摘要
目的探讨平板运动试验在老年冠心病诊断中的应用价值。方法回顾性分析本院收治的具有胸闷、胸痛症状,拟诊为冠心病的80例患者的临床资料,所有患者均先后进行平板运动试验与冠状动脉造影检查,并以冠状动脉造影作为金标准,计算平板运动试验对老年冠心病的诊断效能。结果冠状动脉造影共检测出阳性病例38例,阴性病例42例,平板运动试验诊断的灵敏度为92. 10%、特异度为83. 33%、准确度为87. 50%、阳性预测值为83. 33%、阴性预测值为92. 11%、Kappa一致性为0. 751。平板运动试验不同指标中ST/HR滞后诊断敏感度为92. 11%,高于ST段压低(76. 32%)、微伏级T波电交替(MTWA,39. 47%)、ST/HR斜率(78. 95%)、ST/HR指数(76. 32%),差异有统计学意义(P <0. 05);ST/HR斜率诊断特异度为83. 33%,高于ST段压低(59. 52%)、MTWA(69. 05%)、ST/HR指数(64. 29%)、ST/HR滞后(21. 43%),差异有统计学意义(P <0. 05);ST/HR斜率判断老年冠心病的准确度为81. 25%,高于ST段压低(67. 50%),MTWA(55. 00%)、ST/HR指数(70. 00%)、ST/HR滞后(55. 00%),差异有统计学意义(P <0. 05);冠状动脉造影共检测出单支病变16例,多支病变22例,单支病变平板运动试验运动参数中的总运动时间、峰值心率、出现时间高于多支病变,下移幅度与持续时间低于多支病变(P <0. 05);各项参数联合预测病变程度ROC曲线下AUC=0. 889,高于单独总运动时间AUC=0. 722、峰值心率AUC=0. 730、下移幅度AUC=0. 685、出现时间AUC=0. 733、持续时间AUC=0. 622(P <0. 05)。结论平板运动试验检测老年冠心病的发生与冠状动脉造影具有较高的一致性,ST/HR斜率、ST/HR指数预测灵敏度、特异度高于传统的ST段压低标准,各项运动参数联合可用于冠脉病变程度的判断。
Objective To explore the application value of treadmill exercise test(TET) in diagnosis of coronary heart disease( CHD) in the elderly. Methods A retrospective analysis was performed on the clinical data of80 patients with chest tightness and chest pain diagnosed with CHD who were admitted to the hospital from August2017 to November 2018. All patients underwent ECG TET and coronary angiography in turn. Taking coronary angiography as golden standard,diagnostic efficiency of ECG TET for elderly CHD patients was calculated. Results Thirty-eight positive cases and forty-two negative cases were detected by coronary angiography. The diagnostic sensitivity,specificity,accuracy,positive predictive value,negative predictive value and Kappa consistency of ECG TET were 92. 10%,83. 33%,87. 50%,83. 33%,92. 11% and 0. 751,respectively. In all indexes of ECG TET,diagnostic sensitivity of ST/HR hysteresis was higher than that of ST segment depression,MTWA,ST/HR slope and ST/HR(92. 11% vs. 76. 32%,39. 47%,78. 95%,76. 32%,P < 0. 05). The diagnostic specificity of ST/HR slope was higher than that of ST segment depression,MTWA,ST/HR index and ST/HR hysteresis(83. 33%vs. 59. 52%,69. 05%,64. 29%,21. 43%,P < 0. 05). The accuracy of ST/HR slope for determining CHD in the elderly was higher than that of ST segment depression,MTWA,ST/HR index and ST/HR hysteresis(81. 25% vs.67. 50%,55. 00%,70. 00%,55. 00%,P < 0. 05). Sixteen cases of single-vessel lesion and twenty-two cases of multi-vessel lesion were detected by coronary angiography. The total exercise time,peak heart rate and appearance time of single-vessel lesion were higher than those of multi-vessel lesion,while amplitude of downward movement and duration were lower than those of multi-vessel lesion(P < 0. 05). Area under ROC curve(AUC) of all parameters for predicting lesion degree was higher than that of total exercise time,peak heart rate,amplitude of downward movement,appearance time and duration( 0. 889 vs. 0. 722,0. 730,0. 685,0. 733,0. 622,P < 0. 05).Conclusion The consistency between ECG TET and coronary angiography is high for detecting occurrence of coronary heart disease in the elderly. The prediction sensitivity and specificity of ST/HR slope and ST/HR index are higher than those of traditional ST segment depression standard. And a combination of various exercise parameters can be applied for the judgment of coronary lesions degree.
作者
陈晓改
Chen Xiao-gai(Department of Electrocardiogram,Xuchang Central Hospital,Xuchang Henan 461000,China)
出处
《实用心电学杂志》
2019年第5期318-322,328,共6页
Journal of Practical Electrocardiology
关键词
冠心病
心电图平板运动试验
冠状动脉造影
诊断价值
coronary heart disease
electrocardiogram treadmill exercise test
coronary angiography
diagnostic value
