ATP负荷及运动负荷试验中心电图的变化对冠心病的诊断价值

目的探讨ATP负荷及运动负荷心肌灌注单光子发射计算机体层摄影术(SPECT)中的ECG变化及其对冠心病的诊断价值。方法选择61例疑诊冠心病的患者,并在不同时间分别行ATP负荷及运动负荷SPECT检查,其中46例行冠状动脉造影。收集ATP及运动负荷试验中的ECG资料并进行分析。结果ATP与运动负荷试验中ECG心律失常的发生情况相似(χ2=1.985,P=0.159);ATP负荷试验ST段下降发生率明显低于运动负荷试验(12.5%vs51.8%,χ2=19.813,P<0.001),且下降幅度低。ATP负荷试验ECG诊断冠心病的敏感性明显低于运动负荷试验(28.6%vs71.4%,χ2=7.714,P=0.005),特异性、阳性预测值及阴性预测值与运动负荷试验相似(95.2%vs71.4%,85.7%vs71.4%,57.1%vs71.4%,P>0.05)。结论与运动负荷试验比较,ATP负荷试验ECG诊断冠心病的敏感性低,但特异性及阳性预测值相对较高。

Value of electrocardiogram changes in diagnosis of coronary artery disease during ATP and exercise stress test

Objective To explore the electrocardiogram changes and the value of ST segment depression in diagnosis of coronary artery disease(CAD) during adenosine triphosphate(ATP) stress and exercise stress myocardial perfusion SPECT imaging.Methods Sixty-one patients with suspected CAD underwent technetium-99m sestamibi myocardial perfusion tomographic imaging at rest,after symptom-limited multistage exercise,and after intravenous ATP(0.16 mg·kg-1·min-1 for 5 minutes) at different time.Forty-six of them also underwent coronary angiography.Results ST segment depression during ATP stress test was less common than that during exercise stress test(12.5% vs 51.8%,χ2 = 19.813,P<0.001).There was no significant difference in arythmia rate between ATP stress test and exercise stress test(χ2=1.985,P=0.159).The sensitivity of ATP stress test and exercise stress test in the diagnosis of coronary artery disease was 28.6% and 71.4%,respectively(χ2 = 7.714,P=0.005),and the specificity,positive predictive value and negaetive predictive value were 95.2%,85.7%,57.1% and 71.4%,71.4%,71.4% respectively(P>0.05).Conclusion ATP stress test has lower sensitivity and relatively higher specificity and positive predictive value in diagnosis of coronary artery disease than exercise stress test.