Ikeda K, Kubota I, Yamaki M, Kato N, Hosoya Y, Tomoike H, Yasui S
First Department of Internal Medicine, Yamagata University School of Medicine, Japan.
Jpn Circ J. 1992 Mar;56(3):223-34. doi: 10.1253/jcj.56.223.
The purpose of this study was to investigate the relationship of dipyridamole-induced ST changes to the severity of coronary artery disease. The subjects were 100 patients without myocardial infarction who underwent coronary arteriography for the diagnosis of coronary artery disease. The dipyridamole injection test (D) (0.568 mg/kg/4 min), and symptom-limited treadmill exercise test (T) were performed separately. Body surface electrocardiographic mapping of 87 leads was performed in both tests. The incidences of significant ST depression greater than or equal to 0.10 mV, number of leads showing significant ST depression (nST) and the maximal voltage of ST depression (maxST) in D and T were compared to the number of diseased coronary arteries. In patients without significant coronary stenosis (0VD group), the incidence of ST depression in the dipyridamole test was significantly lower than that in the treadmill test (D 9% vs T 47%, p less than 0.01). While, in one vessel disease (1VD), two vessel disease (2VD), and three vessel disease (3VD) groups, there was no significant difference in the incidence of ST depression between the dipyridamole test and the treadmill test (in 1VD, D 44% vs. T 65%; in 2VD, D 67% vs. T 93%; and in 3VD, D 93% vs. T 96%). In the dipyridamole test, nST was 0.6 +/- 2.4 in 0VD, 4.5 +/- 6.9 in 1VD, 4.1 +/- 4.5 in 2VD, and 10.6 +/- 8.1 in 3VD. Significant differences were found between 0VD and 1VD (P less than 0.05), 0VD and 3VD (P less than 0.01), 1VD and 3VD (P less than 0.01), and 2VD and 3VD (p less than 0.01). The maxST in the dipyridamole test was 0.02 +/- 0.04 mV in 0VD, 0.10 +/- 0.12 mV in 1VD, 0.13 +/- 0.11 mV in 2VD, and 0.22 +/- 0.11 mV in 3VD. Significant differences were found between 0VD and 1VD (p less than 0.01), 0VD and 2VD (p less than 0.01), 0VD and 3VD (p less than 0.01), 1VD and 3VD (p less than 0.01), and 2VD and 3VD (P less than 0.01). For the diagnosis of 3VD, the dipyridamole ECG test had as high a sensitivity (93% vs 96%), higher specificity (68% vs 38%, p less than 0.01), and higher predictive accuracy (75% vs 54%, p less than 0.01) than the treadmill test.(ABSTRACT TRUNCATED AT 400 WORDS)
本研究的目的是探讨双嘧达莫诱发的ST段改变与冠状动脉疾病严重程度之间的关系。研究对象为100例无心肌梗死且因诊断冠状动脉疾病而接受冠状动脉造影的患者。分别进行双嘧达莫注射试验（D）（0.568mg/kg/4分钟）和症状限制性平板运动试验（T）。两项试验均进行87导联的体表心电图标测。将D试验和T试验中ST段压低≥0.10mV的发生率、出现ST段压低的导联数（nST）以及ST段压低的最大电压（maxST）与病变冠状动脉的数量进行比较。在无明显冠状动脉狭窄的患者（0VD组）中，双嘧达莫试验中ST段压低的发生率显著低于平板运动试验（D试验为9%，T试验为47%，p<0.01）。而在单支血管病变（1VD）、双支血管病变（2VD）和三支血管病变（3VD）组中，双嘧达莫试验与平板运动试验的ST段压低发生率无显著差异（1VD组中，D试验为44%，T试验为65%；2VD组中；D试验为67%，T试验为93%；3VD组中，D试验为93%，T试验为96%）。在双嘧达莫试验中，0VD组的nST为0.6±2.4，1VD组为4.5±6.9，2VD组为4.1±4.5，3VD组为10.6±8.1。0VD组与1VD组（P<0.05）、0VD组与3VD组（P<0.01）、1VD组与3VD组（P<0.01）以及2VD组与3VD组（p<0.01）之间存在显著差异。双嘧达莫试验中的maxST，0VD组为0.02±0.04mV，1VD组为0.10±0.12mV，2VD组为0.13±0.11mV，3VD组为0.22±0.11mV。0VD组与1VD组（p<0.01）、0VD组与2VD组（p<0.01）、0VD组与3VD组（p<0.01）、1VD组与3VD组（p<0.01）以及2VD组与3VD组（P<0.01）之间存在显著差异。对于三支血管病变的诊断，双嘧达莫心电图试验具有与平板运动试验一样高的敏感性（93%对96%）、更高的特异性（68%对38%，p<0.01）以及更高的预测准确性（75%对54%，p<0.01）。（摘要截选至400字）
