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体表心电图 P 波时限在运动试验中识别心肌缺血的作用

Usefulness of p-wave duration to identify myocardial ischemia during exercise testing.

机构信息

Memorial Heart and Vascular Institute, Long Beach Memorial Medical Center, Long Beach, California, USA.

出版信息

Am J Cardiol. 2010 May 15;105(10):1365-70. doi: 10.1016/j.amjcard.2009.12.060. Epub 2010 Apr 2.

Abstract

It is well recognized that ST-segment depression is due to subendocardial ischemia secondary to an increase in left ventricular end-diastolic pressure. The increase in left ventricular end-diastolic pressure is associated with increased left atrial pressure, resulting in left atrial wall distension that contributes to increasing P-wave duration (PWD). The objective of this study was to determine if PWD measured in leads II and V(5) during maximum exercise stress testing could be a reliable predictor of myocardial ischemia. Patients with suspected coronary disease underwent maximum exercise stress testing with myocardial perfusion imaging. PWD was measured using leads II and V(5) at rest and after exercise, with electrocardiographic complexes magnified 4 times (100 mm/s, 40 mm/mV). The change in PWD was calculated as Delta = PWD(recovery) - PWD(rest). DeltaPWD and ST-segment changes were related to the absence or presence of ischemia (localized reversible perfusion abnormalities) on myocardial perfusion imaging scans. DeltaPWD had sensitivity of 72%, specificity of 82%, negative predictive power (NPP) of 90%, and positive predictive power of 57%. ST-segment change had sensitivity of 34%, specificity of 87%, NPP of 80%, and positive predictive power of 47%. When DeltaPWD and ST changes were combined, sensitivity increased to 79% and NPP increased to 91%. In conclusion, DeltaPWD outperformed ST-segment changes in predicting myocardial ischemia on myocardial perfusion imaging scans. Furthermore, when DeltaPWD and ST-segment changes were combined, sensitivity and NPP were also significantly increased. In this study population, measuring DeltaPWD substantially increased the diagnostic value of maximum exercise stress testing.

摘要

众所周知,ST 段压低是由于左心室舒张末期压力增加导致的心内膜下缺血。左心室舒张末期压力的增加与左心房压力的增加有关,导致左心房壁扩张,从而导致 P 波持续时间(PWD)延长。本研究的目的是确定在最大运动应激测试中测量的 II 导联和 V(5)导联的 PWD 是否可以作为心肌缺血的可靠预测指标。怀疑患有冠心病的患者接受了最大运动应激测试和心肌灌注成像。使用 II 导联和 V(5)导联在休息和运动后测量 PWD,心电图复极 4 倍放大(100mm/s,40mm/mV)。计算 PWD 的变化量为 Delta = PWD(恢复)-PWD(休息)。DeltaPWD 和 ST 段变化与心肌灌注成像扫描上是否存在缺血(局部可逆灌注异常)有关。DeltaPWD 的敏感性为 72%,特异性为 82%,阴性预测值(NPP)为 90%,阳性预测值为 57%。ST 段变化的敏感性为 34%,特异性为 87%,NPP 为 80%,阳性预测值为 47%。当 DeltaPWD 和 ST 变化相结合时,敏感性增加到 79%,NPP 增加到 91%。总之,DeltaPWD 在预测心肌灌注成像扫描上的心肌缺血方面优于 ST 段变化。此外,当 DeltaPWD 和 ST 段变化相结合时,敏感性和 NPP 也显著增加。在本研究人群中,测量 DeltaPWD 大大提高了最大运动应激测试的诊断价值。

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