Puelacher Christian, Wagener Max, Abächerli Roger, Honegger Ursina, Lhasam Nundsin, Schaerli Nicolas, Prêtre Gil, Strebel Ivo, Twerenbold Raphael, Boeddinghaus Jasper, Nestelberger Thomas, Rubini Giménez Maria, Hillinger Petra, Wildi Karin, Sabti Zaid, Badertscher Patrick, Cupa Janosch, Kozhuharov Nikola, du Fay de Lavallaz Jeanne, Freese Michael, Roux Isabelle, Lohrmann Jens, Leber Remo, Osswald Stefan, Wild Damian, Zellweger Michael J, Mueller Christian, Reichlin Tobias
Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University Basel, Switzerland.
Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University Basel, Switzerland; Research, Schiller AG, Baar, Switzerland; Lucerne University of Applied Sciences and Arts (HSLU), Horw, Switzerland.
Int J Cardiol. 2017 Jul 1;238:166-172. doi: 10.1016/j.ijcard.2017.02.079. Epub 2017 Feb 27.
Exercise ECG stress testing is the most widely available method for evaluation of patients with suspected myocardial ischemia. Its major limitation is the relatively poor accuracy of ST-segment changes regarding ischemia detection. Little is known about the optimal method to assess ST-deviations.
A total of 1558 consecutive patients undergoing bicycle exercise stress myocardial perfusion imaging (MPI) were enrolled. Presence of inducible myocardial ischemia was adjudicated using MPI results. The diagnostic value of ST-deviations for detection of exercise-induced myocardial ischemia was systematically analyzed 1) for each individual lead, 2) at three different intervals after the J-point (J+40ms, J+60ms, J+80ms), and 3) at different time points during the test (baseline, maximal workload, 2min into recovery).
Exercise-induced ischemia was detected in 481 (31%) patients. The diagnostic accuracy of ST-deviations was highest at +80ms after the J-point, and at 2min into recovery. At this point, ST-amplitude showed an AUC of 0.63 (95% CI 0.59-0.66) for the best-performing lead I. The combination of ST-amplitude and ST-slope in lead I did not increase the AUC. Lead I reached a sensitivity of 37% and a specificity of 83%, with similar sensitivity to manual ECG analysis (34%, p=0.31) but lower specificity (90%, p<0.001).
When using ECG stress testing for evaluation of patients with suspected myocardial ischemia, the diagnostic accuracy of ST-deviations is highest when evaluated at +80ms after the J-point, and at 2min into recovery.
运动心电图负荷试验是评估疑似心肌缺血患者最常用的方法。其主要局限性在于，在检测缺血方面，ST段改变的准确性相对较差。关于评估ST段偏移的最佳方法，人们知之甚少。
共纳入1558例连续接受自行车运动负荷心肌灌注成像（MPI）的患者。根据MPI结果判定是否存在诱发性心肌缺血。系统分析ST段偏移对运动诱发心肌缺血的诊断价值：1）针对每个导联；2）在J点后三个不同时间间隔（J + 40ms、J + 60ms、J + 80ms）；3）在试验期间的不同时间点（基线、最大负荷、恢复2分钟时）。
481例（31%）患者检测到运动诱发的缺血。ST段偏移的诊断准确性在J点后80ms及恢复2分钟时最高。此时，表现最佳的导联I的ST段幅值曲线下面积（AUC）为0.63（95%可信区间0.59 - 0.66）。导联I中ST段幅值和ST段斜率的联合并未增加AUC。导联I的敏感性为37%，特异性为83%，与人工心电图分析的敏感性相似（34%，p = 0.31），但特异性较低（90%，p < 0.001）。
在使用心电图负荷试验评估疑似心肌缺血患者时，ST段偏移的诊断准确性在J点后80ms及恢复2分钟时评估最高。
