本文選題：冠狀動脈粥樣硬化性心臟病 + 運(yùn)動心電圖��； 參考：《山東醫(yī)藥》2017年40期

【摘要】：目的探討運(yùn)動心電圖對伴完全性右束支傳導(dǎo)阻滯(RBBB)者冠心病的(CHD)的診斷價值。方法選擇49例疑診CHD、靜息心電圖診斷為RBBB的老年患者,均行運(yùn)動心電圖檢查,并于30天內(nèi)進(jìn)行冠狀動脈(簡稱冠脈)影像學(xué)檢查(冠狀動脈造影或冠狀動脈CT血管造影)。以冠脈影像學(xué)檢查結(jié)果"金標(biāo)準(zhǔn)",計(jì)算運(yùn)動心電圖診斷CHD的敏感性、特異性、陽性預(yù)測值、陰性預(yù)測值及準(zhǔn)確性。用Mc Nemar檢驗(yàn)、Kappa檢驗(yàn)判斷運(yùn)動心電圖診斷結(jié)果與冠脈影像檢查的一致性。計(jì)算運(yùn)動心電圖診斷單支、雙支、三支病變的敏感性。對運(yùn)動心電圖陽性者出現(xiàn)ST段水平或下斜型下降≥0.1 mV的導(dǎo)聯(lián)進(jìn)行統(tǒng)計(jì),計(jì)算其診斷CHD的陽性預(yù)測值。結(jié)果本組冠脈影像學(xué)檢查確診CHD 27例,其中單支病變14例,雙支病變7例,三支病變6例。運(yùn)動心電圖檢查運(yùn)動心電圖檢查結(jié)果陽性24例,其中2例出現(xiàn)心絞痛癥狀,24例均出現(xiàn)心電圖ST段水平或下斜型下降≥0.1 mV,無出現(xiàn)血壓下降者。運(yùn)動心電圖診斷CHD的敏感性為62.9%,特異性為68.2%,陽性預(yù)測值為70.8%,陰性預(yù)測值為60%,準(zhǔn)確性為65.3%。運(yùn)動心電圖與冠脈影像檢查結(jié)果的一致性尚可(κ=0.61)。運(yùn)動心電圖診斷單支、雙支、三支病變的敏感性分別為57%(8/14)、57.1%(4/7)、83.3%(5/6)。運(yùn)動心電圖中V5導(dǎo)聯(lián)ST段壓低診斷CHD的陽性預(yù)測值最高,為81.8%。結(jié)論運(yùn)動心電圖可作為RBBB患者篩查CHD的無創(chuàng)檢測手段。運(yùn)動心電圖診斷冠脈三支病變的敏感性較高,各導(dǎo)聯(lián)中V5導(dǎo)聯(lián)ST段壓低診斷CHD的陽性預(yù)測值較高。
[Abstract]:Objective to investigate the diagnostic value of motor electrocardiogram (ECG) for coronary artery disease (CHD) with complete right bundle branch block (RBBB). Methods 49 aged patients with suspected CHD and resting electrocardiogram (RBBB) were examined by motor electrocardiogram and coronary angiography or coronary artery (coronary artery) was performed within 30 days. CT angiography). The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of CHD in the diagnosis of motor electrocardiogram were calculated with the results of coronary imaging examination "gold standard". Mc Nemar test and Kappa test were used to determine the consistency between the results of electrocardiogram diagnosis and coronary image examination. The single, double, and three branches of the motor electrocardiogram diagnosis were calculated. The sensitivity of the lesions. The positive predictive values of the ST segment or the descending 0.1 mV were calculated for the positive motor electrocardiogram, and the positive predictive value of the diagnosis of CHD was calculated. Results in this group, 27 cases of CHD were diagnosed by coronary imaging, including 14 cases of single branch lesions, 7 cases of double branch lesions and 6 cases of three lesions. Exercise electrocardiogram examination was used for exercise electrocardiogram examination. The results were positive in 24 cases, of which 2 cases had angina pectoris symptoms, 24 cases had electrocardiogram ST segment level or lower deviation more than 0.1 mV, and no blood pressure decreased. The sensitivity of CHD was 62.9%, specificity was 68.2%, positive predictive value was 70.8%, negative predictive value was 60%, and 65.3%. motor electrocardiogram and coronary imaging examination were accurate. The consistency of the results was still available (kappa =0.61). The sensitivity of the exercise electrocardiogram was 57% (8/14), 57.1% (4/7), and 83.3% (5/6). The positive predictive value of CHD was the highest in the ST segment depression of the V5 lead in the exercise electrocardiogram, and the 81.8%. conclusion exercise electrocardiogram could be used as a noninvasive detection method for CHD in RBBB patients. The sensitivity of electrocardiogram in diagnosing three coronary artery lesions is higher. The positive predictive value of V5 segment ST segment depression in diagnosis of CHD is higher.
【作者單位】： 北京大學(xué)第一醫(yī)院;
【分類號】：R541.4

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