三种无创检查方法诊断冠心病无症状心肌缺血的价值

SILENT MYOCARDIAL ISCHEMIA IN PATIENTS WITH CORONARY HEART DISEASE

本文以冠状动脉造影作为诊断冠心病的标准,对临床确诊为冠心病的患者进行运动心电图、运动^(201)铊心肌显像和动态心电图检查。结果证明:这三种方法诊断冠心病心肌缺血的敏感性在心绞痛组分别为85.9%、88.7%和58.4%,心肌梗塞组分别为77.2%、91.1%和53.4%,特异性分别为77%、90%和73%。检查中无症状心肌缺血发生率在心绞痛组分别为52.9%、56.3%和58.4%,心肌梗塞组分别为58.7%、75.3%和53.4%。表明这三种方法对诊断冠心病无症状心肌缺血有较高价值。

In patients with coronary heart disease identified by coronary angiography, the value of exercise ECG, exercise TI 201 scintigraphy and Holter monitoring for detecting myocardial ischemia, especialy, for silent myocardial ischemia was assessed. The results showed that the sensitivities for detecting myocardial ischemia in the three methods were 85.9%, 88.7% and 58.4% for patients with angina pectoris (AP), and 77.2%, 91.1% and 53.4% for patients with myocardial infarction (MI) patients, respectively. Their specificities were 77%, 90% and 73% respectively. In exercise ECG, there were 52.9% of AP patients and 58.7% of MI patients showed silent myocardial ischemia. Only 32.9% of AP patients and 18.5% of MI patients had angina attack; In exercise TI 201 scintigraphy, 56.3% of AP patients and 75.3% of MI patients showed silent myocardial ischemia, only 32.4% of AP patients and 15.8% of MI patients had angina attack. In Holter monitoring, silent myocardial ischemia was recorded in 58.4% of AP patients and in 53.4% of MI patients, some of these patients had both angina and silent myocardial ischemia. This study demonstrates that silent myocardial ischemia is very common in patients with angina pectoris and myocardial infarction. Not only the angina symptom should be controlled, but also silent myocardial ischemia should he detected and treated.