Quyyumi A, Crake T, Wright C, Mockus L, Fox K
Eur Heart J. 1987 Feb;8(2):124-9. doi: 10.1093/oxfordjournals.eurheartj.a062239.
The value of ambulatory ST-segment monitoring in the detection of underlying coronary artery disease was investigated in one hundred consecutive patients who underwent exercise testing and coronary arteriography for chest pain. Forty-seven also had thallium-201 radioisotope imaging performed. Six of the 26 patients with normal coronary arteries and 52 of the 74 patients with significant coronary artery disease had ST-segment changes during 48 h of ambulatory monitoring (sensitivity 77%). In comparison, the sensitivity of conventional exercise testing was 73% and specificity was 81%. Previous myocardial infarction did not influence the results, but patients with poor left ventricular function more often had absence of ambulatory ST-segment changes. Three-vessel coronary artery disease was detected more efficiently (sensitivity 80%), compared with single vessel disease (sensitivity 50%). Thallium scintigraphy demonstrated defects of uptake in nine patients without ambulatory ST-segment changes (sensitivity 82%, specificity 71%). The majority of these patients had small inferior or posterior defects in thallium uptake. Only one patient with ambulatory ST-segment changes had normal coronary arteries and demonstrable spasm. Thus, ambulatory ST-segment monitoring is as valuable as stress testing in the detection of coronary artery disease and in addition helps detect patients with coronary spasm and normal coronary arteries.
对100例因胸痛接受运动试验和冠状动脉造影的连续患者进行了动态ST段监测在潜在冠状动脉疾病检测中的价值研究。47例患者还进行了铊-201放射性核素成像。26例冠状动脉正常的患者中有6例，74例有显著冠状动脉疾病的患者中有52例在48小时动态监测期间出现ST段改变（敏感性77%）。相比之下，传统运动试验的敏感性为73%，特异性为81%。既往心肌梗死不影响结果，但左心室功能差的患者更常无动态ST段改变。与单支血管疾病（敏感性50%）相比，三支血管冠状动脉疾病的检测效率更高（敏感性80%）。铊闪烁显像显示9例无动态ST段改变的患者有摄取缺陷（敏感性82%，特异性71%）。这些患者大多数在铊摄取方面有小的下壁或后壁缺陷。只有1例有动态ST段改变的患者冠状动脉正常且有明显痉挛。因此，动态ST段监测在冠状动脉疾病检测中与负荷试验一样有价值，此外还有助于检测出冠状动脉痉挛和冠状动脉正常的患者。
