不同联合检查方法对无症状心肌缺血患者冠状动脉病变程度的诊断价值

目的比较运动平板试验、动态心电图、超声心动图两两联合检查对无症状心肌缺血患者冠状动脉病变程度的诊断价值。方法选取80例无症状的疑似冠心病患者为研究对象,患者均进行运动平板试验、动态心电图、超声心动图和冠状动脉造影检查,以冠状动脉造影检查结果为金标准,比较运动平板试验联合超声心动图法(A联合法)、动态心电图联合超声心动图法(B联合法)、动态心电图联合运动平板试验法(C联合法)对无症状心肌缺血患者冠状动脉病变程度的诊断价值。结果冠状动脉造影检查结果显示,阳性(冠心病)患者45例,其中轻度狭窄12例、中度狭窄22例、重度狭窄11例;C联合法的诊断敏感性、阴性预测值分别为97.78%、96.30%,高于B联合法、A联合法,差异有统计学意义(P<0.05);B联合法、A联合法对轻度狭窄的检测阳性率均为41.67%,低于对中度狭窄和重度狭窄的检测阳性率,差异有统计学意义(P<0.05);C联合法对不同程度冠状动脉狭窄的检测阳性率比较,差异无统计学意义(P>0.05)。结论动态心电图联合运动平板试验对无症状心肌缺血具有较高的诊断价值。

Value of different combined examination in diagnosis of severity of coronary artery lesions in asymptomatic myocardial ischemia patients

Objective To investigate the diagnostic value of two examinations in combination from exercise plate test,dynamic electrocardiogram and echocardiography in patients with asymptomatic myocardial ischemia.Methods A total of 80 suspected patients with coronary heart disease were selected as study objects,and all of them underwent exercise plate test,dynamic electrocardiogram,echocardiography and coronary angiography,and the results of coronary angiography were considered as golden standard.The value of exercise plate test combined with echocardiography(A combined method),dynamic electrocardiogram combined with echocardiography(B combined method)and dynamic electrocardiogram combined with exercise plate test(C combined method)in diagnosing the degree of coronary artery lesions in patients with asymptomatic myocardial ischemia were compared.Results According to the findings of coronary arteriography,45 cases were positive for coronary heart disease,including 12 cases with mild stenosis,22 cases with moderate stenosis,and 11 cases with severe stenosis.The diagnostic sensitivity and negative predictive value of C combined method were 97.78%and 96.30%,respectively,which were significantly higher than those of B and A combined methods(P<0.05).The positive rates of B combined method and A combined method for detection of mild stenosis were both 41.67%,which were significantly lower than those in moderate stenosis and severe stenosis(P<0.05).There was no significant differences in the positive rate of C combined method in diagnosis of different stenosis(P>0.05).Conclusion Dynamic electrocardiogram combined with exercise plate test has better value in diagnosis of asymptomatic myocardial ischemia.