心率校正的ST段改变诊断冠心病的准确性探讨

The acuracy of heart rate adjusted ST segment depression of exercise electrocardiography test in diagnosis of coronary artery disease

目的评价运动心电图ＳＴ段压低的几个变量对诊断冠心病价值。方法９７例冠心病病人和５０例健康人作对照组进行Ｂｒｕｃｅ方案的活动平板试验，受试对象计算运动末ＳＴ段（ＳＴｅｎｄ）压低，恢复期ＳＴ段（ＳＴｒｅｃ）压低，ＳＴ／ＨＲＩｎｄｅｘ和ＳＴ／ＨＲｈｙｓｔｅｒｅｓｉｓ，其中ａＶＲ导联不计其内。结果冠心病组和健康对照组的ＳＴ／ＨＲｈｙｓｔｅｒｅｓｉｓ指标的敏感性和特异性均高于其它三个指标的任何一个（Ｐ均＜００５）。结论ＳＴ／ＨＲｈｙｓｔｅｒｅｓｉｓ反映了心率校正后的运动期与恢复期的ＳＴ段差值的平均值，因而比ＳＴｅｎｄ、ＳＴｒｅｃ和ＳＴ／ＨＲＩｎｄｅｘ三个指标均准确，值得临床推广。

Objective To evaluate several new ST segment depression variables in exercise electrocardiography test. Method Ninety seven patients who were later taken coronary angiography and 50 clinically normal subjects were recieved treadmill exercise electrocardiography tests under Bruce protocol. For each object, end exercise ST depression (STend), recovery ST depression (STrec), ST/HR index, and ST/HR hysteresis were determined from the standard 12 leads exercise electrocardiography excluding aVR lead.Results The results showed that the sensitivity and speciality of ST/HR hysteresis of both groups (angiography and clinical “normal” group) in diagnosis of coronary artery disease are higher than the other three variables ( P <0.05). Conclusion It is concluded that the accuracy of ST/HR hysteresis is definitely better than STend, STrec and ST/HR index because it actually represents the average difference in heart rate adjusted ST segment depression between the exercise and recovery phases regardless of the magnitude of heart rate decrease during the recovery phase.