Detrano R, Gianrossi R, Mulvihill D, Lehmann K, Dubach P, Colombo A, Froelicher V
Veterans Administration Medical Center, Long Beach, California 90822.
J Am Coll Cardiol. 1989 Nov 15;14(6):1501-8. doi: 10.1016/0735-1097(89)90388-4.
To evaluate the variability in the reported accuracy of the exercise electrocardiogram (ECG) for predicting severe coronary disease, meta analysis was applied to 60 consecutively published reports comparing exercise-induced ST depression with coronary angiographic findings. The 60 reports included 62 distinct study groups comprising 12,030 patients who underwent both tests. Both technical and methodologic factors were analyzed. Wide variability in sensitivity and specificity was found (mean sensitivity 81% [range 40% to 100%, SD 12%]; mean specificity 66% [range 17% to 100%, SD 16%]). All three variables found to be significantly and independently related to sensitivity were methodologic (the exclusion of patients with right bundle branch block, the comparison with another exercise test thought to be superior in accuracy and the exclusion of patients taking digitalis). Exclusion of patients with right bundle branch block and comparison with a "better" exercise test were both significantly associated with sensitivity for the prediction of triple vessel or left main coronary artery disease. Adjustment of exercise-induced ECG changes for changes in heart rate was strongly associated with the specificity for critical disease (partial R2 = 0.436, p = 0.0001).
为评估运动心电图（ECG）预测严重冠状动脉疾病的报告准确性的变异性，我们对60篇连续发表的比较运动诱发ST段压低与冠状动脉造影结果的报告进行了荟萃分析。这60篇报告包括62个不同的研究组，共12030例接受了两项检查的患者。我们分析了技术和方法学因素。结果发现敏感性和特异性存在很大变异性（平均敏感性81%[范围40%至100%，标准差12%]；平均特异性66%[范围17%至100%，标准差16%]）。发现与敏感性显著且独立相关的所有三个变量均为方法学方面的（排除右束支传导阻滞患者、与另一种被认为准确性更高的运动试验进行比较以及排除服用洋地黄的患者）。排除右束支传导阻滞患者以及与“更好”的运动试验进行比较，均与预测三支血管或左主干冠状动脉疾病的敏感性显著相关。针对心率变化调整运动诱发的心电图变化与严重疾病的特异性密切相关（偏R² = 0.436，p = 0.0001）。
