Xiang Ding-cheng, Yin Ji-lin, Teng Ai-ping, He Jian-xin, Gong Zhi-hua, Hong Chang-jiang
Department of Cardiology, Guangzhou General Hospital of Guangzhou Command, Guangzhou 510010, China.
Zhonghua Nei Ke Za Zhi. 2007 Apr;46(4):287-9.
To investigate the value of stress electrocardiography (S-ECG) and stress myocardial perfusion scintigraphy (S-MPS) in the differential diagnosis of patients with atypical chest pain.
Patients with atypical chest pain were undergone S-ECG, S-MPS, coronary angiography and coronary artery spastic provocation with intracoronary acetylcholine test. The final diagnoses of those patients were coronary heart disease, coronary spasm, coronary artery muscular bridge, microvascular angina pectoris and chest pain with non-coronary heart disease. Those patients were grouped by final diagnoses to retrospectively compare the results of S-ECG and S-MPS between groups.
Totally 186 patients with integrated data were included. The final diagnoses were coronary artery stenosis (above 50% stenosis in diameter) in 20%, coronary artery spasm in 27%, coronary artery muscular bridge in 14%, microvascular angina pectoris in 5%, and chest pain with non-coronary artery disease in 34%. The sensitivity and specificity to diagnose ischemic coronary artery disease (including coronary stenosis, coronary artery muscular bridge and syndrome X but not coronary artery spasm) were 92% and 65% in S-ECG, 62% and 79% in S-MPS, respectively. Combination of atypical chest pain, negative S-ECG and reversal redistribution of S-MPS was an accurate non-invasive method to diagnose coronary artery spasm with sensitivity of 94% and specificity of 96%.
Most of patients with atypical chest pain have organic or functional ischemic coronary artery disease. Combination of heart stress tests are helpful to differentiate the etiology of atypical chest pain.
探讨应激心电图（S-ECG）和应激心肌灌注显像（S-MPS）在非典型胸痛患者鉴别诊断中的价值。
对非典型胸痛患者进行S-ECG、S-MPS、冠状动脉造影及冠状动脉内乙酰胆碱试验诱发冠状动脉痉挛检查。这些患者的最终诊断为冠心病、冠状动脉痉挛、冠状动脉肌桥、微血管性心绞痛和非冠心病性胸痛。根据最终诊断将患者分组，回顾性比较各组间S-ECG和S-MPS的检查结果。
共纳入186例资料完整的患者。最终诊断为冠状动脉狭窄（直径狭窄超过50%）者占20%，冠状动脉痉挛者占27%，冠状动脉肌桥者占14%，微血管性心绞痛者占5%，非冠状动脉疾病性胸痛者占34%。S-ECG诊断缺血性冠状动脉疾病（包括冠状动脉狭窄、冠状动脉肌桥和X综合征，但不包括冠状动脉痉挛）的敏感性和特异性分别为92%和65%，S-MPS分别为62%和79%。非典型胸痛、S-ECG阴性及S-MPS反向再分布相结合是诊断冠状动脉痉挛的一种准确的非侵入性方法，敏感性为94%，特异性为96%。
大多数非典型胸痛患者患有器质性或功能性缺血性冠状动脉疾病。联合心脏应激试验有助于鉴别非典型胸痛的病因。
