运动试验恢复期收缩压异常升高诊断冠心病的初步探讨

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，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，两指标联用的诊断准确性最高。结论 运动后收缩压异常升高可作为诊断冠心病的一个有效指标。     

平板运动试验对冠心病的诊断价值

目的：对照平板运动试验（TET）与冠状动脉造影（CAG）的结果,评价TET对冠心病的辅助诊断价值。方法：随机选取武汉大学人民医院心内科2007年6月至2008年12月收治的临床拟诊为冠心病,行CAG并于CAG前10d内已行TET检查的患者192例,以CAG为诊断冠心病的“金标准”,对比TET与CAG结果,分析TET的敏感性和特异性等指标,并对影响TET结果的各项临床资料进行统计学分析。结果：①CAG检查确诊冠心病107例,测得TET诊断冠心病敏感性为78．5％,特异度为69．4％,符合率为74．5％。假阳性30．6％,假阴性21．5％;②双支、三支冠脉病变的TET敏感性（83％,95．2％）均明显高于单支病变（64．1％,P〈0．05）。结论：TET诊断冠心病的敏感度和特异度较高,尤其对于存在多支血管病变的患者;可作为冠心病临床诊断、评估预后的首选无创检查项目。     

运动试验收缩压和舒张压反应异常对冠心病的诊断价值及其机制

104例患者接受冠脉造影和平板运动试验,评价运动后SBP恢复比和运动中DBP增量对冠心病的诊断价值。SBP恢复比与DBP增量异常的敏感度与特异度分别为59%、52%与96%、92%,而ST段压低标准则分别为71%与84%。高血压病组中三种指标的假阳性率分别为38%、42%与33%。SBP恢复比与EF呈负相关,与SVR呈正相关,提示运动引起的血压反应异常是左心功能受损和SVR增加所致。     

冠状动脉CT成像和平板运动试验对冠心病的诊断价值

目的探讨冠状动脉CT成像(CTCA)和平板运动试验(TET)对冠心病的诊断价值。方法选择怀疑冠心病并于2周内分别行CTCA、TET及冠状动脉造影检查的患者共254例,以冠状动脉造影结果为对照指标,分析CTCA、TET及两者联合时对冠心病的诊断价值。结果 TET、CTCA及CTCA联合TET的敏感性、特异性、阳性预测值、阴性预测值和准确率分别为:60.8%、64.7%、82.5%、37.6%和61.8%;84.9%、80.9%、92.4%、66.3%和83.9%;88.3%、86.0%、94.2%、74.0%和87.7%。CTCA对左主干病变的检出率明显高于冠状动脉造影(P<0.01)。结论 CTCA和CTCA联合TET在诊断冠心病时的准确率比单独TET高,CTCA对左主干病变的检出更有一定优势。因此,临床上可将CTCA作为可疑冠心病患者的筛查方法之一。     

运动试验后收缩压异常升高对冠心病诊断价值的初步探讨

目的　评价运动试验恢复期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　观察了 80例先后行平板运动试验和冠状动脉造影的患者 ,根据高血压病的有无和冠状动脉造影结果分组 ,以运动试验后 6min内 ,收缩压后期比前期升高≥ 10mmHg(1mmHg =0 133kPa)为收缩压异常升高为阳性判定标准。结果　收缩压异常升高诊断冠心病的敏感性、特异性、准确性、阳性预测值和阳性似然比 ,高于ST段压低标准 ;其敏感性与冠状动脉病变程度成正比 ;对合并高血压的患者 ,两指标 (收缩压异常升高和ST段压低 )联用可显著提高诊断的特异性和阳性预测值。结论　运动试验恢复期收缩压异常升高可作为诊断冠心病的一个有效参考指标     

运动平板试验对冠心病诊断价值的探讨

心电图运动试验为临床诊断心肌缺血的常用方法,运动平板试验（TET）又是运动试验中最常用的一种,具有方便、实用、可靠、易普及等特点,适用于对冠心病者的初步筛选。冠状动脉造影术（CAG）是目前诊断冠心病最可靠的方法,因是一种有创性检查,对医务人员的技术要求较高,基层医院尚不能普及开展。本文旨在通过TET与CAG结果比较探讨TET对冠心病的诊断意义。     

平板运动试验结合动态心电图对冠心病的诊断价值

目的：以冠状动脉造影（CAG）结果作为标准,探讨平板运动试验（TET）结合24h动态心电图（DCG）对冠心病（CHD）的诊断价值。方法：对236例患者行CAG,且同时行TET及DCG检查,分析TET及DCG两种检查方法各自对CHD的诊断价值,以及两者联合时对CHD的诊断价值。结果：TET诊断cHD的敏感性79．11％,特异性69．23％;DCG诊断CHD的敏感性67．72％,特异性80．77％;两者联合行并联试验时敏感性96．83％,特异性53．84％,阳性预测值80．95％,阴性预测值89．36％,敏感性、阴性预测值较单独TET、DCG试验有显著提高（P〈0.05）;两者联合行串联试验时敏感性50．00％,特异性96．15％,阳性预测值96．34％,阴性预测值48．70％,特异性、阳性预测值较单独TET、DCG试验有显著提高（P〈0．05）。结论：单独行TET或DCG对冠心病诊断的敏感性和特异性相对较低,两者联合诊断可明显提高上述两项指标。     

老年冠心病患者对运动负荷的反应

目的研究老年冠心病患者对运动负荷的反应及在心脏活动平板运动试验(TET)中参数的变化特征。方法选择经TET并行冠状动脉造影的患者110例。按年龄分为2组:年龄>75岁为老年组(50例),年龄<60岁为对照组(60例)。结果 (1)在TET阳性患者中,增龄在冠心病的诊断价值中差异有统计学意义,老年组冠心病的诊断率83.7%明显高于对照组60.0%(P<0.05);在TET阴性患者中,两组对冠心病的诊断率方面差异无统计学意义(P>0.05)。(2)老年组的总运动时间、峰值心率、ST段下移出现时间均明显小于对照组(P<0.05),而ST段下移幅度及持续时间,两组差异无统计学意义(P>0.05)。结论老年人在TET中对冠心病的诊断率升高;老年冠心病患者对运动负荷的耐受力下降。     

胸痛患者心电图平板运动试验阳性结果分析

目的　正确分析心电图运动试验 (TET)阳性结果 ,提高诊断水平。方法　对 2 5 8例胸痛患者进行TET和冠状动脉造影 (CAG)检查 ,收集病史及各项检查资料。 (1)对比分析TET真阳性组和假阳性组的临床资料特点 ;(2 )对比分析女性患者TET真阳性组和假阳性组的临床资料特点。结果　(1)TET假阳性组女性患者例数较多 ;具有典型胸痛症状、高脂血症、吸烟史、冠心病家族史的例数较少 ;运动中ST段的下降多发生于Ⅱ、Ⅲ、aVF导联 ,ST段下降 >0 2mV以及运动中出现心绞痛的例数较少 ;(2 )女性患者TET假阳性组 <6 0岁、静息心电图ST段改变及左室肥厚的例数多于真阳性组 ,差别有统计学意义。结论　应结合性别、典型缺血性胸痛症状、冠心病的某些危险因素、左室肥厚、运动前后心电图变化的部位和程度、运动中胸痛出现等临床因素正确分析TET的阳性结果     

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

Objectives This study sought to evaluate 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 10mmHg higher than earlier periods during the recover), 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.     

运动试验收缩压恢复比对冠心病的诊断价值研究

目的探讨运动试验中收缩压恢复比对冠心病的诊断价值。方法对苏州大学附属第一医院2003—2005年收治的88例冠状动脉造影的患者行平板运动试验,分析运动停止后3min收缩压恢复比与冠状动脉造影的相关性。结果3min收缩压恢复比对冠心病诊断的敏感性、特异性、准确性、阳性预测值分别为:55·6%、82·0%、73·9%、57·7%,与心电图ST段改变的标准相比,差异有显著性意义(P<0·05)。结论运动试验收缩压恢复比对冠心病的诊断,在特异性、准确性、阳性预测值等方面要明显优于心电图ST段压低标准。     

Exercise induced increase in diastolic blood pressure. Is it an indicator of coronary artery disease?

It has been previously reported that an increase in diastolic blood pressure greater than 15 mmHg comparing values at rest with those on treadmill exercise, with or without ST changes, enhances the probability of coronary artery disease. To investigate whether the diastolic blood pressure variation keeps its diagnostic value during upright bicycle exercise, we evaluated the diastolic blood pressure variations in 111 patients with angiographically documented coronary artery disease without previous myocardial infarction and in 53 patients with normal coronary arteries undergoing maximal stress testing on a bicycle ergometer. The sensitivity of diastolic blood pressure (DBP) variations to detect coronary artery disease was 66%, the specificity 32%, the positive predictive value 67%, the negative predictive value 31% and the predictive accuracy 55%. The respective values for ST depression were 83% (P less than 0.001 vs DBP variations), 53% (P less than 0.05 vs DBP variations), 64% (P less than 0.05 vs DBP variations) and 75% (P less than 0.001 vs DBP variations). Forty-nine of the 75 patients with multivessel coronary artery disease and 60 of the 89 patients without coronary artery disease or with single vessel disease had abnormal DBP variations (sensitivity 65; specificity 33%). The sensitivity of ST segment depression in predicting multivessel disease was 91% (P less than 0.001 vs DBP variations), and the specificity 42%. Thus, for bicycle ergometer exercise testing, ST segment depression seems to be more accurate than DBP variations in the diagnosis of coronary artery disease.     

Longitudinal quantitative assessment of coronary atherosclerosis related to normal systolic blood pressure maintenance in the absence of established cardiovascular disease

BackgroundAtherosclerosis‐related adverse events are commonly observed even in conditions with low cardiovascular (CV) risk. Longitudinal data regarding the association of normal systolic blood pressure maintenance (SBP_maintain) with coronary plaque volume changes (PVC) has been limited in adults without traditional CV disease.HypothesisNormal SBP_maintain is important to attenuate coronary atherosclerosis progression in adults without baseline CV disease.MethodsWe analyzed 95 adults (56.7 ± 8.5 years; 40.0% men) without baseline CV disease who underwent serial coronary computed tomographic angiography with mean 3.5 years of follow‐up. All participants were divided into two groups of normal SBP_maintain (follow‐up SBP < 120 mm Hg) and ≥elevated SBP_maintain (follow‐up SBP ≥ 120 mm Hg). Annualized PVC was defined as PVC divided by the interscan period.ResultsCompared to participants with normal SBP_maintain, those with ≥elevated SBP_maintain had higher annualized total PVC (mm³/year) (0.0 [0.0–2.2] vs. 4.1 [0.0–13.0]; p < .001). Baseline total plaque volume (β = .10) and the levels of SBP_maintain (β = .23) and follow‐up high‐density lipoprotein cholesterol (β = −0.28) were associated with annualized total PVC (all p < .05). The optimal cutoff of SBP_maintain for predicting plaque progression was 118.5 mm Hg (sensitivity: 78.2%, specificity: 62.5%; area under curve: 0.700; 95% confidence interval [CI]: 0.59–0.81; p < .05). SBP_maintain ≥ 118.5 mm Hg (odds ratio [OR]: 4.03; 95% CI: 1.51–10.75) and baseline total plaque volume (OR: 1.03; 95% CI: 1.01–1.06) independently influenced coronary plaque progression (all p < .05).ConclusionNormal SBP_maintain is substantial to attenuate coronary atherosclerosis progression in conditions without established CV disease.     

冠状动脉造影检查在冠心病诊断中作用的再探讨

目的探讨冠状动脉造影（CAG）检查在诊断冠心病中作用,就其对多年来被认为是金标准作用进行再探讨。方法对138例怀疑有冠心病的患者,均经普通ECG,动态ECG,活动平板和CAG。结果只有71例患者的冠状动脉造影检查符合目前冠心病标准,其余67例患者冠状动脉未达标（轻度-中度狭窄,或完全正常或仅见散在斑块形成）。结论冠心病的诊断是一个较为复杂的问题,CAG检查是诊断冠心病的一个重要依据,有相当比例的冠心病患者（CAG）无明显异常。     

Value and mechanism of abnormal postexercise systolic blood pressure response for detection of coronary artery disease]

The value of an abnormal ratio of recovery systolic blood pressure to peak exercise SBP for detecting coronary artery diseases (CAD) is controversial. We evaluated the ratio in 39 patients with angiographically documented CAD and 52 patients with normal coronary artery undergoing treadmill exercise. If a response with the ratio higher than 1.0 and 0.8 at 1 and 3 min. of recovery was considered as abnormal, the sensitivity for detecting CAD was 66.7%, the specificity 73.1% and the accuracy 70.3%. If ST segment depression is combined into the criteria, the specificity and accuracy reach 94.2% and 76.9%. In CAD, the ratio at 3 min. of recovery showed significant negative correlation with resting left ventricular ejection fraction (LVEF) (r = -0.461, P < 0.01). It is suggested that low resting LVEF may be one of the mechanism of this abnormal ratio in CAD.     

脉压与冠状动脉狭窄严重程度的相关性研究

目的探讨脉压与冠状动脉病变狭窄严重程度的相关性。方法对拟诊冠心病或确诊冠心病的住院患者405例,行冠状动脉造影术。根据病变累及左前降支、左回旋支和右冠状动脉支数分为4组:冠状动脉正常组(102例)、单支病变组(77例)、双支病变组(102例)和3支病变病(124例)。冠状动脉病变狭窄的严重程度用病变的血管支数及Gensini积分表示。所有患者在术中测量主动脉血压及外周桡动脉血压。结果3支病变组主动脉、外周桡动脉收缩压和脉压均显著高于冠状动脉正常组(P<0.05),双支病变组主动脉收缩压、外周桡动脉收缩压和脉压显著高于冠状动脉正常组,单支病变组与冠状动脉正常组差异无统计学意义。收缩压与脉压随着狭窄支数的增加而增加。多因素分析结果显示,主动脉脉压、桡动脉脉压、年龄与冠状动脉狭窄程度的关系最为密切。结论脉压是冠心病冠状动脉狭窄发生发展的独立危险因素,且主动脉脉压的预测价值更大。     

ATP负荷及运动负荷试验中心电图的变化对冠心病的诊断价值

目的探讨ATP负荷及运动负荷心肌灌注单光子发射计算机体层摄影术(SPECT)中的ECG变化及其对冠心病的诊断价值。方法选择61例疑诊冠心病的患者,并在不同时间分别行ATP负荷及运动负荷SPECT检查,其中46例行冠状动脉造影。收集ATP及运动负荷试验中的ECG资料并进行分析。结果ATP与运动负荷试验中ECG心律失常的发生情况相似(χ2=1.985,P=0.159);ATP负荷试验ST段下降发生率明显低于运动负荷试验(12.5%vs51.8%,χ2=19.813,P<0.001),且下降幅度低。ATP负荷试验ECG诊断冠心病的敏感性明显低于运动负荷试验(28.6%vs71.4%,χ2=7.714,P=0.005),特异性、阳性预测值及阴性预测值与运动负荷试验相似(95.2%vs71.4%,85.7%vs71.4%,57.1%vs71.4%,P>0.05)。结论与运动负荷试验比较,ATP负荷试验ECG诊断冠心病的敏感性低,但特异性及阳性预测值相对较高。