Beth Israel Deaconess Medical Center, Department of Medicine, Division of Cardiovascular Medicine, Boston, MA, United States of America; Harvard School of Public Health, Department of Environmental Sciences, Boston, MA, United States of America; Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
Beth Israel Deaconess Medical Center, Department of Medicine, Division of Cardiovascular Medicine, Boston, MA, United States of America; Harvard Medical School, Department of Medicine, Boston, MA, United States of America.
Int J Cardiol. 2020 Jan 1;298:32-38. doi: 10.1016/j.ijcard.2019.07.066. Epub 2019 Aug 7.
Despite widespread use of ETT and vasodilator-stress with myocardial perfusion imaging (MPI) for noninvasive detection of flow-limiting coronary artery disease, there is continued need to improve diagnostic accuracy. We examined whether measurement of interlead T-wave heterogeneity (TWH) during exercise tolerance testing (ETT) or pharmacologic stress testing improves detection of stenoses in large epicardial coronary arteries.
All 137 patients at our institution who underwent diagnostic coronary angiography within 0 to 5 days after ETT (N = 81) or dipyridamole IV infusion (N = 58) in 2016 were studied, including 2 patients with both tests. Cases (N = 93) had angiographically significant stenosis (≥50% of left main or ≥ 70% of an epicardial coronary artery ≥2 mm in diameter); controls (N = 44) did not. TWH, i.e., interlead splay of T waves, was determined by second central moment analysis from precordial leads by an investigator blinded to angiographic results.
At rest, TWH levels were similar for cases and controls. ETT and dipyridamole stress testing increased TWH by 69% (p < 0.0001) and 27% (p < 0.0001), respectively, in cases. In controls, TWH did not change. Areas under the ROC curves for TWH increase for any flow-limiting coronary artery stenosis were 0.737 (p < 0.0001) for ETT and 0.818 (p < 0.0001) for dipyridamole stress testing. By contrast, neither ST-segment changes during ETT (p = 0.12) nor MPI during dipyridamole stress testing (p = 0.60) discriminated cases from controls.
TWH measurement is a novel method that improves detection of angiographically confirmed flow-limiting stenoses in large epicardial coronary arteries during both ETT and MPI during pharmacologic stress testing with dipyridamole.
尽管广泛使用经食管超声心动图（ETT）和血管扩张剂应激与心肌灌注成像（MPI）进行非侵入性检测限制血流的冠状动脉疾病，但仍需要提高诊断准确性。我们研究了在运动耐量试验（ETT）或药物应激试验期间测量导联间 T 波异质性（TWH）是否可以改善对大心外膜冠状动脉狭窄的检测。
我们研究了 2016 年在我院接受 ETT（n=81）或二吡啶酰胺静脉输注（n=58）后 0 至 5 天内进行诊断性冠状动脉造影的所有 137 例患者，包括 2 例患者进行了两种检查。病例组（n=93）有经血管造影证实的狭窄（左主干≥50%或直径≥2mm 的心外膜冠状动脉≥70%）；对照组（n=44）无狭窄。通过第二中央矩分析从胸前导联确定 TWH，由一位对血管造影结果不知情的研究者进行。
在休息时，病例组和对照组的 TWH 水平相似。ETT 和二吡啶酰胺应激试验分别使病例组的 TWH 增加 69%（p<0.0001）和 27%（p<0.0001）。在对照组中，TWH 没有变化。对于任何限制血流的冠状动脉狭窄，TWH 增加的 ROC 曲线下面积为 ETT 的 0.737（p<0.0001）和二吡啶酰胺应激试验的 0.818（p<0.0001）。相比之下，ETT 期间的 ST 段变化（p=0.12）或二吡啶酰胺应激试验期间的 MPI（p=0.60）均不能区分病例组和对照组。
TWH 测量是一种新方法，可提高 ETT 和二吡啶酰胺药物应激试验期间 MPI 对大心外膜冠状动脉限制血流狭窄的检测。
