Klepzig H, Standke R, Baum R P, Tezak S, Mildenberger D, Maul F D, Hör G, Kaltenbach M
Abteilung für Kardiologie, Klinikum der Johann Wolfgang Goethe-Universität, Frankfurt/Main, BRD.
Nuklearmedizin. 1988 Mar;27(2):57-62.
21 patients with LAD-stenoses of at least 70% and 21 patients with LAD-stenoses and additional intramural anterior wall infarctions were studied. 20 patients without heart disease or after successful transluminal coronary angioplasty and 18 patients with intramural anterior wall infarction after successful transluminal dilatation of the LAD (remaining stenosis maximal 30%) served as controls. The normal range of global and regional left ventricular ejection fraction response to exercise was defined based on the data of 25 further patients without relevant coronary heart disease. Thus, a decrease in global ejection fraction and regional wall motion abnormalities were judged pathological. All patients were comparable with respect to age, ejection fraction at rest and work load. Myocardial ischemia could be detected by the exercise ECG in 81% of all patients without infarction and in 71% of patients with infarction. The corresponding values for global left ventricular ejection fraction were 76% and 81%, respectively, and for regional ejection fraction 95% in both groups. No false-positive exercise ECGs were observed in the healthy controls and 2 (11%) in the corresponding group with intramural infarction. The global ejection fraction was pathological in 1 (5%) healthy subject without infarction and in 3 (17%) corresponding patients with infarction. Sectorial analysis revealed 5 and 22%, respectively. Our findings suggest that the exercise ECG has a limited sensitivity to detect myocardial ischemia in patients with isolated LAD-stenoses and intramural myocardial infarction. Radionuclide ventriculography yields pathological values more often; however, false-positive results also occur more frequently.
对21例左前降支狭窄至少达70%的患者以及21例左前降支狭窄且伴有壁内前壁梗死的患者进行了研究。20例无心脏病或经皮腔内冠状动脉成形术成功后的患者以及18例左前降支经皮腔内扩张成功后（残余狭窄最大为30%）伴有壁内前壁梗死的患者作为对照。根据另外25例无相关冠心病患者的数据确定了左心室整体和局部射血分数对运动反应的正常范围。因此，整体射血分数降低和局部室壁运动异常被判定为病理性的。所有患者在年龄、静息射血分数和工作负荷方面具有可比性。在所有无梗死的患者中，81%可通过运动心电图检测到心肌缺血，在有梗死的患者中这一比例为71%。两组患者整体左心室射血分数的相应值分别为76%和81%，局部射血分数均为95%。健康对照组未观察到运动心电图假阳性，壁内梗死相应组有2例（11%）出现假阳性。在无梗死的健康受试者中有1例（5%）整体射血分数病理性，在有梗死的相应患者中有3例（17%）整体射血分数病理性。扇形分析显示分别为5%和22%。我们的研究结果表明，运动心电图在检测孤立性左前降支狭窄和壁内心肌梗死患者的心肌缺血方面敏感性有限。放射性核素心室造影更常得出病理性值；然而，假阳性结果也更频繁出现。
