心电图活动平板运动试验对诊断冠心病的价值

The diagnostic value of treadmill exercise test(TET) in patients with coronary heart disease

目的评价平板负荷试验对冠心病无创性诊断的临床价值。方法临床疑诊冠心病患者258例,先后分别行平板负荷试验和冠状动脉造影,平均间隔时间为10d。统计分析平板负荷试验敏感性、特异性,比较不同程度冠状动脉病变的敏感性,并分析不同冠状动脉病变程度与运动试验参数的关系。结果平板试验检出冠心病敏感性76.5%,特异性61.9%,准确度70.6%,其敏感度与冠状动脉的病变程度有关,冠脉双支、三支病变的敏感性高于单支病变(P<0.05)。在运动总时间、ST段下移幅度、出现时间及持续长短方面,单支、双支及三支病变组间比较差异有显著性意义(P<0.05)。相比胸导联,下壁导联ST段改变有较高假阳性(P<0.05)。结论平板负荷试验是一项诊断冠心病较理想的非创伤性的检查方法,根据多项参数可初步估测其病变范围,全面综合分析可提高诊断准确率。

Objective To investigate the clinical significance of treadmill exercise test （ TET）in the non-invasive diagnosis of coronary heart disease （CHD）314ethods 258 patients that had been submitted to TET up to the average 10 clays before coronary angiography on suspicion of coronary heart disease.Statistical analyses were used to assess the sensitity and specificity of TET.The sensivity of TET in the difference of severity of coronary lesion were analyzed.The multi-parameters of TET and severity of coronary lesion were also analyzed to explore the relationship between them.Results TET identified patients with coronary heart disease with a sensitivity of 76.5%, specificity of 61.9% and accuracy of 70.6%.The sensitivity was associated with the extent of coronary artery disease,In patients with double or triple vessel disease were significantly higher than that in patients with single vessel disease（P〈0.05）.The total time of TET, the depth of S-T segment depression,the duration of ST segment depression and the ST segment recovery time value of TET in patients with single-vessel disease had singnificant difference from those in patients with two or three-vessel disease. Inferior lead＇s false positive rate was more than that of limb lead （P〈0.05）.Conclusion TET is a reliable method in the non-invasive method to diagnosis of CHD.It＇s multi-parameters may be helpful to predict the severity of coronary lesion.Aggregate analysis acould help improve the diagnostic accuracy of TET.