运动时QRS波时限变化对经皮冠状动脉腔内血管成形术后冠状动脉事件的预测价值。

The predictive value of exercise QRS duration changes for post-PTCA coronary events.

作者信息

Efrati Shai, Cantor Angel, Goldfarb Benjamin, Ilia Reuben

机构信息

Exercise Testing Unit, Cardiology Department, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.

出版信息

Ann Noninvasive Electrocardiol. 2003 Jan;8(1):60-7. doi: 10.1046/j.1542-474x.2003.08110.x.

DOI:10.1046/j.1542-474x.2003.08110.x

PMID:12848815

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6932111/

Abstract

BACKGROUND

The sensitivity and predictive values of exercise ECG testing using ST-T criteria after percutaneous transluminal coronary angioplasty (PTCA) are low, precluding its routine use for screening for restenosis. The predictive value of QRS duration criteria during exercise testing (ET) ECG after PTCA for future coronary events has not been reported. The aim of the study was to compare QRS duration changes with ST-T criteria during ET, as a predictor of coronary events after PTCA.

METHODS

A prospective study of 206 consecutive patients who underwent ET at a mean of 34 +/- 14 days after their first PTCA, and were the followed for a mean of 23 +/- 9 months. Patients were divided by QRS duration into two groups-Q1: ischemic response (QRS duration prolongation of more than 3 ms relative to the resting duration), and Q2: normal response (QRS duration shortening or without change from resting duration). Patients were also divided by their ST-T response, S1: ischemic response, and S2: normal response.

RESULTS

During follow-up 52 patients (58%) experienced restenosis or MI, or underwent CABG-Q1: 44 (85%), Q2: 8(15%) (P < 0.0002), S1: 8 (15%), S2: 44 (85%), (P < 0.641), two patients died-Q1: 1 (1%) and Q2: 1 (1%). For QRS and ST-T, the relative risk of having at least one of the coronary events was 4.02 (CI 2.1-9.9) versus 1.13 (CI 0.8-2.9), respectively. The sensitivity for future coronary events was 85% and 52% and the specificity was 48% and 98% for the QRS and ST-T criteria, respectively.

CONCLUSION

QRS prolongation during peak ET ECG after PTCA is a more sensitive marker than ST-T criteria for detection of patients at risk for later coronary events.

摘要

背景

经皮腔内冠状动脉成形术（PTCA）后使用ST-T标准进行运动心电图检测的敏感性和预测价值较低，使其无法常规用于再狭窄筛查。PTCA后运动试验（ET）心电图期间QRS时限标准对未来冠状动脉事件的预测价值尚未见报道。本研究的目的是比较ET期间QRS时限变化与ST-T标准，作为PTCA后冠状动脉事件的预测指标。

方法

对206例连续患者进行前瞻性研究，这些患者在首次PTCA后平均34±14天接受ET，并平均随访23±9个月。根据QRS时限将患者分为两组——Q1组：缺血反应（QRS时限相对于静息时限延长超过3毫秒），和Q2组：正常反应（QRS时限缩短或与静息时限无变化）。患者还根据其ST-T反应进行分组，S1组：缺血反应，和S2组：正常反应。

结果

随访期间，52例患者（58%）发生再狭窄或心肌梗死，或接受冠状动脉旁路移植术——Q1组：44例（85%），Q2组：8例（15%）（P<0.0002），S1组：8例（15%），S2组：44例（85%）（P<0.641），2例患者死亡——Q1组：1例（1%），Q2组：1例（1%）。对于QRS和ST-T，发生至少一项冠状动脉事件的相对风险分别为4.02（CI 2.1 - 9.9）和1.13（CI 0.8 - 2.9）。QRS和ST-T标准对未来冠状动脉事件的敏感性分别为85%和52%，特异性分别为48%和98%。