摘要
Abstract
Objective To explore the application value of treadmill exercise test (TET) in diagnosis of coronary heart disease (CHD) in the elderly. Methods A retrospective analysis was performed on the clinical data of 80 patients with chest tightness and chest pain diagnosed with CHD who were admitted to the hospital from August 2017 to November 2018. All patients underwent ECG TET and coronary angiography in turn. Taking coronary angiography as golden standard, diagnostic efficiency of ECG TET for elderly CHD patients was calculated. Results Thirty-eight positive cases and forty-two negative cases were detected by coronary angiography. The diagnostic sensitivity, specificity, accuracy, positive predictive value, negative predictive value and Kappa consistency of ECG TET were 92.10%, 83. 33%, 87.50%, 83.33%, 92.11% and 0.751, respectively. In all indexes of ECG TET, diagnostic sensitivity of ST/HR hysteresis was higher than that of ST segment depression, MTWA, ST/HR slope and ST/HR (92.11% vs. 76.32%, 39.47%, 78.95%, 76.32%, P< 0.05). The diagnostic specificity of ST/HR slope was higher than that of ST segment depression. MTWA, ST/HR index and ST/HR hysteresis (83.33% vs. 59.52%, 69.05%, 64.29%, 21.43%, P<0.05). The accuracy of ST/HR slope for determining CHD in the elderly was higher than that of ST segment depression , MTWA , ST/HR index and ST/HR hysteresis (81.25% vs. 67.50% , 55.00% , 70.00%, 55. 00%, P < 0. 05 ). Sixteen cases of single-vessel lesion and twenty-two cases of multi-vessel lesion were detected by coronary angiography. The total exercise time, peak heart rate and appearance time of single-vessel lesion were higher than those of multi-vessel lesion, while amplitude of downward movement and duration were lower than those of multi-vessel lesion (P <0.05) . Area under ROC curve (AUC) of all parameters for predicting lesion degree was higher than that of total exercise time, peak heart rate, amplitude of downward movement, appearance time and duration (0.889 vs. 0.722, 0.730, 0.685, 0.733, 0.622,P<0.05). Conclusion The consistency between ECG TET and coronary angiography is high for detecting occurrence of coronary heart disease in the elderly. The prediction sensitivity and specificity of ST/HR slope and ST/HR index are higher than those of traditional ST segment depression standard. And a combination of various exercise parameters can be applied for the judgment of coronary lesions degree.关键词
冠心病/心电图平板运动试验/冠状动脉造影/诊断价值Key words
coronary heart disease/ electrocardiogram treadmill exercise test/ coronary angiography/ diagnostic value分类
医药卫生
