平板运动试验心率校正的ST段压低参数对冠心病诊断价值的探讨

Value of Heart Rate Adjusted ST Segment Depression Index in Detecting Coronary Artery Disease.

探讨心率校正的ST段压低参数诊断冠状动脉 (简称冠脉 )病变的准确性 ,12 8例患者接受次极量平板运动试验和冠脉造影。观察各例患者运动中心率相关的ST段压低最大速度即最大ST段 /心率斜率 ,最大心率时ST段与静息时ST段压低值之差除以最大心率与静息心率之差即ΔST/HR指数 ,以及ST段压低 ,观察值与阳性判断标准比较。结果显示 ,最大ST/HR斜率诊断冠心病的敏感性、特异性及诊断符合率最高 ,分别为 94.1%、92 .3%、94.5 % ,ST段压低诊断冠心病的敏感性、特异性及诊断符合率最低 ,分别为 74.5 %、6 9.2 %、73.4%。最大ST/HR斜率在冠脉不同程度病变间无重叠 ,其它参数虽与冠脉病变程度有平行关系 ,但有较大程度的重叠。结论 :心率校正的ST段压低参数显著提高了对冠心病的诊断价值 。

From July 1998 to May 2000,128 patients which were suspected to suffer from coronary artery disease(CHD),all underwent treadmill exercise test(TET) within two weeks of coronary angiography.Their heart rate adjusted ST segment depression index and results of coronary angiography were independently obtained and the two sets of date were compared.Results:In contrast to the 74.5% sensitivity of standard exercise ECG criteria for the detection of disease in this population,the sensitivity of an ST segment/heart rate slope was 94.1% and that of a ΔST segment/heart rate index was 86.3%.ST segment/heart rate slope had superior performance than other ones.The difference had statistical signifiance.The slope in each group had no overlap.While other index had many overlap.Conclutions:Heart rate adjusted ST segment depression index can significantly improve the value in detecting coronary artery disease.Maximal ST segment/heart rate slope can detect the presence and assess the severity of coronary obstruction.