Bokhari Sabahat, Shahzad Arsalan, Bergmann Steven R
Division of Cardiology, Department of Medicine, College of Physicians and Surgeons of Columbia University, New York, New York, USA.
Coron Artery Dis. 2008 Sep;19(6):399-404. doi: 10.1097/MCA.0b013e3283021ab4.
Wide variations in the sensitivity and specificity of the exercise ECG for the diagnosis of coronary artery disease (CAD) have been reported. The aim of this study was to reexamine the sensitivity and specificity of the stress ECG and stress myocardial perfusion imaging (MPI) relative to cardiac catheterization in an era of aggressive screening.
We evaluated 218 patients [mean age: 62+/-13 (SD) years; 69% males] with symptoms of chest pain or dyspnea, normal resting ECGs, and no earlier myocardial infarction. All patients exercised to age-corrected and sex-corrected Bruce protocol times and achieved >or=85% of predicted maximum heart rate. Coronary angiography was performed within 3 months of stress testing. Sixty-six percent of patients had significant CAD by angiography. The overall sensitivity of the exercise ECG (36%) was significantly lower than that of exercise MPI (81%) (P<0.001). In addition, the specificity of the exercise ECG was higher in men than in women (94% men, 74% women; P<0.01), whereas there were no significant differences in sensitivity or specificity (79%) of MPI between men and women. In patients with multivessel CAD or proximal left anterior descending stenosis >or=70%, the sensitivity of the exercise ECG was higher (58%), but still less than MPI (88%) (P<0.01).
MPI is vastly superior to the stress ECG for the diagnosis of CAD, especially in patients with single-vessel CAD. Older literature reporting higher sensitivity for the stress ECG was likely biased by patients with more severe CAD and must be reexamined in the era of earlier diagnosis and intervention.
已有报道称，运动心电图用于诊断冠状动脉疾病（CAD）时，其敏感性和特异性存在很大差异。本研究的目的是在积极筛查的时代，重新审视应激心电图和应激心肌灌注成像（MPI）相对于心导管检查的敏感性和特异性。
我们评估了218例有胸痛或呼吸困难症状、静息心电图正常且无早期心肌梗死的患者[平均年龄：62±13（标准差）岁；69%为男性]。所有患者均按照年龄和性别校正后的Bruce方案进行运动，并达到或超过预测最大心率的85%。在应激试验后3个月内进行冠状动脉造影。66%的患者经血管造影显示患有严重CAD。运动心电图的总体敏感性（36%）显著低于运动MPI的敏感性（81%）（P<0.001）。此外，运动心电图在男性中的特异性高于女性（男性为94%，女性为74%；P<0.01），而MPI在男性和女性中的敏感性或特异性（79%）无显著差异。在患有多支血管CAD或左前降支近端狭窄≥70%的患者中，运动心电图的敏感性较高（58%），但仍低于MPI（88%）（P<0.01）。
MPI在诊断CAD方面远优于应激心电图，尤其是在单支血管CAD患者中。早期文献报道应激心电图具有较高的敏感性，这可能受到患有更严重CAD患者的偏倚影响，在早期诊断和干预的时代必须重新审视。
