平板运动试验心电图可疑阳性与冠脉造影结果的对比分析

目的 比较平板运动试验心电图可疑阳性与冠状动脉造影结果,探讨平板运动试验可疑阳性的原因.方法 对65例平板运动试验可疑阳性而有心前区不适者同期内（相距时间〈1周）行冠状动脉造影检查,并进行对比分析.结果 65例平板运动试验可疑阳性者冠状动脉造影阳性32.3%（21/65）,冠状动脉造影阴性67.7%（44/65）;冠状动脉造影阳性患者男性多于女性,年龄高于冠状动脉造影阴性（P〈0.05）;CAG阳性患者23.8%有平板运动试验运动量不足,明显高于冠状动脉造影阴性（11.4%）（P〈0.05）.21例冠状动脉造影阳性共累计冠脉病变数31处：病变范围在50%～74%占19处（61.3%）、75%～89%占10处（32.3%）、90%～95%占2处（6.4%）;冠状动脉单支病变13例（61.9%）,双支病变6例（28.6%）,三支病变2例（9.5%）;且男性冠脉病变程度明显重于女性（P〈0.05）;33.3%患者有侧支循环.44例冠状动脉造影阴性临床诊断以植物神经功能紊乱最多见（47.7%）,其次高血压病（25.0%）、糖尿病（13.6%）,且与性别有一定的关系（P〈0.05）.结论 平板运动试验可疑阳性在诊断冠心病时要慎重,评价其结果应综合分析患者性别、年龄、运动时间长短、运动量高低、冠心病易患因素及其他原发病,从而提高其诊断的准确性.应及时行CAG检查,以明确诊断.

Comparative analysis of coronary angiography results in patients with questionable positive electrocardiogram treadmill exercise test

Objective To compare the treadmill exercise test （TET） electrocardiogram results with coronary angiogrsphy, and to investigate the reason causing questionable positive resuhs in TET. Methods CAG was performed in 65 patients with questionable positive TET in the same period （ 〈 1 week）. The results were compared between CAG and TET. Resuits 21 positive CAG （32.3%） and 44 negative CAG （67.7%） were detected in 65 questionable positive TET patients. There were more males than females in positive CAG patients （ P 〈 0.05 ）. The average age in positive CAG patients was signif- icantly higher than that in the negative CAG ones （ P 〈0.05）. Sport quantity shortage during TET were presented in 23.8% positive CAG patients, but only in 11.4% negative CAG ones （ P 〈 0.05）. 31 coronary artery occlusion were detected in 21 positive CAG patients： 19 of 31 （61.3 % ）presenting 50% -74% vessel obstruction, 10 of 31 （32.3 % ） presenting 75% - 89% vessel obstruction, and 2 of 31 （6.4%）presenting 90% -95% vessel obstruction. Among these patients, there were single vessel disease in 13 cases （61.9%）, double vessel disease in 6 ones （28.6%） , and triple vessel disease in 2 ones （9.5 % ）. There were more serious coronary vessel diseases in male than those in female positive CAG patients （P 〈 0.05 ）. There were 5 patients （33.3%） with collateral circulation among 21 positive CAG cases. Among 44 negative CAG patients, 21 with autonomic neurosis（47.7% ）, 11 with hypertension （25.0%）, and 6 with diabetes mellitus （13.6%）were diagnosed. Furthermore, there were significant differences between male and female （ P 〈 0.05 ）. Conclusion Coronary heart disease should be diagnosed carefully in questionable positive TET patients. To raise the accuracy of TET in diagnosing coronary artery disease, sport time and quantity during TET, combined with sex, age, susceptible factors to the disease, and other primary diseases should be evaluated and analyzed comprehensively. CAG should be performed promptly on patients with questionable positive TET to define the diagnosis.