运动试验恢复期收缩压异常升高诊断冠心病的初步探讨

Preliminary study of abnormal increase of postexercise systolic blood pressure in the diagnosis of coronary artery disease

目的 探讨运动后收缩压异常升高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 88例先后行平板运动试验和冠脉造影的患者 ,根据高血压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为收缩压异常升高的阳性判定标准。结果 收缩压异常升高诊断冠心病的敏感性、特异性、准确性 ,高于ST段压低标准 ;其敏感性与冠脉病变程度成正比 ,其升高值亦与冠脉病变成正相关 ;在非高血压组其诊断的准确性较高 ,对合并高血压的患者 ,两指标联用的诊断准确性最高。

Objectives This study sought to evealuate the diagnostic value of abnormal increase of postexercise systolic blood pressure (SBP) for detecting coronary artery disease (CAD) in patients with or without hypertension. Methods Treadmill exercise testing (TET) was conducted in 88 patients (40 CAD patients, 48 control subjects) with or without hypertension, each of whom underwent selective coronary angiography (CAG). The abnormal increase of postexercise SBP was defined as 10 mmHg higher than earlier periods during the recovery phase (6 minutes) of exercise testing. Results The abnormal increase of postexercise SBP had higher sensitivity, specificity, and accuracy for detecting CAD than those of ST segment depression in patients with or without hypertension. Its accuracy increased with the severity of CAD while decreased in patients with hypertension, and the increase value of SBP had a positive correlation with the extent of coronary artery lesion. The combination of ST segment depression and abnormal increase of postexercise SBP diagnosed CAD most accurately in patients with hypertension. Conclusions Abnormal increase of postexercise SBP may be a useful index for diagnosing CAD.