Pruvost P, Lablanche J M, Thieuleux F A, Fourrier J L, Traisnel G, Bertrand M E
Arch Mal Coeur Vaiss. 1986 Dec;79(13):1878-83.
The diagnostic value of ST segment changes on exercise were reassessed by computerised analysis in 807 patients without myocardial infarction who underwent coronary angiography. All the stress tests were carried out according to Bruce's protocol with a system of continuous averaging of the ST segment in V5, V2 and VF. An abnormal response was defined by the association of the following three criteria: 1) ST depression less than or equal to 1 mm, 2) the algebraic sum of the depression + ST slope less than or equal to -1, 3) changes occurring during exercise or the first minute of recovery. A significant coronary lesion was defined as at least 50 per cent narrowing of the vessel lumen. In the study population the prevalence of lesions was 55 per cent in men and 18 per cent in women. The sensitivity of exercise stress testing was 69 per cent but the specificity was only 65 per cent. The positive predictive value was 70 per cent in men, 29 per cent in women; the negative predictive value was 90 per cent in women compared with 62 per cent in men. The predictive values depended on the interpretation of the amplitude, morphology and topography of the ST depression. The low sensitivity and specificity were independent of the coronary angiographic criteria and not related to the bias usually encountered in the correlation between stress testing and coronary angiography. These results show that the quantitative analysis of ST changes during computerised stress testing is not sufficiently accurate in itself to detect atherosclerotic coronary artery disease.
通过计算机分析重新评估了807例未发生心肌梗死且接受冠状动脉造影的患者运动时ST段改变的诊断价值。所有的负荷试验均按照布鲁斯方案进行，采用对V5、V2和VF导联ST段进行连续平均的系统。异常反应由以下三个标准共同定义：1）ST段压低小于或等于1mm；2）压低程度与ST段斜率的代数和小于或等于-1；3）在运动期间或恢复的第一分钟内出现改变。显著冠状动脉病变定义为血管腔至少50%狭窄。在研究人群中，病变的患病率男性为55%，女性为18%。运动负荷试验的敏感性为69%，但特异性仅为65%。阳性预测值男性为70%，女性为29%；阴性预测值女性为90%，男性为62%。预测值取决于对ST段压低的幅度、形态和部位的解读。低敏感性和特异性与冠状动脉造影标准无关，也与负荷试验和冠状动脉造影相关性中通常遇到的偏差无关。这些结果表明，计算机化负荷试验期间ST段改变的定量分析本身不足以准确检测动脉粥样硬化性冠状动脉疾病。
