运动负荷超声心动图联合运动心电图对严重冠状动脉病变的诊断价值
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摘要
目的评价运动负荷超声心动图(ESE)联合运动心电图(ExECG)对严重冠状动脉病变的诊断价值及安全性。方法对疑有冠心病且症状稳定的199例患者行平板ExECG和ESE检查。在试验1个月内行冠状动脉造影(CAG),至少一支心外膜下主要冠脉或主要分支内径减少≥70%或左主干内径减少≥50%判断为严重冠脉病变。结果 199例患者中严重冠脉病变52例。ESE诊断的灵敏度、特异度为81%、93%,ExECG为85%、69%。试验中只有2例患者出现严重心律失常。结论 ESE有较高的灵敏度及特异度,ExECG有较高的灵敏度,ESE联合ExECG是无创筛查症状稳定的冠状动脉严重病变的安全而有效的手段。
Objective Evaluation of the diagnostic value and safety of exercise stress echocardiography(ESE)combined with exercise electrocardiography(ExECG)in patients got significant coronary lesion.Methods ExECG and ESE were performed in 199 patients with suspected coronary heart disease and stable symptoms.All patients underwent coronary angiography(CAG)within a month after exercise testing,and significant coronary lesion was defined as a luminal diameter narrowing≥70%in either a main epicardial artery or a major branch,or a left mayor luminal diameter narrowing≥50%in the left main artery.Results CAG confirmed severe coronary artery disease 52 cases in 199 patients.ESE showed diagnostic sensitivity 81%,specificity 93%.ExECG showed diagnostic sensitivity 85%,specificity 69%.During the exercise test,only 2 patients showed significant arrhythmia.Conclusions ESE has high specificity and sensitivity,ExECG has high sensitivity.ESE combined with ExECG is an effective and safe method to screen patients with significant coronary lesion and stable symptoms noninvasively.
Objective Evaluation of the diagnostic value and safety of exercise stress echocardiography(ESE)combined with exercise electrocardiography(ExECG)in patients got significant coronary lesion.Methods ExECG and ESE were performed in 199 patients with suspected coronary heart disease and stable symptoms.All patients underwent coronary angiography(CAG)within a month after exercise testing,and significant coronary lesion was defined as a luminal diameter narrowing≥70%in either a main epicardial artery or a major branch,or a left mayor luminal diameter narrowing≥50%in the left main artery.Results CAG confirmed severe coronary artery disease 52 cases in 199 patients.ESE showed diagnostic sensitivity 81%,specificity 93%.ExECG showed diagnostic sensitivity 85%,specificity 69%.During the exercise test,only 2 patients showed significant arrhythmia.Conclusions ESE has high specificity and sensitivity,ExECG has high sensitivity.ESE combined with ExECG is an effective and safe method to screen patients with significant coronary lesion and stable symptoms noninvasively.
引文
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[10]张佳佳,张平洋,马小五,等.三维斑点追踪结合腺苷负荷超声评价心肌存活性的临床研究[J].中国超声医学杂志,2014,30(7):613-616.
[2]GIBBONS R J,BALADY G J,BRICKER J T,et al.ACC/AHA 2002 Guideline Update for Exercise Testing:Summary Article[J].Journal of the American College of Cardiology,2002,40(8):1531-1540.
[3]American Society of Echocardiography Recommendations for Performance,Interpretation,and Application of Stress Echocardiography[J].Journal of the American Society of Echocardiography,2007,20(9):1021-1041.
[4]LANG R M,BADANO L P,MOR-AVI V,et al.Recommendations for cardiac chamber quantification by echocardiography in adults:an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging[J].Journal of the American Society of Echocardiography,2015,28(1):1-39.
[5]KOSINSKI A S.Outcomes of anatomical versus functional testing for coronary artery disease[J].New England Journal of Medicine,2015,372(14):1291.
[6]SOUTHARD J,BAKER L,SCHAEFER S.In search of the false-negative exercise treadmill testing evidence-based use of exercise echocardiography[J].Clinical Cardiology,2008,31(1):35-40.
[7]QAMRUDDIN S.False-Positive Stress Echocardiograms:AContinuing Challenge[J].Ochsner Journal,2016,16(3):277.
[8]Comparative Effectiveness of Exercise Electrocardiography With or Without Myocardial Perfusion Single Photon Emission Computed Tomography in Women With Suspected Coronary Artery Disease Clinical Perspective-Data Supplement[J].
[9]孙步高,张宁,徐伟,等.负荷斑点追踪评价心脏再同步化治疗响应的价值[J].中国超声医学杂志,2016,32(1):25-27.
[10]张佳佳,张平洋,马小五,等.三维斑点追踪结合腺苷负荷超声评价心肌存活性的临床研究[J].中国超声医学杂志,2014,30(7):613-616.