心脏活动平板运动试验参数对冠心病的诊断价值

目的 总结平板运动试验对冠心病的诊断价值.方法 2006年1月至2011年3月在我院住院接受心脏活动平板运动试验（TET）及冠状动脉造影（CAG）检查的患者445例,回顾性总结分析其平板运动试验中不同参数变化对冠心病的诊断价值.结果 ①进行平板运动试验的445例患者中,TET阳性200例,其中CAG阳性150例、CAG阴性50例;TET阴性245例,其中CAG阴性206例、CAG阳性39例.TET检出冠心病的敏感性为79.36%（150/189）,特异性为80.47%（206/256）,预测准确性为80.00%（356/445）.②CAG阳性组（189例）与CAG 阴性组（256例）比较,CAG阳性组的总运动时间、峰值心率、ST段下移出现时间明显小于CAG阴性组（P＜0.05）,其ST段下移幅度及持续时间显著大于CAG阴性组（P＜0.05）.③CAG阳性的189例中,单支病变87例、多支病变102例,多支病变组总运动时间、峰值心率、ST段下移出现时间明显小于单支病变组（P＜0.05）,ST段下移幅度及持续时间显著大于单支病变组（P＜0.05）.④在平板运动试验阳性组中,性别在冠心病的诊断价值中差异有统计学意义,男性对冠心病的诊断率明显高于女性（P＜0.05）;在平板运动试验阴性组中,性别在冠心病的诊断率方面差异无统计学意义（P＞0.05）.⑤平板运动试验Bruce方案级别与冠心病也有明显的相关性：1级的阳性预测值、阴性预测值和准确率均较其他级高,分别为85.71%、94.44%和88.33%.随着级别的递增,到4级时,其阴性预测值达100%,准确率也为100%.结论 平板运动试验是一项诊断冠心病较理想的非创伤性的检查方法,综合多项参数分析可初步估测其病变程度.

The diagnosis value of treadmill exercise test parameters for coronary artery disease

Objective To determine the diagnostic value of treadmill exercise test （TET） in patients with coronary heart disease （CHD） by comparing the diagnostic conclusion with coronary angiography （CAG）. Methods 445 patients with CHD and suspected CHD underwent treadmill exercise test and CAG, and the diag- nostic conclusions were compared. Results （1）The 200 cases had the positive result during treadmill exercise test and 150 cases hand been diagnosed CHD by coronary angiography. The 245 cases had the negative result during treadmill exercise test and 39 cases hand been diagnosed CHD by coronary angiography. The sensitivity, specifici- ty, positive predictive value, negative predictive value, the false positive incidence, the false negative incidence and agreement rate in diagnosis of CHD by treadmill exercise test were 79.36%, 80.40%, 75.00%, 84.08%, 25.00%, 15.92% and 80.00%, respectively. The patients with multi-vessel diseased had a higher positive rate of TET as compared with those with single diseased vessel （P〈0.05）. （2）The parameters for 189 cases positive CAG （diagnosed CHD by coronary angiography patients） and 256 cases negative CAG（the control group）, including the general of exercise time, peak heart rate and the beginning time of ST depression, were lower than the control group（P〈0.05 ）. But, there were higher than the control group between the extent of ST depression and duration of ST depression （P〈0.05）. （3）189 cases positive CAG, include 87 cases of single coronary artery and 102 cases of binary or more coronary arteries （the control group）. The parameters, including the general of exercise time, peak heart rate and the beginning time of ST depression, were lower than the control group （P〈0.05）. But, there were higher than the control group between the extent of ST depression and duration of ST depression （P〈0.05）. （4）In TET positive Group, there were significant differences about men in the diagnosis of coronary heart disease rates significantly higher than women（P〈0.05 ）. But, in TET negative group, there were no significtmt differences about gender in the diagnosis of coronary heart disease rates （P〉0.05）. （5）Bruce programme level of treadmill exercise test and coronary heart disease also have significant correlation. Conclusion The treadmill exercise test is valuable in noninvasive diagnosis of CHD, especially for patients with muhi-vessel diseased.