动态心电图检出的老年人缺血性ST段压低的临床病理意义

The clinical significance of ischemic ST-segment depression in elderly detected by dynamic electrocardiography

对４７例老年人尸检中冠状动脉病变情况与动态心电图检查时的缺血性ＳＴ段压低结果进行了对比分析。结果：动态心电图检出的缺血性ＳＴ段压低诊断老年人冠心病的敏感性为８０．９％，特异性为８４．６％，准确性为８２．９％。对单支血管病变诊断的敏感性为６６．７％，对双支或三支血管病变为８６．７％。２１例冠状动脉明显狭窄（达Ⅲ级或Ⅲ级以上）患者中，１７例动态心电图检查时有缺血性ＳＴ段压低，其中１１例（６４．７％）无心绞痛或相关症状，说明日常活动情况下，动态心电图检出的缺血性ＳＴ段压低，不论有无心绞痛均明显提示冠心病的存在。

Abstract Dynamic electrocardiography (DCG) and autopsy findings in 47 elderly cases were analysed. The sensitivity, specificity and accuracy of DCG monitoring fur ischemic ST-segment depression to detect coronary heart disease (CHD) in elderly were 80.9%, 84.6% and 82.9% respectively. Ischemic ST-segment depression in DCG was found in 66.7% of the patients with one-branch disease and in 86.7% of the patients with two-or three-branch disease. In 17 of the 21 cases of CHD having positive DCG, 11 (64.7%) had no angina or relevant symptoms. It is suggested that the ischemic ST-segment depression detected by DCG during daily activities indicates the presence of CHD whether it is accompanied by angina or not.