心脏远程监护技术、超声心动图及动态心电图诊断无症状心肌缺血的准确性
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摘要
目的:探讨心脏远程监护技术、超声心动图(ECHO)和动态心电图(DCG)诊断冠心病无症状心肌缺血(SMI)的临床准确性。方法:选取医院收治的63例冠心病(CHD)患者,以冠状动脉造影(CGA)诊断结果为金标准,回顾性分析心脏远程监护技术、ECHO和DCG诊断SMI的灵敏度、准确度、特异度、阳性预测值、阴性预测值、Youden指数以及Kappa值。结果:以冠状动脉造影诊断结果为金标准,在63例CHD患者中共检出41例SMI,心脏远程监护技术、ECHO和DCG诊断SMI的符合率分别为92.68%、53.66%和90.24%;诊断SMI的灵敏度和特异度分别为92.68%和77.27%、53.66%和90.24%以及86.36%和22.73%;Youden指数分别为0.700、0.236和0.766;心脏远程监护技术、DCG诊断SMI的Youden指数明显高于ECHO,二者诊断SMI结果与CGA具有极好一致性。结论:心脏远程监护技术可作为DCG诊断的有效补充手段,对于SMI早期诊断具有十分重要的临床意义。
Objective: To investigate the clinical accuracy of cardiac remote monitoring, echocardiography(ECHO) and dynamic electrocardiography(DCG) in the diagnosis for silent myocardial ischemia(SMI) of coronary heart disease(CHD). Methods: 63 patients with CHD were enrolled in this retrospective analysis and coronary angiography(CGA) was used as gold standard to analyze and judge the sensitivity, accuracy, specificity, positive predictive value, negative predictive value, Youden index and Kappa value of cardiac remote monitoring technique, ECHO and DCG in the diagnosis for SMI. Results: As the results of gold standard(CGA), 41 cases of 63 patients with CHD were diagnosed as SMI, the diagnose accordance rates of cardiac remote monitoring technique, ECHO and DCG, respectively, were 92.68%, 53.66% and 90.24%. And the sensitivity and specificity of the three methods for SMI, respectively, were 92.68% and 77.27%, 53.66% and 90.24%, and 86.36% and 22.73%. The Youden Indexes of the three methods were 0.700, 0.236 and 0.766, respectively. As above results, the Youden Indexes of cardiac remote monitoring technique and DCG were obviously higher than that of ECHO, and their diagnosis for SMI has excellent accordance with CGA. Conclusion: The technique of cardiac remote monitoring can be used as an effective supplementary means of DCG, and it has great clinical significance in the early diagnosis for SMI.
Objective: To investigate the clinical accuracy of cardiac remote monitoring, echocardiography(ECHO) and dynamic electrocardiography(DCG) in the diagnosis for silent myocardial ischemia(SMI) of coronary heart disease(CHD). Methods: 63 patients with CHD were enrolled in this retrospective analysis and coronary angiography(CGA) was used as gold standard to analyze and judge the sensitivity, accuracy, specificity, positive predictive value, negative predictive value, Youden index and Kappa value of cardiac remote monitoring technique, ECHO and DCG in the diagnosis for SMI. Results: As the results of gold standard(CGA), 41 cases of 63 patients with CHD were diagnosed as SMI, the diagnose accordance rates of cardiac remote monitoring technique, ECHO and DCG, respectively, were 92.68%, 53.66% and 90.24%. And the sensitivity and specificity of the three methods for SMI, respectively, were 92.68% and 77.27%, 53.66% and 90.24%, and 86.36% and 22.73%. The Youden Indexes of the three methods were 0.700, 0.236 and 0.766, respectively. As above results, the Youden Indexes of cardiac remote monitoring technique and DCG were obviously higher than that of ECHO, and their diagnosis for SMI has excellent accordance with CGA. Conclusion: The technique of cardiac remote monitoring can be used as an effective supplementary means of DCG, and it has great clinical significance in the early diagnosis for SMI.
引文
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[10]黄晶,李淑美,段文元,等.动态心电图对冠心病无症状性心肌缺血的临床诊断价值[J].广西医学,2015,37(3):388-389.
[11]徐丽英,邢福泰,王红宇.心脏远程监护系统对心血管疾病的临床应用价值[J].中西医结合心脑血管病杂志,2010,8(8):1002-1003.
[12]张玉,高海青.心脏远程监护技术监测无症状性心肌缺血患者的临床体会[J].山东医药,2016,56(5):35-36.
[2]王波,王临池,赵翼洪,等.2009-2013年苏州20岁及以上居民冠心病发病率变化趋势及类型分析[J].中国全科医学,2015,18(24):2952-2956.
[3]Malhotra S,Sharma R,Kliner DE,et al.Relationship between silent myocardial ischemia and coronary artery disease risk factors[J].JNucl Cardiol,2013,20(5):731-738.
[4]徐济民.缺血性心脏病诊断的命名及标准-国际心脏病学会和协会世界卫生组织临床命名标准化专题组的联合报告[J].国外医学心血管疾病分册,1979,5(6):365-366.
[5]盛军,陈宏山,杨奕,等.64排螺旋CT冠状动脉造影对冠心病的诊断价值[J].安徽医药,2013,17(8):1312-1313.
[6]Tang X,Laskowitz DT,He L,et al.Neighborhood socioeconomic status and the prevalence of stroke and coronary heart disease in rural China:a population-based study[J].Int JStroke,2015,10(3):388-395.
[7]刘英.冠心病无症状心肌缺血的临床特点[J].医学理论与实践,2015,28(18):2456-2457.
[8]Mohareb MM,Qiu F,Cantor WJ,et al.Validation of the appropriate use criteria for coronary angiography:a cohort study[J].Ann Inter Med,2015,162(8):549-56.
[9]陈琳.负荷超声心动图结合超声新技术诊断心肌缺血的研究进展[J].临床超声医学杂志,2015,17(7):473-475.
[10]黄晶,李淑美,段文元,等.动态心电图对冠心病无症状性心肌缺血的临床诊断价值[J].广西医学,2015,37(3):388-389.
[11]徐丽英,邢福泰,王红宇.心脏远程监护系统对心血管疾病的临床应用价值[J].中西医结合心脑血管病杂志,2010,8(8):1002-1003.
[12]张玉,高海青.心脏远程监护技术监测无症状性心肌缺血患者的临床体会[J].山东医药,2016,56(5):35-36.