Furuse T, Mashiba H, Jordan J W, O'Donnell J, Morris S N, McHenry P L
Am J Cardiol. 1987 Jan 1;59(1):57-60. doi: 10.1016/s0002-9149(87)80069-3.
In lead CM5, the Q-wave response to exercise has been reported as an effective index in predicting coronary artery disease (CAD) and CAD with left anterior descending (LAD) disease. The purpose of this study was to verify these findings when the Q wave was analyzed in lead CC5 in 135 patients. The sensitivity for abnormal ST depression was 77%, specificity 83% and predictive value 78%. The corresponding values for the abnormal Q-wave response (reduction or no change in Q-wave amplitude) were 70%, 61% and 59%. These differences (except sensitivity) were significant. When either a positive ST or Q-wave response was used, sensitivity, specificity and predictive value did not significantly increase compared with the ST segment alone. In addition, only 45% of normal subjects with false-positive ST depression had a normal Q-wave response (increase) and 57% of patients with false-negative ST responses had an abnormal Q-wave response. When a positive response for CAD with an LAD lesion and for multivessel CAD with LAD narrowing was defined as having a Q-wave reduction, the sensitivities were extremely low (15% and 17%), but both the specificities and the predictive values were 100%. Therefore, the Q-wave analysis in lead CC5 is no more sensitive for detecting CAD than the ST-segment response. However, when a decreased Q-wave amplitude is observed, multivessel CAD and LAD narrowing can be predicted.
在CM5导联中，运动时Q波反应已被报道为预测冠状动脉疾病（CAD）及合并左前降支（LAD）病变的CAD的有效指标。本研究的目的是在135例患者的CC5导联中分析Q波时验证这些发现。异常ST段压低的敏感性为77%，特异性为83%，预测值为78%。异常Q波反应（Q波振幅降低或无变化）的相应值分别为70%、61%和59%。这些差异（除敏感性外）具有显著性。当使用ST段或Q波阳性反应时，与单独的ST段相比，敏感性、特异性和预测值并未显著增加。此外，仅有45%ST段压低假阳性的正常受试者Q波反应正常（增加），57%ST段反应假阴性的患者Q波反应异常。当将LAD病变的CAD及LAD狭窄的多支血管CAD的阳性反应定义为Q波降低时，敏感性极低（分别为15%和17%），但特异性和预测值均为100%。因此，CC5导联中的Q波分析在检测CAD方面并不比ST段反应更敏感。然而，当观察到Q波振幅降低时，可预测多支血管CAD和LAD狭窄。
