24 h动态心电图与平板运动试验诊断冠心病无症状性心肌缺血的价值比较

Value of 24-hour dynamic electrocardiogram and treadmill exercise test in diagnosis of coronary heart disease complicated by silent myocardial ischemia

目的分析24 h动态心电图和平板运动试验用于冠心病无症状心肌缺血诊断的价值。方法抽取2020年1月至2021年12月于南阳市中心医院就诊的80例疑似冠心病无症状心肌缺血患者进行研究,所有患者均开展平板运动试验和24 h动态心电图检查。将冠状动脉造影结果作为金标准,比较两项检查的诊断结果及诊断效能,并观察两种方法检查确诊患者ST段下移的维持时间和下移幅度。结果冠状动脉造影显示阳性62例,阴性18例;24 h动态心电图显示阳性54例,阴性26例;平板运动试验显示阳性56例,阴性24例。平板运动试验诊断准确度(90.00%,72/80)、特异度(94.44%,17/18)高于24 h动态心电图(75.00%,60/80;66.67%,12/18),P<0.05;平板运动试验误诊率(5.56%,1/18)低于24 h动态心电图(33.33%,6/18),P<0.05;两种方法的灵敏度、漏诊率比较差异未见统计学意义(P>0.05)。平板运动试验检查的确诊患者ST段维持下移时间和下移幅度均高于24 h动态心电图(P均<0.05)。结论与24 h动态心电图比较,平板运动试验用于冠心病无症状心肌缺血诊断中的准确度和特异度更高,误诊率更低,能给临床诊断和治疗提供重要依据。

Objective To analyze the diagnostic value of 24-hour dynamic electrocardiogram and treadmill exercise test for coronary heart disease complicated by silent myocardial ischemia.Methods A total of 80 patients with suspected coronary heart disease complicated by silent myocardial ischemia treated in Nanyang Central Hospital from January 2020 to December 2021 were selected for the study.They all successively underwent treadmill exercise test and 24-hour dynamic electrocardiogram examination.Taking results of coronary angiography as the gold standard,the diagnostic results and diagnostic efficacy of the two examinations were compared.And the maintenance time and extent of ST segment depression of the patients diagnosed with coronary heart disease complicated by silent myocardial ischemia by the two methods were observed.Results Coronary angiography showed positive in 62 cases and negative in 18 cases;24-hour dynamic electrocardiogram showed positive in 54 cases and negative in 26 cases;the treadmill exercise test showed positive in 56 cases and negative in 24 cases.The diagnostic accuracy and specificity of treadmill exercise test were 90.00%(72/80)and 94.44%(17/18),respectively,higher than the 75.00%(60/80)and 66.67%(12/18)of 24-hour dynamic electrocardiogram(P<0.05);and the misdiagnosis rate of treadmill exercise test was 5.56%(1/18),lower than the 33.33%(6/18)of 24-hour dynamic electrocardiogram(P<0.05);however,there was no significant difference in diagnostic sensitivity and missed diagnosis rate between the two methods(P>0.05).The duration and extent of ST segment depression of patients with coronary heart disease complicated by silent myocardial ischemia detected by treadmill exercise test were higher than those by 24-hour dynamic electrocardiogram(all P<0.05).Conclusions Compared with 24-hour dynamic electrocardiogram,treadmill exercise test in the diagnosis of coronary heart disease complicated by silent myocardial ischemia has a higher accuracy and specificity and a lower misdiagnosis rate,therefore,it can provide an important basis for clinical diagnosis and treatment.