动态心电图检查对老年冠心病的诊断价值

Diagnostic Value of Holter Monitoring in Older Patients with Coronary Heart Diseases

目的探讨动态心电图(Holter)检查对老年冠心病(CHD)的诊断价值。方法选取2016年1月~2016年12月在我院就诊的疑似老年CHD患者88例,所有患者行Holter检查、平板运动试验和冠脉造影检查。结果88例患者中确诊为CHD64例;平板运动试验诊断CHD的灵敏度65.63%、特异.性70.83%、阳性预测值85.71%、阴性预测值43.59%,约登指数为0.365;Holter诊断CH1)的灵敏度59.38%、特异性75.00%、阳性预测值86.36%、阴性预测值40.91%,约登指数为0.344;运动平板试验和Holter检查与冠脉造影之间,经一致性检验Kappa值分别为0.305和0.273,一致性一般,P<0.05;运动平板试验和Holter联合检查诊断CHD灵敏度79.69%、特异性80.33%、阳性预测值92.73%、阴性预测值60.61%,约登指数为0.630;与冠脉造影之间,经一致性检验,Kappa值0.628,—致性较好,P<0.05;单支病变狭窄程度M75%的患者ST段压低幅度及持续时间分别为(2.07±0.36)mm和(132.17±20.48)min,明显高于狭窄程度50%-74%的患者(P<0.05).结论Holler检查作为无创性诊断CHD的方法,有一定的诊断价值,与平板运动试验联合检查时可提高诊断准确性.同时在病变冠脉狭窄程度初步判断中有一定的作用。

Objective To investigate the diagnostic value of Holter monitoring in older patients with coronary heart disease (CHD).Methods 88 patients with suspected CHD were selected in our hospital from Januaiy 2016 to December 2016.Holter monitoring, treadmill exercise test and coronary angiography were performed in these patients.Results 64 of 88 cases were diagnosed as CHD.The sensitivity and specificity of treadmill exercise test were 65.63% and 70.83%, respectively.The positive and negative predictive values were 85.71 % and 43.59%, respectively.Youden index was 0.365.The sensitivity and specificity of Holter were 59.38% and 75.00%, respectively.The positive and negative predictive values were 86.36% and 40.91 %, respectively.Youden index was 0.344.The Kappa values of treadmill exercise test and Holter examination (0.305 , 0.273 ) demonstrated poor consistencies with coronary angiography ( P<0.05 ).The sensitivity and specificity of treadmill exercise test combined with Holter monitoring were 79.69% and 80.33%, respectively.The positive and negative predictive values were 92.73% and 60.61 %, respectively.Youden index was 0.630.Combination of treadmill exercise test and Holter showed good consistency with coronary angiography ( Kappa value = 0.628 , P<0.05).ST segment depression and duration in patients with single vessel stenosis ≥75% were (2.07±0.36) mm and ( 132.17±20.48 ) min, respectively and significantly higher than those in patients with stenosis 50% to 74%(P<0.05 ).Conclusion Combination of Holter and treadmill exercise test can improve the diagnostic accuracy of CHD and be helpful in the preli minaiy assessment of the severity of coronary stenosis.