增强的等长运动超声心动图负荷试验检测冠心病的应用研究

Clinical study on enhanced isometric exercise and stress echocardiography for diagnosis of coronary artery disease

目的:设计一种在上肢握力负荷的同时再增加下肢等长运动负荷方法即增强的等长运动负荷,并结合超声心动图对冠心病(CAD)进行初步研究,探讨其检测冠心病的价值。方法:采用自行研制的等长运动心脏负荷试验机对一组临床上疑似CAD的胸痛病例(45例)进行增强的等长运动超声心动图负荷试验及冠脉造影检查,并根据冠脉造影结果将上述45例患者分为CAD组和正常组。结果:(1)负荷后的血流动力学变化明显,心率、动脉收缩压、心率-收缩压乘积显著性增加;(2)诊断敏感性、特异性、阳性预测值、阴性预测值分别为79.3%、81.3%、88.5%、57.9%;(3)CAD组在负荷后左室舒张、收缩功能指标二尖瓣口血流E峰/A峰、LVEF明显低于负荷前以及正常组的负荷前、后(P<0.05)。结论:增强的等长运动超声心动图负荷试验方法对于CAD诊断的准确率较高,并可有效评价CAD患者舒张、收缩功能的变化,有推广应用价值。

Objective： To investigate the diagnostic value of enhanced isometric exercise and stress echocardiography in patients with coronary artery disease （CAD） by designing a new instrument for sustained handgrip. Methods The enhanced isometric exercise and stress echocardiography, and coronary cineangiography were performed on 45 suspected CAD cases by using a self-made instrument. Resuits HR, SBP and RPP increased significantly after enhanced isometric stress. The diagnostic sensitivity, specificity, and positive and negative predictive value in detecting CAD were 79.3%, 81.3%, 88. 5% and 57.9%, respectively. Compared with control group, the systolic and diastolic function （E/A and LVEF） in CAD group decreased remarkably （P〈0.05）. Conclusion： The enhanced isometric stress test with Doppler echoeardiography is a noninvasive, simple method for evaluation of systolic and diastolic function and diagnosis of CAD patients.