联合心脏负荷试验对非典型胸痛患者鉴别诊断的意义

目的探讨利用心电图运动试验（S-ECG）和核素灌注心肌显像负荷试验（S-MPS）在非典型胸痛患者临床诊断中的价值。方法对非典型胸痛为主诉、临床诊断明确且S-ECG、S-MPS、冠状动脉（冠脉）造影和冠脉痉挛激发试验资料完整的患者为研究对象,回顾性分析两种负荷试验结果并与最后诊断进行对照分析。结果资料完整的186例非典型性胸痛患者,最后诊断冠心病患者占20％,冠脉痉挛占27％,冠脉肌桥占14％,X综合征5％,非冠脉疾病占34％。在除外冠脉痉挛后,S-ECG诊断冠脉缺血性病变的敏感性和特异性分别为92％和65％;S-MPS的敏感性和特异性分别为62％和79％。非典型胸痛患者中S-ECG阴性,但S-MPS呈反向再分布诊断冠脉痉挛的敏感性和特异性分别为94％和96％。结论非典型胸痛患者中多数具有缺血意义的冠脉病变基础,联合负荷试验对鉴别诊断具有重要临床价值。

The differential diagnostic value and significance of combined heart stress tests in patients with atypical chest pain

OBJECTIVE: To investigate the value of stress electrocardiography (S-ECG) and stress myocardial perfusion scintigraphy (S-MPS) in the differential diagnosis of patients with atypical chest pain. METHODS: Patients with atypical chest pain were undergone S-ECG, S-MPS, coronary angiography and coronary artery spastic provocation with intracoronary acetylcholine test. The final diagnoses of those patients were coronary heart disease, coronary spasm, coronary artery muscular bridge, microvascular angina pectoris and chest pain with non-coronary heart disease. Those patients were grouped by final diagnoses to retrospectively compare the results of S-ECG and S-MPS between groups. RESULTS: Totally 186 patients with integrated data were included. The final diagnoses were coronary artery stenosis (above 50% stenosis in diameter) in 20%, coronary artery spasm in 27%, coronary artery muscular bridge in 14%, microvascular angina pectoris in 5%, and chest pain with non-coronary artery disease in 34%. The sensitivity and specificity to diagnose ischemic coronary artery disease (including coronary stenosis, coronary artery muscular bridge and syndrome X but not coronary artery spasm) were 92% and 65% in S-ECG, 62% and 79% in S-MPS, respectively. Combination of atypical chest pain, negative S-ECG and reversal redistribution of S-MPS was an accurate non-invasive method to diagnose coronary artery spasm with sensitivity of 94% and specificity of 96%. CONCLUSIONS: Most of patients with atypical chest pain have organic or functional ischemic coronary artery disease. Combination of heart stress tests are helpful to differentiate the etiology of atypical chest pain.