冠状动脉造影对比活动平板心电图负荷试验评价对冠心病的诊断价值

目的用冠状动脉造影(冠造)对比活动平板心电图负荷试验(平板运动)评价平板运动对冠心病的诊断价值.方法临床可疑冠心病,符合平板运动适应证98例,行18导联平静心电图、平板运动及冠造对比分析.结果 (1)平板运动与冠造对比98例平板运动属阳性者35例(35.7%),其中冠造有改变者25例(71.4%),其中有狭窄≥50%符合冠心病诊断的为18例(51.4%),属阴性者63例(64.3%),其中冠造有改变者21例(33.3%),两组对比有明显差异(P＜0.01).(2)平静心电图可疑心肌缺血78例(79.6%),其中冠造有改变者39例(50.0%),平静心电图正常者20例,其中冠造有改变者7例(35.0%).(3)35例阳性者平板运动终止后心电图异常出现时间与冠造对比运动结束后即刻～2min出现阳性者18例(51.4%),冠造有狭窄者13例(72.2%),其中双支及3支病变12例(92.3%),包括全闭2例;＞2min～4min阳性者9例(25.7%),冠造有改变者6例(66.7%);＞4min～6min阳性者6例(17.1%),冠造有改变者4例;＞6min～8min阳性者2例(5.70%),均为单支病变.各组病变程度比较有明显差异(P＜0.01).结论 (1)平板运动与冠造对比存在假阳性与假阴性分别为28.6%和33.3%,不能只凭平板运动肯定与否定冠心病.(2)平板运动结束后其阳性出现时间愈早,冠脉病变愈重而且双支及3支病变较多.

The diagnostic value of treadmill exercises test(TMET)in patients with coronary heart disease compared with selective coronary angiocardiography

Objective To determine the diagnostic value of treadmill test(TT) in patients with coronary heart disease (CHD) compared with selective coronary angiocardiography (SCA). Methods 98 patients with clinical suspicious of CHD and with the indication of TT were enrolled into the study. The 18-lead electrocariogram,TT and SCA were performed in all patients. Results (1)Among the 35 positive cases(35. 7%)of TT,25 cases(71. 4%)had CHD by SCA,among the other 63 negative ca-ses(64. 3%) ,21 cases(33. 3%)had CHD by SCA. There were significant differences between these two groups(P< 0. 01 ). (2) Among the 78 cases(79. 6 %) suspicious myocardial ischemia by electrocardiogram,39 cases(50. 0%)had CHD by SCA. And among the other 21 cases,7 cases(33. 3%)had CHD by SCA. (3)In 2 min,4 min,6 min,8 min after TT,the positive cases were 18(51. 4%) ,9(25. 7%) ,6 (17. 1%),2(5. 7%)respectively,and the corresponding cases with CHD by SCA were 13(72. 2%) ,6(66. 7%),4(66. 7%),2(100. 0%)respectively. And 12 cases among the 13 CHD cases in 2 minutes had two or three branches arteries involved, including 2 cases whose coronary arteries were completely shut. And the 2 CHD cases in 8 minutes had single branch involved. There were significant differences between the above groups( P<0. 01 ). Conclusions (1)Compared with SCA,TT has false-positive and false-negative, 28. 6% and 33. 3% respectively. So CHD can not be diagnosed or disdiagnosed by TT. (2)The earlier the positive result appear after TT,the more severe the CHD are and the more branches were involved.