平板运动试验对左前降支单支病变部位的预测价值

The predictive value of treadmill exercise test in single left anterior descending artery lesions

目的 探讨平板运动试验对左前降支（LAD）单支病变部位的预测价值.方法 选取2008年1月至2013年7月平板运动试验阳性,且冠状动脉造影为LAD单支病变患者64例,根据病变部位分成两组,LAD近端病变组34例,LAD中远端病变组30例,回顾性对比分析平板运动试验与LAD病变部位的关系.结果 LAD近端组的aVR导联抬高幅度明显高于LAD中远端组（P＜0.01）,伴胸闷、胸痛例数LAD近端组明显多于LAD中远端组（P＜0.05）,Duke评分LAD近端组明显低于LAD中远端组（P＜0.05）.运动时间、ST段改变开始时间、累积ST段下移幅度、达到目标心率的比率两组比较差异无统计学意义（P＞0.05）.LAD近端病变组出现aVR导联ST段抬高≥0.10 mV患者例数明显多于LAD中远端病变组（64.7％比20.0％,P=0.000）.aVR导联ST段抬高≥0.10 mV预测LAD近端病变的敏感度为64.71％、特异度为80.00％、阳性预测值78.57％、阴性预测值66.67％、准确率为71.88％.结论 平板运动试验诱发aVR导联ST段抬高对早期预测LAD近端病变有重要价值.

Objective To assess the predictive value of treadmill exercise test in the left anterior descending artery （LAD） single lesion.Methods Chose 64 patients who were positive in the treadmill exercise test （TET） of Dalian Municipal Central Hospital from January 2008 to July 2013,and LAD coronary angiography for the 64 patients with single vessel disease.They were divided into two groups according to the lesion：proximal LAD group of 34 cases,middle and distal LAD group of 30 cases.Retrospectively contrast and analyze the relationship between the results of treadmill exercise test with LAD lesion.Results The proximal LAD group elevation magnitude in lead aVR much higher than in the middle and distal LAD group（P＜0.01）,the cases with chest pain in proximal LAD group were significantly greater than the number of the middle and distal LAD group （P＜0.05）.Duke score in proximal LAD group was significantly lower than that in middle and distal LAD group （P＜0.05）.The difference was not statistically significant for the two groups in the exercise time,the start time of STsegment change,the cumulative magnitude of ST-segment depression,and the rate for achieving target heart rate （P＞0.05）.The occurrence rate in degree of ST-segment elevation≥0.10 mV in lead aVR was significantly higher than in the proximal LAD group compared with the middle and distal LAD group（64.7％ vs 20.0％,P=0.000）.ST segment elevation in lead aVR predicted proximal of LAD with sensitivity of 64.71％,specificity of 80％,positive predictive value of 78.57％,negative predictive value of 66.67％,accuracy of 71.88％.Conclusion It is significant value for the early prediction in proximal of LAD lesion that ST-segment elevation in lead aVR induced by TET.