运动平板测试在冠状动脉微血管疾病的诊断指标分析

Diagnostic sensitivity and specificity of ETT for CMD

目的:探讨运动平板测试(ETT)在冠状动脉微血管疾病(CMD)诊断中的灵敏度和特异度。方法:本研究为回顾性研究,选取2020年1月至2023年1月南京市中心医院收治的因胸痛、胸闷行ETT的98例患者,依据中国CMD专家共识评价指标将其分为CMD组(54例)和对照组(44例)。所有患者分别于ETT前、中、后进行心电图记录,根据ETT阳性判断标准统计阳性和阴性病例数,计算心电图QT离散度(QTd)和QT间期离散度(QTcd),准确性检验指标采用灵敏度、特异度和准确率。结果:98例患者经ETT检查,运动中QTcd≥50 ms的ETT阳性37例,阴性25例,<50 ms的ETT阳性17例,阴性19例。CMD组ETT前、中、后QTd均明显高于对照组,差异有统计学意义(t=25.520、30.256、44.562,P<0.05),ETT前、中、后QTcd均明显高于对照组,差异有统计学意义(t=15.073、28.945、22.690,P<0.05)。ETT前、中、后QTd诊断冠状动脉CMD的受试者工作特征(ROC)曲线下面积(AUC)分别为0.804(95%CI:0.717~0.891)、0.710(95%CI:0.602~0.818)和0.670(95%CI:0.550~0.789),灵敏度分别为81.50%、72.20%和68.50%,特异度分别为54.50%、54.50%和59.10%;ETT前、中、后QTcd诊断冠状动脉CMD的AUC分别为0.762(95%CI:0.654~0.870)、0.766(95%CI:0.672~0.861)和0.626(95%CI:0.507~0.746),灵敏度分别为77.80%、77.80%和63.00%,特异度分别为65.90%、52.30%和45.50%。结论:ETT前、中、后QTd和QTcd诊断CMD中的灵敏度和特异度均较高,可作为CMD的诊断指标。

Objective:To investigate the sensitivity and specificity of exercise treadmill testing(ETT)in diagnosing coronary microvascular disease(CMD).Methods:This study is a retrospective study,and 98 patients who underwent ETT due to chest pain and chest tightness in Nanjing Central Hospital from January 2020 to January 2023 were selected.They were divided into CMD group(54 cases)and control group(chest tightness patients)(44 cases)according to the CMD experts consensus of China.All patients underwent electrocardiogram before,during and after ETT.The number of positive and negative cases were calculated by using statistical method according to the judgement criteria of positive ETT.The electrocardiogram dispersion(QTd)and QTc dispersion(QTcd)were calculated.The test index of accuracy adopted sensitivity,specificity and accuracy rate.Results:In 98 patients who underwent ETT,37 cases were positive ETT whose QTcd values were larger or equal to 50 ms,and 25 cases were negative ETT whose OTcd values were larger than or equal to 50 ms,and 17 cases were positive ETT whose QTcd values were less than 50 ms,and 19 cases were negative ETT whose QTcd values were less than 50 ms.QTd values before,during and after underwent ETT in the CMD group were significantly higher than these in the control group,and the differences were statistically significant(t=25.520,30.256,44.562,P<0.05),and QTcd values before,during and after underwent ETT in the CMD group were significantly higher than those in the control group(t=15.073,28.945,22.690,P<0.05),respectively.The area under curve(AUC)values of the receiver operating characteristic(ROC)curves of QTd before,during and after underwent ETT were respectively 0.804(95%CI:0.717~0.891),0.710(95%CI:0.602~0.818)and 0.670(95%CI:0.550~0.789)in diagnosing CMD,respectively.The sensitivities of them were respectively 81.50%,72.20%and 68.50%.The specificities of them were respectively 54.50%,54.50%and 59.10%.The AUC values of QTcd before,during and after underwent ETT were respectively 0.762(95%CI:0.654~0.870),0.766(95%CI:0.672~0.861)and 0.626(95%CI:0.507~0.746),and the sensitivities of them were respectively 77.80%,77.80%and 63.00%,and the specificities of them were respectively 65.90%,52.30%and 45.50%.Conclusion:Both the sensitivity and specificity of QTd and QTcd before,during and after undergo ETT are higher in diagnosing CMD,which can be used as the diagnostic indicators of CMD.