食管调搏心负荷二维超声心动图试验对冠心病诊断价值研究

Study on Diagnostic Value of the Transesophageal Atrial Pacing Loading Two dimensional Echocardiography Test to Coronary Heart Disease

目的 探讨食管调搏心负荷二维超声心动图（ＴＥＡＰＬ２ＤＥ） 试验对冠心病（ＣＨＤ） 的诊断价值，并与同期静息二维超声心动图（ｒｅｓｔ２ＤＥ） 、食管调搏心负荷心电图（ＴＥＡＰＬＥＣＧ） 试验相比较。方法 ８０ 例拟诊ＣＨＤ 的住院病人均行ＴＥＡＰＬ２ＤＥ、Ｒｅｓｔ２ＤＥ及ＴＥＡＰＬＥＣＧ试验，以冠状动脉造影（ＣＡＧ） 冠脉狭窄＞ ５０ ％ 作为确诊ＣＨＤ 的依据，６０ 例确诊为ＣＨＤ，但除外心肌梗塞。２０ 例ＣＡＧ正常者作为对照。结果 ＴＥＡＰＬ２ＤＥ 助诊ＣＨＤ 的敏感性为８６６７ ％ ，特异性为８５ ％ ，同ＴＥＡＰＬＥＣＧ、ｒｅｓｔ２ＤＥ比较，ＴＥＡＰＬ２ＤＥ有更高的敏感性（ Ｐ＜ ００２５，Ｐ＜ ０００５） 。三种试验的特异性无显著性差异（ Ｐ＞ ００５） 。ＴＥＡＰＬ２ＤＥ 对早期ＣＨＤ 冠脉轻度狭窄病变也有较高敏感性，而ＴＥＡＰＬＥＣＧ 则对多支冠脉血管的中、重度狭窄病变敏感性较高。结论 ＴＥＡＰＬ２ＤＥ 是一安全、有效、无创性助诊ＣＨＤ 的方法，与ＴＥＡＰＬＥＣＧ结合更能提高ＣＨＤ的诊断价值。

Objective To research the dagnostic value of the transesophageal atrial pacing loading two dimensional echocardiography test (TEAPL 2DE) to the coronary heart disease (CHD).The results of this test were compared with the homochronous results of the rest two dimensional echocardiography (rest 2DE) and the transesophageal atrial pacing loading electrocardiography (TEAPL ECG).Methods 80 cases who were suspected with CHD were all performed with TEAPL 2DE,rest 2DE and TEAPL ECG as well as coronary angiography (CAG).Among them,60 cases,except with myocardial infarction,were diagnosed as CHD when the luminaldiameter reduction in one major coronary artery at least was >50%.20 cases with normal CAG were made as a contrast.Results The sensitivity of TEAPL 2DE in helping the diagnosis of CHD was 86.67%,and its specificity was 85%.TEAPL 2DE had higher sensitivity than TEAP ECG and rest 2DE( P <0 025, P <0 005),and the specificity of these three tests had no obvious difference ( P >0 05).TEAPL 2DE had relatively a higher sensitivity to the low grade coronary lesion of CHD in its early stage,while TEAPL ECG had a higher sensitivity to the mid grade and the high grade lesion of multiple branches coronary vessel stenosis.Conclusion TEAPL 2DE was the safe,effective and noninvasic method in helping the diagnosis of CHD.Its combination with TEAPL ECG will promote the diagnostic value of CHD. [