DM may affect TIB.