运动平板试验在冠状动脉粥样硬化性心脏病中的诊断价值分析

Analysis of the Diagnostic Value of Treadmill Exercise Test in Coronary Atherosclerotic Heart Disease

目的探究运动平板试验(TET)在冠状动脉粥样硬化性心脏病(冠心病)中的诊断价值.方法将2019年2月—2021年3月我院收治的88例疑似冠心病患者纳为研究对象,所有患者均于入院3 d内行TET试验,并于TET检查后7 d再行冠状动脉造影检查.分析TET检查及冠状动脉造影检查结果;分析TET检查在不同病变血管数目中的阳性检出率;对比单支与多支病变血管的相关运动参数;以冠状动脉造影检查结果为"金标准",分析TET在冠心病中的诊断价值,并计算TET与冠状动脉造影检查的一致性.结果88例疑似患者中,经冠状动脉造影检查共检出阳性67例,阴性21例;TET检出阳性65例,阴性23例.TET阳性中的三支病变检出率高于双支病变及单支病变.多支病变血管患者的峰值心率低于单支病变血管患者,运动时间、ST段下移出现时间均短于单支病变血管患者,ST段下移持续时间长于单支病变血管患者,ST段下移幅度大于单支病变血管患者,组间差异有统计学意义(P<0.05).TET在冠心病诊断中的灵敏度为89.55%,特异度为76.19%,准确度为86.36%,阳性预测值为92.31%,阴性预测值为69.57%.kappa检验显示:TET与冠状动脉造影检查的一致性尚可(kappa=0.637,P=0.000).结论TET在冠心病诊断中具有较高的临床应用价值,可依据各运动参数水平变化判断患者的心脏情况,具有无创性、操作简单,更适用于不具备冠状动脉造影检查的医院,值得推广.

Objective To investigate the diagnostic value of treadmill exercise test(TET)in coronary atherosclerotic heart disease(coronary heart disease).Methods From February 2019 to March 2021,88 patients with suspected coronary artery disease admitted to our hospital were enrolled in the study.All patients underwent TET test within 3 days of admission and coronary angiography 7 days after TET test.The results of TET and coronary angiography were analyzed;the positive detection rate of TET in different number of diseased vessels was analyzed;the relevant motion parameters of single and multiple diseased vessels were compared;the diagnostic value of TET in coronary artery disease was analyzed using coronary angiography as the"gold standard",and the agreement between TET and coronary angiography was calculated.Results Among the 88 suspected patients,a total of 67 positive cases and 21 negative cases were detected by coronary angiography;65 positive cases and 23 negative cases were detected by TET.The detection rate of three-branch lesions among TET positives was higher than that of two-branch lesions and single-branch lesions.The peak heart rate of multi-branch lesions vein patient was lower than that of single-branch lesions vein patient,the exercise time and appearance time of ST segment down were shorter than that of single-branch lesions vein patient,the duration of ST segment down was longer than that of single-branch lesions vein patient,and the downward shift of ST segment was greater than that of single-branch lesions vein patient,and the differences between the groups were statistically significant(P<0.05).The sensitivity of TET in the diagnosis of coronary artery disease was 89.55%,specificity was 76.19%,accuracy was 86.36%,positive predictive value was 92.31%and negative predictive value was 69.57%.kappa test showed that the agreement between TET and coronary angiography was fair(kappa=0.637,P=0.000).Conclusion TET has a high clinical application value in the diagnosis of coronary artery disease,which can determine the cardiac condition of patients based on the changes in the level of each exercise parameter.It is non-invasive,simple to operate,and more suitable for hospitals that do not have coronary angiography examination,and is worth promoting.