运动心电图对伴有完全性右束支传导阻滞者冠心病的诊断价值

发布时间：2018-06-29 13:17

本文选题：冠状动脉粥样硬化性心脏病 + 运动心电图　；参考：《山东医药》2017年40期

【摘要】：目的探讨运动心电图对伴完全性右束支传导阻滞(RBBB)者冠心病的(CHD)的诊断价值。方法选择49例疑诊CHD、静息心电图诊断为RBBB的老年患者,均行运动心电图检查,并于30天内进行冠状动脉(简称冠脉)影像学检查(冠状动脉造影或冠状动脉CT血管造影)。以冠脉影像学检查结果"金标准",计算运动心电图诊断CHD的敏感性、特异性、阳性预测值、阴性预测值及准确性。用Mc Nemar检验、Kappa检验判断运动心电图诊断结果与冠脉影像检查的一致性。计算运动心电图诊断单支、双支、三支病变的敏感性。对运动心电图阳性者出现ST段水平或下斜型下降≥0.1 mV的导联进行统计,计算其诊断CHD的阳性预测值。结果本组冠脉影像学检查确诊CHD 27例,其中单支病变14例,双支病变7例,三支病变6例。运动心电图检查运动心电图检查结果阳性24例,其中2例出现心绞痛症状,24例均出现心电图ST段水平或下斜型下降≥0.1 mV,无出现血压下降者。运动心电图诊断CHD的敏感性为62.9%,特异性为68.2%,阳性预测值为70.8%,阴性预测值为60%,准确性为65.3%。运动心电图与冠脉影像检查结果的一致性尚可(κ=0.61)。运动心电图诊断单支、双支、三支病变的敏感性分别为57%(8/14)、57.1%(4/7)、83.3%(5/6)。运动心电图中V5导联ST段压低诊断CHD的阳性预测值最高,为81.8%。结论运动心电图可作为RBBB患者筛查CHD的无创检测手段。运动心电图诊断冠脉三支病变的敏感性较高,各导联中V5导联ST段压低诊断CHD的阳性预测值较高。
[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.
【作者单位】：北京大学第一医院;
【分类号】：R541.4

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