运动试验中右侧胸部导联对检测冠状动脉再狭窄的作用。

Right-sided chest leads in exercise testing for detection of coronary restenosis.

机构信息

Exercise Laboratory, 1st University Department of Cardiology, Athens Medical School, Hippokration Hospital, Athens, Greece.

出版信息

Clin Cardiol. 2010 Apr;33(4):236-40. doi: 10.1002/clc.20609.

DOI:10.1002/clc.20609

PMID:20162735

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6653329/

Abstract

BACKGROUND

The incorporation of right-sided chest leads (V(3)R through V(5)R) into standard exercise testing has been reported to improve its diagnostic utility.

HYPOTHESIS

The purpose of this study was to evaluate any improvement in the ability of exercise testing in detecting restenosis, using additional V(3)R through V(5)R leads, in asymptomatic patients undergoing percutaneous coronary intervention (PCI) in the right coronary artery (RCA) or/and left circumflex (LCX).

METHODS

We studied 172 consecutive patients (54 +/- 7 years old, 106 males) undergoing PCI in RCA or/and LCX. A treadmill test had been performed before PCI. Six months later, all patients underwent a second treadmill test and arteriography in order to detect silent ischemia due to restenosis. Recordings during exercise were obtained with the standard 12-leads plus V(3)R through V(5)R.

RESULTS

Out of 172 patients, 106 had stenosis in RCA, 35 in LCX, and 31 in both vessels while 6 months later, restenosis was detected in 8 (for RCA), 3 (for LCX), and 3 (for both vessels) patients respectively. Sensitivity, specificity, positive prognostic value, negative prognostic value, and accuracy of exercise testing performed post PCI were ameliorated using V(3)R through V(5)R (79% vs 57%, 97% vs 80%, 69% vs 21%, 98% vs 95%, and 95% vs 78% respectively, P < .05 for all except negative prognostic value). Maximal exercise-induced ST-segment deviation (in mm) was not changed post PCI in 12 leads (1.4 +/- 0.2 vs 1.5 +/- 0.2, P = NS) while it was decreased in V(3)R through V(5)R (0.2 +/- 0.2 vs 1.2 +/- 0.3, P < .01).

CONCLUSIONS

The addition of V(3)R through V(5)R improves the diagnostic ability of standard exercise testing in detecting silent ischemia due to restenosis in patients undergoing PCI in RCA or/and LCX.

摘要

背景

将右侧胸部导联（V(3)R 至 V(5)R）纳入标准运动试验已被报道可提高其诊断效用。

假设

本研究的目的是评估在经皮冠状动脉介入治疗（PCI）后无症状患者中，使用额外的 V(3)R 至 V(5)R 导联，在右冠状动脉（RCA）或/和左旋支（LCX）进行运动试验，是否能改善检测再狭窄所致复发性缺血的能力。

方法

我们研究了 172 例连续接受 RCA 或/和 LCX 行 PCI 的患者（54±7 岁，男性 106 例）。所有患者在 PCI 前均进行了跑步机测试。6 个月后，所有患者均进行了第二次跑步机测试和血管造影，以检测因再狭窄导致的无症状性缺血。运动期间的记录是通过标准的 12 导联加 V(3)R 至 V(5)R 导联进行的。

结果

172 例患者中，106 例 RCA 狭窄，35 例 LCX 狭窄，31 例同时累及两血管；6 个月后，分别有 8 例（RCA）、3 例（LCX）和 3 例（同时累及两血管）患者发生再狭窄。使用 V(3)R 至 V(5)R 导联后，运动试验的敏感度、特异度、阳性预测值、阴性预测值和准确性（分别为 79%比 57%、97%比 80%、69%比 21%、98%比 95%和 95%比 78%）均有所改善（除阴性预测值外，均 P<.05）。12 导联的最大运动诱导 ST 段偏移（mm）在 PCI 后无变化（1.4±0.2 比 1.5±0.2，P=NS），而 V(3)R 至 V(5)R 导联则降低（0.2±0.2 比 1.2±0.3，P<.01）。