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目的探讨平板运动试验(TET)时运动后心功能及QTc离散度(QTcd)的变化对冠心病的诊断价值。方法对39例临床有心肌缺血症状或疑诊为冠心病的患者,于运动前先行二维超声心动图检查,测量左室射血分数(EF);然后行平板运动试验,同时分别测量运动前、中、后12导联心电图的QT间期,计算出QTcd≥50ms为阳性标准。运动试验结束后即刻做超声心动图检查,再次测量EF,以EF下降为阳性标准。冠状动脉造影:冠状动脉管腔内径狭窄≥50%为异常。结果平板运动试验阳性诊断冠心病的敏感性、特异性、准确性分别为70%、59.9%、64.1%;以EF下降为阳性标准诊断冠心病的敏感性、特异性、准确性分别为82.35%、86.36%8、4.6%;以运动后QTcd≥50ms为依据诊断冠心病的敏感性、特异性、准确性分别为100%、91.3%、95%。结论运动后EF下降可作为诊断冠心病的参考指标。平板运动试验中QTcd≥50ms可作为诊断冠心病特异而敏感的指标。如将三者结果综合判断,对冠心病诊断准确性的提高更有意义。
Objective To investigate the diagnostic value of changes of cardiac function and QTc (QTcd) after exercise on treadmill exercise test (TET) in patients with coronary heart disease. Methods Thirty-nine patients with clinical symptoms of myocardial ischemia or suspected coronary artery disease were examined with two-dimensional echocardiography before exercise to measure the left ventricular ejection fraction (EF). The treadmill exercise test was then performed to measure the movement Before, during and after the 12-lead ECG QT interval calculated QTcd ≥ 50ms as a positive standard. Echocardiography was performed at the end of the exercise test, EF was again measured, and the decline of EF was regarded as a positive standard. Coronary angiography: coronary artery lumen diameter stenosis ≥ 50% is abnormal. Results The sensitivity, specificity and accuracy of treadmill exercise test in diagnosis of coronary heart disease were 70%, 59.9% and 64.1%, respectively. The sensitivity, specificity and accuracy of EF in the diagnosis of coronary heart disease were 82.35% , 86.36% 8,4.6%. The sensitivity, specificity and accuracy of diagnosis of coronary heart disease based on QTcd≥50ms after exercise were 100%, 91.3% and 95% respectively. Conclusions The decline of EF after exercise can be used as a reference index for diagnosis of coronary heart disease. Treadmill exercise test QTcd≥50ms can be used as a specific and sensitive diagnosis of coronary heart disease indicators. As the result of the three comprehensive judgment, the diagnosis of coronary heart disease to improve the accuracy of more meaningful.