活动平板心电图与冠脉造影对照研究

COMPARATIVE STUDY BETWEEN TREADMILL ECG AND CORONARY ANGIOGRAPHY IN THE DIAGNOSIS OF CORONARY ARTERY DISEASE

目的：以冠状动脉造为对照，分析活动平板心电图计算机多变量自动分析结果。方法：Ｔ国４０例，女６例，年龄３５￣６９岁，平均年龄（５０．１５±９．２６）岁，胸痛待查患者。除外睡眠 心电图有明显ＳＴ段改变者，并在平板运动试验后１个月内行冠状动脉造影。ＳＴ段下移测量点Ｊ点皇８０ｍｓ处，以电脑２自动测量为主。结果：非冠心病组２３例，运动心电图阴性１９例，阳性４例，其中２例Ｘ综合征，２例为假阳性。

Objective:To evaluated the value of computerized multivariant analysis of treadmill ECG in the diagnosis of coronary artery disease by using coronary angiography as a control method.Material and Method:46 patients (40 men and 6 women,mean age 50±9.29 years old with range of 35～59years) with chest pain of unknown origin were studied.Those with relevant changes of ST segment on ECG at rest were excluded.Those without first underwent treadmill ECG and one month later coronary angiography.The depression of ST segment was measure 80 ms after J point by computer.Results:In the 23 patients of non-coronary artery disease the treadmill ECGs of 19 patients were found normal,four were abnormal.Of this four cases two were X syndrome and two false positive.In 18 patients with one to two branches of abnormal coronary artery 15 cases were found abnormal,three normal.Five cases with three branches of abnormal coronary artery were all found abnormal with treadmill ECG.Except the two cases of X syndrome,the sensitivity of treadmill ECG was 86.96%,specificity 90.48% and accuracy 90.91%.The period of time for treadmill,mean maximum heart rate and maximum METs were helpful to the diagnosis and determining of the degrees of coronary artery diseases.By using the clockwise ST segment-heart rate-recovery loop the sensitivity was 52.17%,the specificity and accuracy increased to 100%.The high value of ST/HR slope indicated severe coronary artery lesion.Because ST/HR slope does not represent the state of depression of ST segment during the recovery and the measurement needs longer time of duration,the use of it is limited.Conclusion:Comparative to coronary angiography (1)the use of treadmill ECG in the diagnosis of coronary artery disease is safe and applicable;(2)Computerized multivariant analysis of treadmill ECG can increase the specificity and accuracy;(3)When the depression of ST segment,the period of time treadmill ECG,maximum heart rate and maximum SBP×HR were analyzed together it can guide the clinician in making out the diagnosis;(4)the direction ST segment-heart rate-recovery loop and ST/HR slope are useful indices in the diagnosis of coronary artery disease and should be paid attention to.