平板运动试验中变时性不全对冠心病的诊断价值

The diagnosis value of chronotropic incompetence in treadmill exercise test to patients with coronary artery disease

目的评价平板运动试验中变时性不全对冠心病的诊断价值。方法选取91例临床疑诊冠心病患者，行平板运动试验和冠状动脉造影检查，依冠状动脉造影结果分为冠心病组（58例）和非冠心病组（33例），比较两组间心脏变时性功能。结果冠心病组运动后最大心率值、变时性指数和运动后1min心率恢复值明显低于非冠心病组（P〈0．05或〈0．01）。运动后最大心率值法、变时性指数法及运动后1min心率恢复值法与sT段改变法相比，其特异度较高，其中变时性指数法及运动后1min心率恢复值法准确度亦有明显提高，若ST段改变法与变时性不全法相结合，则诊断冠心病的敏感度为67．2％、特异度为84．8％、准确度为73．6％。结论平板运动试验中变时性不全是诊断冠心病的较好方法，若与ST段改变法相结合，则优于其中任意一种方法。

Objective To evaluate the diagnosis value of chronotropic incompetence in treadmill exercise test to patients with coronary artery disease （CAD）. Methods Ninety-one cases of suspicious coronary disease who underwent treadmill exercise test were divided into CAD group and non-coronary artery disease （NCAD） group according to coronary artery angiogram and the chronotropic incompetence index between the two groups were compared. Results The maximal heart rate, chronotropic response index and heart rate recovery at 1 minute after treadmill exercise test in CAD group showed obvious reducing compared with that in NCAD group. Chronotropic incompetence index and the ST segment criteria had the approximate sensitivity, but the former had higher specificity. Chronotropic response index and heart rate recovery at 1 minute after treadmill exercise test had higher accuracy. With the method combining traditional ST segment criteria with chronotropic incompetence,the diagnosing sensitivity,specificity and accuracy in CAD was 67.2%, 84.8% and 73.6% respectively. Conclusions Chronotropic incompetence in treadmill exercise test is a good method to diagnose CAD. The method of chronotropic incompetence in treadmill exercise test combined with traditional ST segment criteria is better than either of them.