QRS延长指标评价食道心房调搏负荷试验对冠心病的诊断价值研究

目的探讨经食管心房调搏负荷试验 (TEAPT)中 ,QRS延长指标对冠心病 (CAD)的诊断价值。方法 6 8例研究对象在作冠状动脉造影术 (CAG)前后 1周内进行TEAPT并测定V5导联静息QRS间期 (QRSr)、负荷峰值QRS间期 (QRSp)及 12导联心电图ST段压低水平 ,以冠状动脉造影结果作为CAD诊断标准 ,比较QRS延长指标 (QRSp r)与ST段压低标准间的诊断效能。结果CAD组 (n =39)的QRSp r值显著大于冠脉无显著狭窄 (NCAD)组 (n =2 9) (t≥ 4 5 9,P <0 0 0 1)。以QRSp r在NCAD组的 90 %上限值 4ms为界限值 ,其诊断冠心病的敏感性和特异性与ST段压低标准相比差异无显著意义(分别为 74 36 %对 5 3 9% ,86 2 1%对 6 5 5 2 % ,P >0 0 5 ) ,但准确性显著高于ST段压低标准 (79 41%对 5 8 82 % ,P <0 0 0 5 )。结论QRSp r是TEAPT诊断CAD的一项较好的新指标

Diagnosis value of QRS prolongation for coronary artery disease in transesophageal atrial pacing stress

Objective To compare the diagnostic power of electrocardiogram(ECG) ST criteria and QRS duration prolongation to detect ischemia in transesophageal atrial pacing stress test(TEAPT).Methods TEAPT were performed in 68 cases before or after coronary arteriography(CAG) within 1 week. QRS duration on lead V5 at rest(QRSr) and load peak(QRSp) and ST segment depression 12 leads was measured respectively. The result of CAG was used as diagnostic criterion of coronary artery disease (CAD). Diagnostic power of the QRS prolongation (QRSp r) and ST segment depression was compared. Results Thirty nine cases (CAD group) with coronary artery disease,29 cases no significant stenosis (NCAD group)was tested. QRSp r in CAD group was significantly increased than that in NCAD group ( P <0.001). The 90% superior limit value was 4ms in NCAD group. Using the superior limit value as diagnostic criterion, the sensitivity and specificity of the QRSp r was no significantly higher than that of ST depression, but the accuracy of the QRSp r was significantly higher than that of ST depression ( P <0.01). Conclusion TEAPT induced QRS prolongation is a new index in diagnosing CAD.