使用12导联心前区应激心电图对间歇性跛行患者冠心病的患病率及分布情况

Prevalence and distribution of coronary disease in claudicants using 12-lead precordial stress electrocardiography.

作者信息

Sonecha T N, Delis K T

机构信息

Academic Vascular Surgery, St Mary's Hospital, Imperial College, London, U.K.

出版信息

Eur J Vasc Endovasc Surg. 2003 Jun;25(6):519-26. doi: 10.1053/ejvs.2002.1902.

DOI:10.1053/ejvs.2002.1902

PMID:12787693

Abstract

AIMS

to evaluate the prevalence of coronary artery disease (CAD) by means of modified stress electrocardiography in patients presenting with intermittent claudication.

METHODS

three hundred consecutive patients (188 male) with intermittent claudication (post-exercise ankle brachial index <0.8), and 100 age and sex-matched controls, were assessed for CAD with resting and stress 12-lead-precordial ECG. A history of angina and previous myocardial infarction (MI) was recorded.

EXCLUSION CRITERIA

recent (<1 month) MI; unstable angina; prior coronary intervention; arrhythmias; conduction abnormalities; uncontrolled hypertension; heart failure, digoxin therapy, and inability to perform tests.

RESULTS

based on antecedent angina, MI and abnormal resting ECG, CAD prevalence was 47% in claudicants and 6% in controls; on 12-lead-precordial ECG stress testing, CAD prevalence was 46% (95% CI: 40.1-51.7%) in claudicants and 11% (95% CI: 4.8-17.2%) in controls (both p <0.0001). Only 67% of claudicants (n=141) with antecedent angina, MI or an abnormal resting ECG, met the criteria of CAD on stress testing; also 28% of claudicants without antecedent angina, MI and a normal resting ECG (n=159) had evidence of CAD. The odds ratio for CAD in claudicants was 6.9. Based on 12-lead-precordial ECG stress testing we detected the presence of: one-, two- and three-vessel disease in 14.7% (95% CI: 10.6-18.7%), 19% (95% CI: 14.5-23.5%) and in 12.3% (95% CI: 8.6-16%) of claudicants; and in 8, 3 and 0% of controls, respectively.

CONCLUSIONS

forty six percent of patients with intermittent claudication had concomitant CAD, and 31% two- or three-vessel disease. In the presence of claudication the odds ratio for CAD is 6.9 (95% CI: 3.5-13.4) and for two- or three-vessel disease 14.8. Non-invasive modified stress electrocardiography by enabling identification of those with multi-vessel CAD and thus by providing cardiac risk stratification may help bridge the gap between clinical evaluation and invasive coronary imaging.

摘要

目的

通过改良的运动心电图评估间歇性跛行患者冠状动脉疾病（CAD）的患病率。

方法

连续纳入300例间歇性跛行患者（188例男性）（运动后踝臂指数<0.8），以及100例年龄和性别匹配的对照者，采用静息和运动12导联心前区心电图评估CAD。记录心绞痛病史和既往心肌梗死（MI）病史。

排除标准

近期（<1个月）MI；不稳定型心绞痛；既往冠状动脉介入治疗；心律失常；传导异常；未控制的高血压；心力衰竭；地高辛治疗；以及无法进行检查。

结果

基于既往心绞痛、MI和静息心电图异常，间歇性跛行患者的CAD患病率为47%，对照者为6%；在12导联心前区心电图运动试验中，间歇性跛行患者的CAD患病率为46%（95%CI：40.1-51.7%），对照者为11%（95%CI：4.8-17.2%）（两者p<0.0001）。在既往有心绞痛、MI或静息心电图异常的间歇性跛行患者中，只有67%（n=141）在运动试验中符合CAD标准；在没有既往心绞痛、MI且静息心电图正常的间歇性跛行患者中，也有28%（n=159）有CAD证据。间歇性跛行患者患CAD的比值比为6.9。基于12导联心前区心电图运动试验，我们检测到间歇性跛行患者中存在单支血管病变、双支血管病变和三支血管病变的比例分别为14.7%（95%CI：10.6-18.7%）、19%（95%CI：14.5-23.5%）和12.3%（95%CI：8.6-16%）；对照者中分别为8%、3%和0%。