右胸导联在运动试验中对冠状动脉再狭窄检测的作用

The Role of Right-sided Chest Leads in Exercise Testing for Detection of Coronary Restenosis

目的:评估附加V3R^V5R导联在运动试验中对检测右冠状动脉(RCA)和/或回旋支动脉(LCX)接受经皮冠状动脉介入治疗(PCI)无症状患者再狭窄诊断能力的作用。方法:129例在RCA和/或LCX接受PCI的患者,术前进行运动试验,6个月后,所有患者为检测再狭窄导致的无症状心肌缺血均接受第二次平板运动试验和冠脉造影,并记录运动中标准12导联和V3R^V5R导联的数据。结果:129例患者中,其中右冠状动脉狭窄80例,回旋支狭窄26例,双支血管狭窄23例。6个月后,分别有6例(RCA)、2例(LCX)及3例(双支血管)出现再狭窄。PCI术后使用V3R^V5R导联运动试验的灵敏度、特异度、阳性预测值,阴性预测值及准确率均有改善(分别为73%VS 55%,97%VS 80%,73%VS 21%,97%VS 95%,95%VS 78%,除了阴性预测值外,P均<0.05)。PCI术后运动试验导致最大ST段下移值(毫米)在12导联中无变化(1.4±0.3 vs 1.5±0.3,P>0.05),而在V3R^V5R导联中有下降(0.2±0.2 vs 1.2±0.2,P<0.01)。结论:对右冠状动脉(RCA)和/或回旋支动脉(LCX)接受经皮冠状动脉介入治疗(PCI)患者,使用附加V3R^V5R导联可以提高标准运动试验检测再狭窄导致的无症状性心肌缺血的诊断能力。

Objective： To evaluate the role of additional V3 R through V5 R leads in exercise testing to detect restenosis in asymptomatic patients undergoing percutaneous coronary intervention（ PCI） in the right coronary artery（ RCA） or/and left circumflex（ LCX）. Methods： We studied 129 consecutive patients（ 54 ± 7 years old,80 males） undergoing PCI in RCA or/and LCX. A treadmill test had been performed before PCI. Six months later,all patients underwent a second treadmill test and arteriography in order to detect silent ischemia due to restenosis. Recordings during exercise were obtained with the standard 12-leads plus V3 R through V5 R. Results： Out of 129 patients,80 had stenosis in RCA,26 in LCX,and 23 in both vessels while 6 months later,restenosis was detected in 6（ for RCA）,2（ for LCX）,and 3（ for both vessels） patients respectively. Sensitivity,specificity,positive prognostic value,negative prognostic value,and accuracy of exercise testing performed post PCI were ameliorated using V3 R through V5R（ 73% VS 55%,97% VS 80%,73% VS 21%,97% VS 95%,95% VS 78% respectively,P〈0. 05 for all except negative prognostic value）. Maximal exercise-induced ST-segment deviation（ in mm） was not changed post PCI in 12 leads（ 1. 4 ± 0. 3 vs 1. 5 ± 0. 3,P = NS）while it decreased in V3 R through V5R（ 0. 2 ± 0. 2 vs 1. 2 ± 0. 2,P〈0. 01）. Conclusion： The addition of V3 R through V5 R improves the diagnostic ability of standard exercise testing in detecting silent ischemia due to restenosis in patients undergoing PCI in RCA or/and LCX.