Friedewald V E
Heart Lung. 1976 Jan-Feb;5(1):91-6.
Recognition of the value of objective parameters in the diagnostic evaluation for coronary arterial occlusive disease had led to increased application of maximal-stress multiple-lead electrocardiography. Changes in the ST-segment during and immediately following exercise are the most significant electrocardiographic indicators of myocardial ischemia. When such causes of ischemia as congenital anomalies, embolism, and arteritis have been excluded, exercise testing is a sensitive and specific means of detecting coronary arterial occlusion. The sensitivity and specificity of this parameter are evaluated in terms of long-term morbidity and mortality and, more recently, through correlation of electrocardiographic results with angiographic evidence. In our series of 308 patients undergoing both exercise testing and coronary arteriography, the sensitivity factor for 80 negative stress tests approached 95 per cent, with only four false-negative resting and exercise electrocardiograms. For 129 patients with ST-segment changes indicative of myocardial ischemia, angiography demonstrated significant coronary stenosis in 84 per cent of the cases. Of the twenty patients with false-positive stress electrocardiograms twelve were females, wich correlates with the generally higher rate of false-negative stress-electrocardiographic response among women.
认识到客观参数在冠状动脉闭塞性疾病诊断评估中的价值，已导致最大负荷多导联心电图的应用增加。运动期间及运动后即刻ST段的改变是心肌缺血最重要的心电图指标。当排除先天性异常、栓塞和动脉炎等缺血原因后，运动试验是检测冠状动脉闭塞的一种敏感且特异的方法。该参数的敏感性和特异性通过长期发病率和死亡率来评估，最近则通过心电图结果与血管造影证据的相关性来评估。在我们的308例同时接受运动试验和冠状动脉造影的患者系列中，80次阴性负荷试验的敏感性接近95%，仅有4例假阴性静息和运动心电图。对于129例有提示心肌缺血的ST段改变的患者，血管造影显示84%的病例有明显冠状动脉狭窄。在20例假阳性负荷心电图患者中，12例为女性，这与女性中假阴性负荷心电图反应的总体发生率较高相关。
