Bertasiene Zita, Brazdzionyte Julija, Zaliūnas Remigijus, Vainoras Alfonsas
Clinic of Cardiology, Kaunas University of Medicine Hospital, Eiveniu 2, 3007 Kaunas, Lithuania.
Medicina (Kaunas). 2004;40(1):54-63.
The aim of the study was to evaluate changes of ventricular repolarization variables during the exercise test in women with coronary heart disease, to determine variables, which can best predict significant coronary artery stenoses, and to improve noninvasive diagnostics of coronary heart disease. Ninety women with unstable angina pectoris undergone coronary artery angiography and exercise test on 4th-6th day of hospitalization at Kaunas University of Medicine Hospital. There was no difference in ventricular repolarization variables (JT interval, JT dispersion, JT and ST product) in women without coronary artery stenoses and those with one or two coronary artery stenoses. Sensitivity (87%), specificity (60%), positive predictive (43%), negative predictive (93%) and diagnostic value (67%) of stress test variable, which had no correlation with heart rate -ST and JT product- was greater comparing with ST depression greater than 0.1 mV (values respectively 61%, 49%, 29%, 79%, 52%). JT dispersion at the peak of exercise greater than 33 ms had the best diagnostic value (77%). The most accurate predictors of three-vessel disease are JT dispersion, ST and JT product at the peak of exercise and the fact of previous MI: JT dispersion at the peak of exercise more than 33 ms significantly increases three-vessel disease odds ratio 7.95 times. ST and JT product greater than 22,38 mV x ms significantly increases three-vessel disease odds ratio 13.9 times. The fact of previous MI significantly increases three-vessel disease odds ratio 6.85 times.
本研究的目的是评估冠心病女性在运动试验期间心室复极变量的变化,确定最能预测显著冠状动脉狭窄的变量,并改善冠心病的无创诊断。90例不稳定型心绞痛女性患者在考纳斯医科大学医院住院第4至6天接受了冠状动脉造影和运动试验。无冠状动脉狭窄的女性与有一或两支冠状动脉狭窄的女性在心室复极变量(JT间期、JT离散度、JT与ST乘积)方面无差异。与ST段压低大于0.1mV相比(其敏感性、特异性、阳性预测值、阴性预测值及诊断价值分别为61%、49%、29%、79%、52%),与心率无关的运动试验变量——ST与JT乘积的敏感性(87%)、特异性(60%)、阳性预测值(43%)、阴性预测值(93%)及诊断价值(67%)更高。运动峰值时JT离散度大于33ms具有最佳诊断价值(77%)。三支血管病变最准确的预测指标是运动峰值时的JT离散度、ST与JT乘积以及既往心肌梗死史:运动峰值时JT离散度大于33ms使三支血管病变比值比显著增加7.95倍。ST与JT乘积大于2238mV·ms使三支血管病变比值比显著增加13.9倍。既往心肌梗死史使三支血管病变比值比显著增加6.85倍。