Wahab Mohamed Abdel Kader Abdel
Department of Cardiology, El Minya University, Egypt.
Egypt Heart J. 2017 Sep;69(3):183-190. doi: 10.1016/j.ehj.2017.01.004. Epub 2017 Feb 20.
Management of patients with a suspected ACS and LBBB is a challenge to the clinician.
To detect the ability of IMA to exclude myocardial ischemia in suspected patients with ACS and LBBB.
A total of 68 patients with suspected ACS and LBBB (group I) and another twenty patients age and sex matched known to have LBBB with normal coronary angiography (group II) were included in this study and subjected to: routine laboratory tests, 12 lead ECG, echocardiography, and measurement of serum troponin I (TnI) and IMA (measured by ELISA). Diagnostic coronary angiography was performed on all patients and scored by severity and modified Gensini scores.
IMA and TnI levels are significantly increased in group I compared to group II (P value <0.001. IMA with a cutoff value >95 could predict significant CAD (lesions >50%) with AUC of 0.923, sensitivity of 88%, specificity of 83.33%, PPV of 93.6%, NPV of 71.4% and accuracy 86.76%. Moreover, by using both simple and multiple logistic regression analyses IMA could also independently detect significant CAD. The combined use of IMA and TnI significantly improved the sensitivity and the negative predictive value to 98% and 90.9% respectively.
There was a distinct advantage of measuring IMA in patients presenting to the emergency department with acute chest pain and LBBB to rule out a final diagnosis of ACS.
对疑似急性冠状动脉综合征（ACS）且伴有左束支传导阻滞（LBBB）的患者进行管理，对临床医生来说是一项挑战。
检测缺血修饰白蛋白（IMA）在疑似ACS且伴有LBBB患者中排除心肌缺血的能力。
本研究纳入了68例疑似ACS且伴有LBBB的患者（I组）以及另外20例年龄和性别匹配、已知患有LBBB且冠状动脉造影正常的患者（II组），并对其进行了：常规实验室检查、12导联心电图、超声心动图以及血清肌钙蛋白I（TnI）和IMA（采用酶联免疫吸附测定法检测）的测定。对所有患者进行诊断性冠状动脉造影，并根据严重程度和改良的Gensini评分进行评分。
与II组相比，I组的IMA和TnI水平显著升高（P值<0.001）。IMA临界值>95时可预测显著冠状动脉疾病（病变>50%），曲线下面积（AUC）为0.923，敏感性为88%，特异性为83.33%，阳性预测值为93.6%，阴性预测值为71.4%，准确率为86.76%。此外，通过单因素和多因素逻辑回归分析，IMA也能够独立检测出显著冠状动脉疾病。联合使用IMA和TnI可将敏感性和阴性预测值分别显著提高至98%和90.9%。
对于因急性胸痛和LBBB就诊于急诊科的患者，检测IMA对于排除ACS的最终诊断具有明显优势。
