运动平板试验诊断无症状糖尿病冠心病的临床意义

目的探讨运动平板试验对于无症状糖尿病患者冠心病诊断的价值。方法挑选门诊患者180例,男106例(58.9%),女74例(41.1%),分为3组。60例为2型糖尿病患者,糖尿病(DM)病史均在5年以上,无或有不典型缺血性胸痛症状;60例患者无或有不典型缺血性胸痛,不合并有DM,高危因素无或少于一个;60例典型缺血性胸痛患者,高危因素不限。3组进行运动平板检查,不论结果阴性或阳性,均同意在2周内行CAG检查,运动平板结果和冠状动脉造影结果进行对照分析。结果 60例无或有不典型缺血性胸痛症状DM患者与60例典型缺血性胸痛患者准确性检验指标一致,无统计学意义。结论运动平板是一种简便、经济、相对安全的无创检查方法,可作为对计划开始积极运动的、无症状的糖尿病患者排除筛选冠心病的有效方法。     

平板运动试验对青年男性冠心病患者的诊断价值

目的 探讨平板运动试验对不同性别青年冠心病患者诊断的价值.方法 选择本院2002年6月～2006年10月住院的有典型胸痛症状的男性及女性患者各100例,分别进行平板运动试验与冠脉造影对照分析.结果 平板运动试验对青年女性冠心病诊断的特异性为49.1%,准确性为69.O%;对青年男性冠心病诊断的特异性为82.8%,准确为性92.0%.结论 平板运动试验对青年男性冠心病有较高的诊断价值,对于早期发现冠心病有重要的临床意义.     

平板运动试验对绝经前后女性冠心病的诊断价值

目的 探讨平板运动试验对绝经前后不典型胸痛女性冠心病的诊断价值.方法 选择115例不典型胸痛女性患者,按是否自然停经分绝经前组和绝经后组,以冠状动脉造影结果作为诊断冠心病的金标准,分析平板运动试验对绝经前后女性冠心病的诊断价值.结果 平板运动试验诊断绝经前组冠心病的敏感性、特异性、假阳性率、假阴性率、阳性预测值、阴性预测值和准确性分别为59.1％、38.9％、61.1％、40.9％、54.2％、43.8％、50.0％,绝经期后组分别为75.5％、76.9％、23.1％、24.5％、86.0％、62.5％、76.0％,两组敏感性、假阴性率、阴性预测值比较无统计学差异（P均＞0.05）;两组特异性、假阳性率、阳性预测值、准确性比较有无统计学差异（P均＜0.05）.结论 平板运动试验诊断女性冠心病敏感性较高、假阴性率较低,可用于排除女性冠心病.     

平板运动试验对青年冠心病的诊断价值

冠状动脉造影为诊断冠状动脉病变的“金标准”，但其检查费用高及有创性使其临床应用受到一定限制。运动平板试验为无创性辅助诊断冠心病的检查方法之一，但有关其诊断价值看法不一。2002年6月-2006年10月，我们对200例有典型胸痛症状的青年患者行平板运动试验和冠脉造影检查，旨在探讨平板运动试验对青年冠心病的诊断价值。     

电子束CT在疑诊冠心病胸痛鉴别诊断中的意义

目的　探讨电子束CT(EBCT)在疑诊冠心病胸痛鉴别诊断中的作用。方法　对 86例以胸痛为主要症状、临床疑诊为冠心病心绞痛者做EBCT检查冠状动脉钙化、冠状动脉造影、平板运动试验和 2 4小时动态心电图检查。结果　冠状动脉造影狭窄组冠脉钙化总积分明显高于无狭窄组 (P <0 0 5 ) ;X综合征患者冠状动脉亦存在不同程度钙化 ,但低于冠状动脉狭窄者 ;冠状动脉无钙化者心绞痛症状不典型 ,平板运动试验阴性 ,冠脉造影正常。结论　结果提示EBCT在冠心病心绞痛的诊断中有较大的意义 ,即无钙化者有可能排除冠心病心绞痛的诊断。     

运动平板试验对青年冠状动脉粥样硬化性心脏病的诊断价值

目的评估运动平板试验对青年冠状动脉粥样硬化性心脏病（冠心病）患者的诊断意义。方法选择有典型胸痛症状的青年男、女患者各200例行运动平板试验,择期进行冠状动脉造影,对其结果进行对照分析。结果男性患者冠状动脉造影结果阳性142例中运动平板试验阳性136例,阴性6例;男性患者冠状动脉造影结果阴性58例中运动平板试验阳性10例,阴性48例。女性患者冠状动脉造影结果阳性90例中运动平板试验阳性84例,阴性6例;女性患者冠状动脉造影结果阴性110例中运动平板试验阳性56例,阴性54例。运动平板试验诊断男性青年冠心病的特异性和准确性高于女性,差异有统计学意义（82．8％vs．46．5％,P〈0．01：93．0％弧60．0％,P〈0．01）。结论运动平板试验对男性青年冠心病的诊断符合率高于女性。     

活动平板运动试验的临床应用

心脏负荷试验是指通过增加心肌的氧耗量来揭示冠脉供血不足或潜在的心功能不全临床诊断试验[1] 。本文通过对3 3 0位就诊患者做活动平板运动试验 ,对照分析阳性、可疑阳性的两组参数指标 ,旨在观察活动平板运动试验的临床应用价值。1　资料与方法选择我院就诊患者中有胸闷、心悸、不典型胸痛或具有冠心病易患因子等3 3 0例 ,男 196例、女 13 4例 ,年龄在 3 1～70岁 ,其中 87例为原发高血压 ,113例为高脂血症 ,15例为合并糖尿病或糖尿病合并高血压 ,15 6例有自觉胸闷气短 ,或阵发性胸痛 (常规心电图不能明确诊断 )。 42例运动前ＳＴ有轻度改…     

心电图平板运动试验诊断冠心病2例体会

近年来 ,我院应用心电图平板运动试验诊断 3例典型冠心病患者。现举 2例报告如下。例 1:男 ,5 4岁。因反复劳累后胸痛及背部发胀 2 0余天入院 ,体检无异常 ,临床诊断冠心病心绞痛。运动前心电图(ECG)为窦性心律 ,87次 / min。采用活动平板负荷试验系统(惠普 HP- 71)进行次极量症状限制性心电图运动试验 ,心率(HR)为 132次 / m in。运动至 7分钟 4 0秒时 ,HR从 12 5次 /min突然降至 10 8次 / min,当时患者无不适 ,1分钟后 HR降至 90次 / m in,停止运动 ,HR仍继续减慢。于恢复期 1分钟HR73次 / min,BP80 / 6 0 mm Hg,患者述头晕、胸痛…     

运动负荷超声心动图试验诊断冠心病评价

冠状动脉造影 (CAG)是诊断冠心病的金标准 ,但由于其设备投入较大 ,技术含量高 ,价格昂贵 ,且为有创 ,难于在临床推广 ,更无法在基层医院开展。运动心电图试验 (EET )阳性率不高 ,约 6 0 %～70 % [1] ,而运动试验与超声心动图检查相结合 ,通过观察运动后的室壁活动情况 ,能够提高诊断冠心病的准确性。1　资料与方法1.1.　资料　 2 0 0 1年 10月— 2 0 0 3年 8月我院住院患者中选取疑似冠心病患者 5 2例 ,均具备以下情况 :①静息心电图有非特异性ST -T改变 ;②不典型胸痛、胸闷 ;③部分患者伴有阵发性心房颤动 (房颤 )、室性期前收缩等。…     

47例胸痛伴心肌缺血患者冠状动脉造影结果分析

对47例胸痛伴心电图心肌缺血患者作冠状动脉造影,结果发现30例冠状动脉有狭窄或阻塞,与门诊急诊冠心病诊断的阳性符合率为64%,其中19例心肌梗塞组阳性率89%,17例心绞痛组为76%,而11例可疑心绞痛组仅为9%;31例平板运动试验与冠脉造影阳性符合率为60%.提示临床对胸痛伴心肌缺血者宜作冠状动脉造影以明确诊断,尤其对不典型胸痛和单纯以ST-改变者的冠状动脉造影更重要.     

Exercise-induced left bundle branch block and its relation to coronary artery disease

The records of 2,584 consecutive patients who underwent both treadmill exercise testing and coronary cineangiography were reviewed to determine the relation between exercise-induced, acceleration-dependent left bundle branch block (LBBB) and the presence of coronary artery disease (CAD). Rate-dependent LBBB during exercise was identified in 28 patients (1.1%), who were categorized according to their presenting symptoms: classic angina pectoris, atypical chest pain, symptomatic cardiac arrhythmia and asymptomatic. Asymptomatic patients underwent a screening exercise test. CAD was present in 7 of 10 patients who presented with classic angina pectoris, but 12 of 13 patients presenting with atypical chest pain had normal coronary arteries. All 10 patients in whom LBBB developed at a heart rate of 125 beats/min or higher were free of CAD, whereas 9 of 18 patients in whom LBBB developed at a heart rate of less than 125 beats/min had CAD. Normal coronary arteries were present in 3 patients who presented with angina and in whom both chest pain and LBBB developed during exercise. It is concluded that patients who present with atypical chest pain in whom rate-dependent LBBB develops on the treadmill are significantly less likely to have CAD than patients who present with classic angina; the onset of LBBB at a heart rate of 125 beats/min or higher is highly correlated with the presence of normal coronary arteries, regardless of patient presentation; and patients with angina in whom both chest pain and LBBB develop during exercise may have normal coronary arteries.     

Significance of the negative exercise test in evaluation of patients with chest pain

Fifty-three patients with chest pain and a negative exercise test at greater than 85% predicted maximal heart rate underwent coronary arteriography. Twenty-one patients (40%) had significant luminal narrowing in one or two vessels. No patient had left main disease. Pathologic electrocardiographic Q waves were present in only coronary heart disease patients (p < 0.001). There was no difference (p > 0.05) in prevalence of T wave abnormalities, chest pain or ventricular beats during exercise in patients with or without coronary disease. Analysis of sex distribution revealed that typical angina pectoris was uncommon in the women (p < 0.001) and all twenty-one coronary patients were men (p < 0.001). We conclude that in patients with chest pain and a negative exercise test, three vessel or left main coronary artery disease is unlikely. Also, women with atypical chest pain and a negative exercise test are unlikely to have a fixed coronary obstruction.     

Chest pain: relationship of psychiatric illness to coronary arteriographic results

Seventy-four patients with chest pain and no prior history of organic heart disease were interviewed with a structured psychiatric interview immediately after coronary arteriography. The majority of patients with both negative and positive coronary angiographies had undergone previous exercise tolerance tests, but the patients with angiographic coronary artery disease were significantly more likely to have had positive results on a treadmill test. Patients with chest pain and negative coronary arteriograms were significantly younger; more likely to be female; more apt to have a higher number of autonomic symptoms (tachycardia, dyspnea, dizziness, and paresthesias) associated with chest pain, and more likely to describe atypical chest pain. Patients with chest pain and normal coronary arteriographic results also had significantly higher psychologic scores on indices of anxiety and depression and were significantly more likely to meet criteria of the Diagnostic and Statistical Manual of Mental Disorders, third edition, for panic disorder (43 percent versus 6.5 percent), major depression (36 percent versus 4 percent), and two or more phobias (36 percent versus 15 percent) than were patients with chest pain and a coronary arteriography study demonstrating coronary artery stenosis.     

Exercise echocardiographic detection of coronary artery disease in women

The utility of exercise echocardiography for the diagnosis of coronary artery disease has been demonstrated in populations consisting largely of men with a high prevalence of disease. To determine the diagnostic value of exercise echocardiography in women, 57 women who presented with chest pain were studied with coronary cineangiography and echocardiography combined with either treadmill (n = 38) or bicycle exercise (n = 19). Significant coronary artery disease (greater than or equal to 50% reduction in luminal diameter) was present in 28 (49%) of 57 patients, including 16 (84%) of 19 who had typical angina, and 12 (32%) of 38 who had atypical chest pain. The overall sensitivity and specificity of echocardiography were both 86%. Exercise echocardiography correctly determined the presence or absence of coronary artery disease in 32 (84%) of 38 patients who had atypical chest pain and in 17 (89%) of 19 who had typical angina (p = NS). The exercise electrocardiogram (ECG) was nondiagnostic in 17 patients (30%) who had rest ST segment depression or ST depression with exercise that could also be induced by hyperventilation or changes in position. The correct diagnosis was made by echocardiography in 14 (82%) of 17 patients with a nondiagnostic exercise ECG. In conclusion, exercise echocardiography has a clinically useful level of sensitivity and specificity for the detection of coronary artery disease in women. The technique provides diagnostic information in women presenting with atypical chest pain and in those who have a nondiagnostic exercise ECG.     

Enhanced risk assessment for primary coronary heart disease events by maximal exercise testing: 10 years'' experience of Seattle Heart Watch

A 10 year prospective community practice study in Seattle of risk of primary morbidity (defined by hospital admission) and mortality due to coronary heart disease in 3,611 men and 547 women initially free of clinical manifestations of this disease revealed a crude incidence of 202 coronary heart disease events, or 4.9% in 6.1 +/- 2.6 years of follow-up. The case fatality rate was 16.8%. Stratification by clinical classification of asymptomatic healthy persons versus patients with atypical chest pain syndrome (not angina pectoris) and hypertension (as classified by physicians) showed an incidence rate of primary events due to coronary heart disease of 2.9, 5.5 (not significant) and 10.0% (p less than 0.001), respectively. Identification of conventional risk factors is known to be important for risk assessment. However, the presence of any conventional risk factor, in conjunction with two or more selected maximal exercise predictors (which vary with the clinical classification) at enrollment, substantially increased the cumulative 6 year incidence rate to 24.3, 15.5 and 33.3% in asymptomatic healthy men, patients with atypical chest pain syndrome and hypertensive patients, respectively. Observation of the exercise predictors in the absence of conventional risk factors increased the risk much less, suggesting that the use of maximal exercise testing for risk assessment in those with no clinical manifestations of disease might be limited to persons with one or more conventional risk factors.     

Usefulness of thallium-201 scintigraphy in predicting the development of angina pectoris in hypertensive patients with left ventricular hypertrophy

Hypertension and left ventricular (LV) hypertrophy are independent risk factors for the development of coronary artery disease. To determine whether patients at higher risk for coronary artery disease can be identified, 40 asymptomatic hypertensive men with LV hypertrophy were prospectively studied using exercise thallium-201 scintigraphy and exercise radionuclide angiography. Endpoints indicative of coronary artery disease were defined as the subsequent development of typical angina pectoris, which occurred in 8 patients during a median follow-up of 38 months, or myocardial infarction, which did not occur. The exercise electrocardiogram was interpreted by standard ST-segment criteria and by a computerized treadmill exercise score. Abnormal ST-segment responses were present in 16 of the 40 hypertensives (40%), whereas the treadmill score was positive in 8 of those same 40 patients (20%). Scintigraphic perfusion defects assessed both visually and semiquantitatively were observed in 8 of 40 (20%) patients. An abnormal ejection fraction response to exercise was present in 40% (16 of 40) of patients, and 3 of 40 (7.5%) developed new wall motion abnormalities during exercise. Six of 8 patients with either perfusion defects or abnormal treadmill score developed typical angina during follow-up. All 5 patients with concordant positive exercise scintigrams and treadmill score developed chest pain during follow-up and had coronary artery disease confirmed by coronary angiography. However, only 7 of 16 (44%) patients with positive ST changes or abnormal ejection fraction responses during exercise developed chest pain during follow-up. In contrast, of 32 patients with negative scintigrams only 2 developed atypical chest pain syndromes, and significant coronary artery disease was excluded by angiography in 1 patient.(ABSTRACT TRUNCATED AT 250 WORDS)     

活动平板运动试验诱发ST段抬高的临床意义

为探讨活动平板运动试验诱发ST段抬高的临床意义 ,分析了 9例无心肌梗死 (简称心梗 )而运动诱发ST段抬高的静息心电图、运动试验及冠状动脉 (简称冠脉 )造影检查结果。结果 :5 0 5 5例行平板运动试验者中 ,有 11例未患心肌梗死而运动诱发心绞痛伴ST段抬高 ,发生率 0 .2 2 %。其中 ,8例患者作了进一步检查 ,冠脉造影显示均有程度不等的血管病变 ,缺血相关血管的狭窄达到 5 0 %～ 10 0 %。ST段抬高导联与缺血相关血管有良好对应关系。另有 1例患者于运动试验 1周后死于心脏性猝死。结论 :无心梗患者运动诱发心电图ST段抬高是冠脉痉挛或冠脉严重狭窄所致心肌局部缺血的标志。     

Exercise Stress Testing in Patients with Chest Pain and Normal Coronary Arteriography: With Review of the Literature

Eighty of 654 patients studied because of chest pain were found to have normal coronary arteriography. Fifty of these completed submaximal treadmill exercise studies. The purpose of this study was to determine whether treadmill electrocardiography could obviate the need for coronary arteriography in the evalution of patients with undiagnosed chest pain. Of patients studied, 22% had typical angina pectoris, while 78% had atypical chest pain. The resting electrocardiogram was normal in 58% of patients, while 42% showed repolarization abnormalities. Submaximal treadmill testing was normal in 64%, incomplete in 12%, and demonstrated classic ischemic S-T depression in 24%. Our findings of 24% positive studies in patients with normal vessels and 12% incomplete tests suggest that stress electrocardiography may be of limited value in predicting the morphologic state of the coronary arteries in patients with undiagnosed chest pain.     

Exercise stress testing in patients with chest pain and normal coronary arteriography: with review of the literature.

Eighty of 654 patients studied because of chest pain were found to have normal coronary arteriography. Fifty of these completed submaximal treadmill exercise studies. The purpose of this study was to determine whether treadmill electrocardiography could obviate the need for coronary arteriography in the evaluation of patients with undiagnosed chest pain. Of patients studied, 22% had typical angina pectoris, while 78% had atypical chest pain. The resting electrocardiogram was normal in 58% of patients, while 42% showed repolarization abnormalities. Submaximal treadmill testing was normal in 64%, incomplete in 12%, and demonstrated classic ischemic S-T depression in 24%. Our findings of 24% positive studies in patients with normal vessels and 12% incomplete tests suggest that stress electrocardiography may be of limited value in predicting the morphologic state of the coronary arteries in patients with undiagnosed chest pain.