运动平板试验Duke评分预测冠状动脉病变程度的价值

目的:评价平板运动试验Duke评分(DTS)对冠心病冠状动脉病变程度的临床价值。方法: 选择169例运动试验阳性和可疑阳性同时行冠状动脉造影的患者为研究对象,按Duke评分分为DTS低危组（Duke≥+5分，n=35）、中危组(DTS:(-10~+4)分，n=77)和DTS高危组(DTS≤-11分，n=57),比较3组患者冠状动脉病变和临床特点。分析DTS预测冠状动脉病变程度的价值。结果: 在DTS高危组和中危组中限制性心绞痛发作例数、ST段偏移≥1 mm例数、运动时ST改变涉及导联数目、ST段偏移值均明显高于DTS中低危组（P＜0.05，P＜0.01）；而运动持续时间和运动最大心率明显低于DTS中低危组 （P＜0.05，P＜0.01）。随冠状动脉病变严重程度的加重DTS高危组病例数显著增多。3组间两两相比差异均有统计学意义(均P＜0.05)。相关分析发现，3组患者的DTS与冠状动脉病变Gensini积分呈负相关（r=-0.74，P＜0.05）。结论: 运动试验DTS与冠状动脉病变狭窄程度高度相关,应用该评分可以更好地对临床中怀疑心肌缺血的患者进行明确诊断及预后的判断。

Value of Duke treadmill score in prediction of degree of coronary artery disease

AIM:To assess the value of Duke treadmill score (DTS) in prediction of the degree of coronary artery diseases. METHODS: Enrolled in the study were 169 patients who had positive or doubtful positive treadmill exercise test (TET) and who underwent coronary angiography (CAG) in Tai'an Central Hospital. According to the DTS value, patients were divided into three groups: low-risk DTS group (DTS ≥+5, n=35), moderate-risk DTS group (DTS: -10 to +4, n=77) and high-risk DTS group (DTS ≤-11, n=57). Correlation between DTS and coronary angiography Gensini score was evaluated. Duke formula was as follows: Treadmill score=(exercise duration in minutes)-(5×ST-segment deviation in millimeters)-(4×treadmill angina index) where the treadmill angina index=0 for no-exercise angina, 1 for exercise angina and 2 for exercise-limiting angina. RESULTS: In the high-risk group and moderate-risk DTS group there were more exercise-limiting angina cases and more ST depression ≥1 mm cases, more ST-segment deviation, emergence time and persistence time, and more maximal ST depression and ECG with leads number, but less nonangina, less exercise time, and lower peak heart rate compared with those in low-risk DTS group (P<0.05, P<0.01). In TET, the DTS was found to be related to the degree of coronary artery stenosis. In low-risk DTS group, 69% had no coronary stenosis and 26% had single-vessel stenosis. By comparison, 63% in the high-risk DTS group had 3-vessel or left main coronary disease. Patients with high-risk DTS all had severe coronary artery disease. DTS correlated negatively with Gensini score of CAG (r=-0.74, P<0.05). Gensini score in low-risk DTS group was much lower than that in moderate-risk DTS group and high-risk DTS group. CONCLUSION: DTS is correlated with the severity of coronary artery lesions and is useful for clinical diagnostic and prognostic evaluation for patients suspected of ischemic heart diseases.