平板运动试验心电图不同部分的变化对冠心病的诊断价值

目的 探讨平板运动试验(TET)中心电图不同部分的变化对冠心病的诊断价值.方法 2006年1月至2011年3月在我院住院接受心脏活动TET及冠状动脉造影(CAG)检查的缺血性心脏病患者445例,回顾性分析其TET中心电图不同部分的变化对冠心病的诊断价值.结果 (1)445例患者中TET阳性200例,其中CAG阳性150例,CAG阴性50例；TET阴性245例,其中CAG阴性206例,CAG阳性39例.TET检出冠心病的敏感性为79.36％ (150/189),特异性为80.47％ (206/256).(2)TET阳性200例患者中CAG阳性150例,其中肢体导联组22例,胸导联组58例,肢体导联+胸导联组70例,肢体导联+胸导联、胸导联ST改变CAG阳性率显著高于单纯肢体导联(x2值分别为6.34、3.93,P均＜0.05).(3)CAG阴性组运动后R波振幅为(17.54±2.52) mm,CAG阳性组为(19.42±3.46) mm,差异有统计学意义(t=6.33,P＜0.05).(4)TET阳性组200例,其中T波正常化60例患者的CAG阳性率为73.3％(44/60),其他140例的CAG阳性率为75.0％ (105/140),差异无统计学意义(x2=0.06,P＞0.05),但均高于TET阴性组15.9％(39/245),x2值分别为80.21、132.82,P均＜0.05].结论 TET是诊断冠心病较理想的非创伤性的检查方法,综合心电图不同部分的变化可初步估测其病变程度.

The diagnostic Value of the change of different parts of electrocardiogram in treadmill exercise test for coronary artery disease

Objective To determine the diagnostic value of the change of different parts of electrocardiogram in treadmill exercise test （TET） for coronary heart disease （CHD）. Methods From Jan. 2006 to Mar. 2011,445 patients with CHD underwent treadmill exercise test and coronary angiography （CAG） in our hospital. We analyzed retrospectively the diagnostic value of the change of different parts of electrocardiogram in TET test. Results （ 1 ） There were 200 cases who had positive results during treadmill exercise test and 150 cases of them had been diagnosed of CHD by coronary angiography;The other 245 cases had negative results during treadmill exercise test and 39 cases of them had been diagnosed as CHD by coronary angiography. The sensitivity and specificity rates of treadmill exercise test in diagnosis of CHD were 79. 36% （ 150/189 ） and 80.47% （ 206/256 ） respectively. （ 2 ） Of the 200 positive cases tested by coronary angiography, 150 cases were diagnosed of CHD, including 22,58 and 70 cases with limb, chest and combined chest and limb leads positive results respectively. The positive rates for the groups of combined chest and limb leads and limb ST leads were significantly higher than that of the chest leads only group （ x2 = 6. 34,3.93 ; P 〈 0. 05 ）. （3） R wave amplitude of the CAG negative group after exercise （ 17. 54 ＋ 2. 52 ） mm was significantly lower than the CAG positive group （ 19.42 ＋ 3.46 ） mm （ t = 6. 33, P 〈 0. 05 ）. （ 4 ） For the 200 cases with positive TET, there were no significant statistical difference （ P 〉 0. 05 ） on CAG positive rate between T wave normalization group 73.3% （44/60）] with and TET positive group 75.0% （105/140）]. But these two groups had significantly higher （ X2 ： 80. 21,132. 82 ; P 〈 0. 05 ） CAG positive rates than TET negative group 15.9% （ 39/245 ） ]. Conclusion The treadmill exercise test is valuable in noninvasive diagnosis of CHD. The severity of CAG can be preliminarily estimated by analyzing the pattern of the change of different parts of electrocardiogram