24小时动态心电图对冠心病的诊断价值

对41例胸痛患者进行24小时动态心电图(AECG)及冠状动脉造影检查,其中24例在作上述检查2—3周内进行平板运动试验。10例正常冠状动脉患者AECG显示心肌缺血者仅1例,特异性90％;冠状动脉病变31例中显示心肌缺血20例,敏感性65％。心肌缺血检出敏感性与冠状动脉病变程度有关,多支病变为78％,单支病变为46％(P<0.01).AECG对单支病变患者,心肌缺血检出率明显低于平板运动试验(P<0.01);对多支病变患者,心肌缺血检出率与平板运动试验相同,均为88％。

Value of 24-hour ambulatory electrocardiographic recordings in the diagnosis of coronary artery disease

Forty-one patients with angiographically-documents coronary artery disease (CAD) underwent 24-hour ambulatory electrocardiographic (ECG) recordings, and a maximal treadmill exercise test was performed in 24 of 41 patients. Myocardial ischemia as evaluated by ST segment deviations during ambulatory ECG recordings was compared with the results of exercise test and coronary angiographle findings. The ST segment deviations during ambulatory ECG recordings detected CAD with a sensitivity of 65% and a specificity of 90%. The occurence rate of ST segment deviations correlated closely with extent of CAD, one vessel disease 46%;multivessel disease 78%, P<0.01. In 24 patients undergone maximal treadmill exercise tests, both 24-hour ambulatory ECG recordings and exercise tests showed a high incidence of myocardial ischemia in patients with multivessel disease (88%), but the sensitivity of these two tests in detecting myocardial ischemia for patients with single vessel disease was only 11% and 78%, respectively, P<0.001.