心肌缺血总负荷筛查无痛性心肌缺血冠心病患者的价值

Role of dynamics cardiograph in screening silent myocardial ischemia paitients

目的:评价应用动态心电图(Holter)诊断心肌缺血总负荷(total ischemia burden,TIB)的方法,筛查无痛性心肌缺血(silent myocardial ischemia,SMI)冠心病患者的价值。方法:对72例有冠心病危险因素但无胸痛主诉的体检者,常规行Holter检查,评价其TIB,对达标者(TIB≥60 mm.min-124 h-1)进一步行冠状动脉造影检查,同时对冠状动脉血管病变的程度进行Gensini积分评价,并行相关性分析。结果:24例(24/72)提示有TIB达标。对其中18例(18/24)进行了冠状动脉造影检查,14例(77%)经造影确诊为冠心病,4例(22.2%)造影无异常发现。相关性分析表明,TIB的大小与冠状动脉血管病变的程度呈正相关(r=0.749,P<0.01)。临床随访显示,TIB达标组患者在3年内接受经皮冠状动脉介入治疗(PCI)的比例显著高于TIB未达标组患者。结论:Holter诊断TIB的方法,可以较为客观地评价心肌缺血的有无及其程度,对于冠心病患者特别是SMI冠心病的检出有一定的价值。

Objective：To evaluate the role of dynamics cardiograph in screening silent myocardial ischemia（SMI） patients by total ischemia burden（TIB）.Methods： Patients with coronary dangerous factor but no chest pain were chose to attend the trial.72 patients had dynamic Cardiograph test and TIB were evaluated at meantime,coronary angiograph（CAG） was needed to those who had the positive result（TIB≥60 mm·min-124h-1）,and Gensini cumulative index of coronary artery was evaluated too.Results∶24 of 72 cases attend the criterion of TIB in dynamic cardiograph,18 of 24 patients had CAG examination.14 of 18 cases were diagnosis coronary heart disease by CAG,the other 4 cases had no positive.There was positive correlations between the levels of TIB and Gensini cumulative index（r=0.7492,P0.01）.Conclusion： TIB in dynamic cardiograph can estimate the exist and extent of myocardial ischemia impersonally,it can assist to screening coronary heart disease patients especially in silent myocardial ischemia patients.