Desai Milind Y, Crugnale Sharon, Mondeau Jennifer, Helin Kristy, Mannting Finn
Division of Nuclear Cardiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass, USA.
Am Heart J. 2002 Mar;143(3):482-7. doi: 10.1067/mhj.2002.120771.
Slow upsloping ST-segment depression during stress is thought to represent an ischemic response to exercise treadmill testing (ETT).
We used modern single-photon emission computed tomography (SPECT) imaging protocols to determine the incidence of ischemia in patients with slow upsloping ST depression during exercise and whether this response signifies more or less severe coronary artery disease (CAD) and risk in comparison with rapid upsloping ST depression and particularly with horizontal or downsloping ST depression.
We enrolled 33 patients (group 1) with rapid upsloping ST depression (>1 mm extending <0.08 seconds beyond J point), 32 patients (group 2) with slow upsloping depression (>1.5 mm extending >0.08 seconds beyond J point), and 35 patients (group 3) with horizontal or downsloping depression (>1 mm at 0.08 seconds beyond J point). Summed stress score (SSS), summed difference score (SDS), stress extent percent (SE%) and reversible extent percent (RE%) of perfusion abnormalities, lung-heart ratio (LHR), and transient ischemic dilatation (TID) were calculated.
The mean SSS, SDS, SE%, RE%, and LHR were similar between groups 1 and 2 but significantly higher in group 3. Incidence of ischemia was similar in groups 1 and 2 (39% and 25%) but significantly higher in group 3 (77%, P <.001). Evidence of TID was seen in none of the patients in groups 1, in 3% of patients in group 2, and in 23% of patients in group 3.
Slow upsloping ST depression does not signify more severe ischemia, more extensive CAD, or more stress-induced backward left ventricular failure. Thus, it would be reasonable to consider patients with slow upsloping ST depression during exercise as having a very low likelihood of CAD, similar to patients with rapid upsloping ST depression.
运动时ST段缓慢上斜型压低被认为代表运动平板试验（ETT）的缺血反应。
我们采用现代单光子发射计算机断层扫描（SPECT）成像方案来确定运动时ST段缓慢上斜型压低患者的缺血发生率，以及与快速上斜型ST段压低，特别是与水平型或下斜型ST段压低相比，这种反应是否意味着更严重或更不严重的冠状动脉疾病（CAD）及风险。
我们纳入了33例快速上斜型ST段压低（J点后>1mm，延长<0.08秒）的患者（第1组），32例缓慢上斜型压低（J点后>1.5mm，延长>0.08秒）的患者（第2组），以及35例水平型或下斜型压低（J点后0.08秒时>1mm）的患者（第3组）。计算灌注异常的总应激评分（SSS）、总差异评分（SDS）、应激范围百分比（SE%）和可逆范围百分比（RE%）、肺心比（LHR）以及短暂性心肌缺血性扩张（TID）。
第1组和第2组之间的平均SSS、SDS、SE%、RE%和LHR相似，但第3组显著更高。第1组和第2组的缺血发生率相似（分别为39%和25%），但第3组显著更高（77%，P<.001）。第1组患者均未出现TID迹象，第2组患者中有3%出现TID迹象，第3组患者中有23%出现TID迹象。
ST段缓慢上斜型压低并不意味着更严重的缺血、更广泛的CAD或更严重的应激诱导的左心室向后衰竭。因此，将运动时ST段缓慢上斜型压低的患者视为CAD可能性极低是合理的，这与快速上斜型ST段压低的患者类似。
