Miyakoda H, Kitamura H, Kinugawa T, Ogino K, Hoshio A, Kotake H, Mashiba H
First Department of Internal Medicine, Tottori University School of Medicine, Yonago, Japan.
Jpn Circ J. 1990 Dec;54(12):1503-10. doi: 10.1253/jcj.54.12_1503.
To evaluate the diagnostic value of an exercise-induced increase in R-wave amplitude (RWA) for detecting coronary artery disease (CAD), treadmill testing using the modified Bruce protocol was performed on a CASE II computerized system (Marquette) in 10 healthy young men, 35 patients (pts) with CAD, 22 subjects with normal coronary arteries, and 11 pts with aortic or mitral regurgitation. Based on the analysis of the patterns of serial changes in RWA in lead V5, we proposed new RWA criteria for detecting CAD. (1) During exercise, RWA increases in stage 1 and subsequently increases further or remains unchanged. (2) During exercise, RWA decreases in the early phase of exercise and subsequently increases. (3) In the recovery period, RWA shows a gradual and excessive increase. A combination of the above RWA criteria showed a sensitivity, specificity and accuracy of an equal value of 86%. We conclude that an exercise-induced RWA increase is a useful indicator for detecting CAD, especially when taking the patterns of serial changes into consideration, and that the abnormal RWA increase may be related to an increase in left ventricular (LV) end-diastolic volume due to exercise-induced LV dysfunction.
为评估运动诱发的R波振幅增加（RWA）对检测冠状动脉疾病（CAD）的诊断价值，采用改良Bruce方案在CASE II计算机系统（马奎特）上对10名健康年轻男性、35例CAD患者、22例冠状动脉正常的受试者以及11例主动脉或二尖瓣反流患者进行了平板运动试验。基于对V5导联RWA连续变化模式的分析，我们提出了检测CAD的新RWA标准。（1）运动期间，RWA在第1阶段增加，随后进一步增加或保持不变。（2）运动期间，RWA在运动早期下降，随后增加。（3）在恢复期，RWA呈逐渐过度增加。上述RWA标准组合显示敏感性、特异性和准确性均为86%。我们得出结论，运动诱发的RWA增加是检测CAD的有用指标，尤其是考虑连续变化模式时，并且异常的RWA增加可能与运动诱发的左心室（LV）功能障碍导致的左心室舒张末期容积增加有关。
