运动平板试验评价的心肌缺血与冠脉狭窄相关性的研究
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摘要
目的:研究运动平板试验评价的心肌缺血与冠脉狭窄的相关性。方法:我院150例稳定型心绞痛患者,根据冠脉CT检查结果分为A组(狭窄<50%)、B组(狭窄50%～75%)、C组(狭窄>75%)三组,每组均50例。比较三组患者病变部位、冠脉狭窄率,运动试验患者ST段压低状况,采用Spearman法分析运动平板阳性率与冠脉狭窄的相关性。结果:与B组比较,C组冠脉直径狭窄率[(63.64±4.21)%比(66.71±4.46)%]及参考段血管直径[(2.92±0.23)mm比(3.03±0.21)mm]明显增加(P<0.05或<0.01);随着冠脉狭窄程度的加重,A、B、C三组运动试验中ST段压低出现时间明显缩短[(712.3±202.7)s比(602.3±210.4)s比(501.2±236.1)s];持续时间[(425.4±200.5)s比(520.8±205.8)s比(603.4±198.4)s]、运动试验阳性率(64.00%比82.00%比92.00%)明显增加;C组ST段压低幅度明显大于A组[(2.4±1.1)mV比(1.9±0.8)mV],P<0.05或<0.01。Spearman分析显示:运动试验阳性率(心肌缺血率)与冠脉狭窄程度无明显相关(r=3.425,P=0.126)。结论:尽管运动平板试验对于心肌缺血诊断具有重要的意义,但是冠状狭窄程度和患者心肌缺血程度并无明显相关性,值得临床注意。
Objective:To study correlation between treadmill exercise test assessing myocardial ischemia and coronary stenosis.Methods:A total of 150 patients with stable angina pectoris in our hospital,according to vascular stenosis by coronary CT were divided into group A(stenosis<50%,n=50),group B(stenosis 50%～75%,n=50)and group C(stenosis>75%,n=50).Coronary stenotic rate and ST depression during exercise test were compared among three groups.Spearman method was used to analyze correlation between treadmill exercise positive rate and coronary stenosis.Results:Compared with group B,there were significant rise in coronary diameter stenotic rate[(63.64±4.21)%vs.(66.71±4.46)%]and vascular diameter of reference segment[(2.92±0.23)mm vs.(3.03±0.21)mm]in group C,P<0.05 or<0.01.Along with coronary stenosis aggravated,there was significant reduction in onset time of ST depression[(712.3±202.7)s vs.(602.3±210.4)s vs.(501.2±236.1)s],and significant rise in duration[(425.4±200.5)s vs.(520.8±205.8)s vs.(603.4±198.4)s]and treadmill exercise positive rate(64.00% vs.82.00% vs.92.00%),in group A,B,C respectively;and ST depression extent of group C was significantly higher than that of group A[(2.4±1.1)mV vs.(1.9±0.8)mV],P<0.05 or<0.01.Spearman correlation analysis indicated that treadmill exercise positive rate(myocardial ischemia rate)was not significantly correlated with coronary stenotic degree(r=3.425,P=0.126).Conclusion:Although treadmill exercise test possesses important significance in diagnosis of myocardial ischemia,but coronary stenotic degree is not correlated with myocardial ischemic degree.which should raise clinical attention
Objective:To study correlation between treadmill exercise test assessing myocardial ischemia and coronary stenosis.Methods:A total of 150 patients with stable angina pectoris in our hospital,according to vascular stenosis by coronary CT were divided into group A(stenosis<50%,n=50),group B(stenosis 50%～75%,n=50)and group C(stenosis>75%,n=50).Coronary stenotic rate and ST depression during exercise test were compared among three groups.Spearman method was used to analyze correlation between treadmill exercise positive rate and coronary stenosis.Results:Compared with group B,there were significant rise in coronary diameter stenotic rate[(63.64±4.21)%vs.(66.71±4.46)%]and vascular diameter of reference segment[(2.92±0.23)mm vs.(3.03±0.21)mm]in group C,P<0.05 or<0.01.Along with coronary stenosis aggravated,there was significant reduction in onset time of ST depression[(712.3±202.7)s vs.(602.3±210.4)s vs.(501.2±236.1)s],and significant rise in duration[(425.4±200.5)s vs.(520.8±205.8)s vs.(603.4±198.4)s]and treadmill exercise positive rate(64.00% vs.82.00% vs.92.00%),in group A,B,C respectively;and ST depression extent of group C was significantly higher than that of group A[(2.4±1.1)mV vs.(1.9±0.8)mV],P<0.05 or<0.01.Spearman correlation analysis indicated that treadmill exercise positive rate(myocardial ischemia rate)was not significantly correlated with coronary stenotic degree(r=3.425,P=0.126).Conclusion:Although treadmill exercise test possesses important significance in diagnosis of myocardial ischemia,but coronary stenotic degree is not correlated with myocardial ischemic degree.which should raise clinical attention
引文
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[11]Shohreh F,Farzan Yu,Chen Judy R,et al.Risk of death from cardiovascular disease associated with low-level arsenic exposure among long-term smokers in a US population-based study[J].Toxicol Applied Pharmacol,2015,287(2):93-97.
[12]Michael P,Pfeiffer Robert W W,Biederman,et al.Cardiac MRI:A General Overview with Emphasis on Current Use and Indications[J].Med Clin North Am,2015,99(4):849-861.
[13]陈宏伟.心肌缺血预适应及冠脉侧支循环对急性心肌梗塞患者的保护[J].心血管康复医学杂志,2011,20(1):22-25.
[2]李绍军,姜宏宁,黄学菁,等.磁共振评价冠状动脉狭窄程度与左心室结构和功能的相关性研究[J].临床放射学杂志,2014,33(2):208-212.
[3]汪彩英,周青,张才智,等.三维及二维斑点追踪技术检测冠状动脉狭窄临床价值的对比研究[J].中华超声影像学杂志,2013,22(8):654-658.
[4]陈青,孙冬冬,王海昌,等.定量冠状动脉造影参数与心肌血流储备分数的相关性分析[J].中国心血管杂志,2013,18(5):325-329.
[5]周志兰,刘超英,李晓辕,等.血浆Hcy水平与冠状动脉病变程度的相关性[J].中国老年学杂志,2013,33(3):659-660.
[6]孙丽杰,米琳,崔鸣,等.冠状动脉临界病变定量冠状动脉造影参数与心肌流量储备分数的关系[J].中华心血管病杂志,2012,40(9):742-746.
[7]郑舒展,龚厚文,余琴,等.冠心病患者冠状动脉狭窄程度与循环B型利钠肽水平的关系[J].中华老年心脑血管病杂志,2012,14(3):277-279.
[8]程华军,廖亮华,陈尚杰,等.肉毒毒素注射后功能性电刺激与运动平板同步治疗脑卒中后足下垂及足内翻的疗效观察[J].中华物理医学与康复杂志,2016,38(9):674-678.
[9]王薇娜,尹岚,杜冰,等.体外反搏对平板运动试验阳性的稳定型心绞痛患者运动耐量和心功能的影响[J].中国循证心血管医学杂志,2016,8(11):1348-1350.
[10]Philippe,Morimont Antoine,Pironet Thomas,et al.Re:Chung,et al.'s Letter to the Editor in response to:Early detection of abnormal left ventricular relaxation in acute myocardial ischemia with a quadratic model.Med Eng Phys 2014;36(September(9)):1101-5by Morimont et al[J].Med Engineering Physics,2015,37(8):827-828.
[11]Shohreh F,Farzan Yu,Chen Judy R,et al.Risk of death from cardiovascular disease associated with low-level arsenic exposure among long-term smokers in a US population-based study[J].Toxicol Applied Pharmacol,2015,287(2):93-97.
[12]Michael P,Pfeiffer Robert W W,Biederman,et al.Cardiac MRI:A General Overview with Emphasis on Current Use and Indications[J].Med Clin North Am,2015,99(4):849-861.
[13]陈宏伟.心肌缺血预适应及冠脉侧支循环对急性心肌梗塞患者的保护[J].心血管康复医学杂志,2011,20(1):22-25.