Brown Oliver I, Clark Andrew L, Chelliah Raj, Davison Benjamin J, Mather Adam N, Cunnington Michael S, John Joseph, Alahmar Albert, Oliver Richard, Aznaouridis Konstantinos, Hoye Angela
Department of Academic Cardiology, University of Hull, Castle Hill Hospital, Daisy Building, Castle Road, Cottingham, HU16 5JQ, UK.
Department of Cardiology, Castle Hill Hospital, Castle Road, Cottingham, HU16 5JQ, UK.
Cardiovasc Eng Technol. 2018 Sep;9(3):439-446. doi: 10.1007/s13239-018-0354-1. Epub 2018 Apr 12.
Cardiogoniometry (CGM) is method of 3-dimensional electrocardiographic assessment which has been shown to identify patients with angiographically defined, stable coronary artery disease (CAD). However, angiographic evidence of CAD, does not always correlate to physiologically significant disease. The aim of our study was to assess the ability of CGM to detect physiologically significant coronary stenosis defined by fractional flow reserve (FFR). In a tertiary cardiology centre, elective patients with single vessel CAD were enrolled into a prospective double blinded observational study. A baseline CGM recording was performed at rest. A second CGM recording was performed during the FFR procedure, at the time of adenosine induced maximal hyperaemia. A significant CGM result was defined as an automatically calculated ischaemia score < 0 and a significant FFR ratio was defined as < 0.80. Measures of diagnostic performance (including sensitivity and specificity) were calculated for CGM at rest and during maximal hyperaemia. Forty-five patients were included (aged 61.1 ± 11.0; 60.0% male), of which eighteen (40%) were found to have significant CAD when assessed by FFR. At rest, CGM yielded a sensitivity of 33.3% and specificity of 63.0%. At maximal hyperaemia the sensitivity and specificity of CGM was 71.4 and 50.0% respectively. The diagnostic performance of CGM to detect physiologically significant stable CAD is poor at rest. Although, the diagnostic performance of CGM improves substantially during maximal hyperaemia, it does not reach sufficient levels of accuracy to be used routinely in clinical practice.
心角测量法（CGM）是一种三维心电图评估方法，已被证明可识别出经血管造影确诊的稳定型冠状动脉疾病（CAD）患者。然而，CAD的血管造影证据并不总是与具有生理意义的疾病相关。我们研究的目的是评估CGM检测由血流储备分数（FFR）定义的具有生理意义的冠状动脉狭窄的能力。在一家三级心脏病中心，将择期单支血管CAD患者纳入一项前瞻性双盲观察性研究。在静息状态下进行基线CGM记录。在FFR检查过程中，即腺苷诱导最大充血时进行第二次CGM记录。显著的CGM结果定义为自动计算的缺血评分＜0，显著的FFR比值定义为＜0.80。计算静息状态和最大充血时CGM的诊断性能指标（包括敏感性和特异性）。纳入45例患者（年龄61.1±11.0岁；60.0%为男性），其中18例（40%）经FFR评估发现有显著CAD。静息时CGM的敏感性为33.3%，特异性为63.0%。最大充血时CGM的敏感性和特异性分别为71.4%和50.0%。静息时CGM检测具有生理意义的稳定型CAD的诊断性能较差。尽管最大充血时CGM的诊断性能有显著改善，但仍未达到足以在临床实践中常规使用的准确水平。
