Aboul-Enein H, Bengston J R, Adams D B, Mostafa M A, Ibrahim M M, Hifny A A, Sheikh K H
Department of Medicine Duke University Medical Center, Durham, NC 27710.
Am Heart J. 1991 Aug;122(2):430-7. doi: 10.1016/0002-8703(91)90996-u.
To determine whether the accuracy of exercise echocardiography is affected by the degree of effort during exercise, we examined 101 patients who had 6 months earlier undergone successful coronary artery angioplasty, with resting and immediate postexercise echocardiography and same-day coronary angiography. A positive exercise echocardiographic response was defined as the development of a new or worsening wall motion abnormality postexercise, compared with resting wall motion. Significant coronary disease (greater than 50% diameter stenosis) was present in 48 patients, 38 of whom had single-vessel disease and 10 of whom had two-vessel disease. Exercise echocardiography correctly identified 32 patients with significant disease (sensitivity 67%) and 44 patients without significant disease (specificity 83%). The effect of the degree of exercise effort on the sensitivity and specificity of the test was evaluated by three criteria; (1) the percentage of maximum predicted heart rate (MHR), (2) the duration of exercise (DUR), and (3) the double product (DP). To determine the influence of the degree of effort upon sensitivity and specificity, the effort criteria were compared between patients with true positive (TP) tests to those with false negative tests (FN), and in patients with true negative (TN) tests compared with those with false positive (FP) tests. No significant differences were detected in MHR, DUR, or DP between TP versus FN patients or between TN versus FP patients. These results indicate that for symptom-limited exercise echocardiography in postangioplasty patients, neither sensitivity nor specificity is significantly affected by the degree of effort during exercise.
为了确定运动超声心动图的准确性是否受运动时用力程度的影响，我们对101例患者进行了检查，这些患者在6个月前成功接受了冠状动脉血管成形术，并接受了静息和运动后即刻超声心动图检查以及同日冠状动脉造影。运动超声心动图阳性反应定义为运动后出现新的或加重的室壁运动异常，与静息时室壁运动相比。48例患者存在显著冠状动脉疾病（直径狭窄大于50%），其中38例为单支血管病变，10例为双支血管病变。运动超声心动图正确识别出32例有显著疾病的患者（敏感性67%）和44例无显著疾病的患者（特异性83%）。通过三个标准评估运动用力程度对该检查敏感性和特异性的影响；（1）最大预测心率（MHR）的百分比，（2）运动持续时间（DUR），以及（3）双乘积（DP）。为了确定用力程度对敏感性和特异性的影响，将真阳性（TP）检查患者与假阴性（FN）检查患者之间的用力标准进行比较，以及将真阴性（TN）检查患者与假阳性（FP）检查患者之间的用力标准进行比较。在TP与FN患者之间或TN与FP患者之间，未检测到MHR、DUR或DP有显著差异。这些结果表明，对于血管成形术后患者进行症状限制的运动超声心动图检查，运动时的用力程度对敏感性和特异性均无显著影响。
