运动试验假阴性而冠状动脉造影阳性冠心病的特点分析

Characteristics analysis of coronary heart disease patients with positive coronary angiography but false negative treadmill exercise test

目的:探讨平板运动试验(TET)假阴性而冠状动脉造影(CAG)阳性冠心病病例的特点。方法:对同期内(相距时间1周)TET阴性而有心前区不适者进行CAG的冠心病患者60例(男性42例,女性18例,平均年龄66±10岁)进行回顾性分析。TET以运动中及恢复期R波为主的导联出现ST段水平型下移0.05mV为阴性标准。CAG以冠状动脉狭窄直径≥50%为阳性标准。结果:60例患者CAG共累计病变106处,其中左主干2例2处、左前降支21例30处、左回旋支7例13处、右冠状动脉27例36处、对角支7例10处、间隔支3例3处、钝缘支3例3处、后降支6例6处、中间支2例3处。病变范围在在50%～74%占65处、病变范围在75%～89%占30处、病变范围在90%～95%占11处。冠状动脉单支病变40例(占66.7%),以右冠状动脉及左前降支为多,占70.0%(28/40),双支病变14例(占23.3%),左前降支+右冠状动脉较多,占57.1%(8/14),三支病变6例(占10.0%)。60例患者中有侧支循环者31例(51.7%)。有16例(26.7%)试验运动量不足,男性明显多于女性(P<0.05)。结论:冠心病患者TET假阴性的原因可能为冠脉病变小、狭窄程度轻、狭窄病变供血心肌建立了良好的侧支循环以及试验运动量不够。对于有临床症状而TET阴性的患者应行CAG检查,以明确诊断。

Objective：To investigate the characteristics in cases of coronary heart disease（CHD） with positive results in coronary angiography（CAG）,but false negative in treadmill exercise test（TET）.Methods：CAG was performed in 60 patients（45 males and 17 females with an average age 66±10 years） with negative results in TET.The TET negative standard was that R-leading ECG appeared ST segment level depression 0.05mV during or after exercise.The CAG positive standard was the obstruction of coronary artery ≥50%.Results：106 coronary artery occlusion were detected in 60 patients undergoing CAG.Among these patients,there were single vessel disease in 40 casees（66.7%）;double vessel disease in 14 ones（23.3%）;triple vessel disease in 6 ones（10.0%）.There were 31 cases（51.7%） with collateral circulation and 16 ones（26.7%） presenting sport quantity shortage among 60 patients.Conclusions：The cause of false negative TET on patients with CHD was that the vessel diseases were not serious,with perfect collateral circulation,and sport quantity shortage in the test.CAG should be performed on patients with negative TET to define the diagnosis.