运动后收缩压异常波动对冠心病的诊断价值

Abnormal Wave of Postexercise Systolic Blood Pressure in the Diagnosis of Coronary Artery Disease

目的 探讨运动后收缩压异常波动对冠心病的诊断价值 ,以及高血压对其诊断准确性的影响。方法 72例先后行平板运动试验和冠脉造影的患者 ,根据高血压病的有无和冠脉造影结果分组。以运动后恢复早期6min内 ,收缩压后期比前期升高≥ 10mmHg( 1mmHg =0 .133kPa)为阳性标准。 结果 收缩压异常波动诊断的敏感性、特异性、准确性、阳性预测值、阳性似然比等 ,均优于ST段压低标准 ;其敏感性与冠脉病变程度成正比 ;高血压可降低其诊断的准确性 ;对合并高血压的冠心病患者 ,两者合用可提高诊断的特异性、准确性和阳性似然比。

Objective To evaluate the diagnostic value of abnormal wave of postexercise systolic blood pressure (SBP) for detecting coronary disease (CAD) in patients with or without hypertension.Methods Treadmill exercise testing was conducted in 72 patients (32 patients,40 control subjects) with or without hypertension,each of whom underwent selective coronary angiography.The abonormal wave of postexercise SBP was defined as an increase of ≥10mmHg than earlier periods during the recovery (6 minutes) of exercise testing.Results The abnormal wave of postexercise SBP had higher sensitivity,specificity,accuracy,positive predictive value,and positive likelihood ratio for detecting CAD than those of ST-segment depression in patients with or without hypertension.But most of their difference did not reach statistical significance.Its' sensitivity increased with the severity of CAD and its' diagnostic value decreased in patients with hypertension.The combination of ST-segment depression and abnormal wave of postexercise SBP diagnosed CAD most accurately in patients with hypertension.Conclusion Abnormal wave of postexercise SBP may be a sensitive and specific index for diagnosing CAD.