Christison G W, Bonoris P E, Greenberg P S, Castellanet M J, Ellestad M H
J Electrocardiol. 1979;12(2):179-85. doi: 10.1016/s0022-0736(79)80027-8.
Coronary angiograms and treadmill stress tests were reviewed independently in 108 nonconsecutively selected cases. There were 16 patients (15%) with infarcts on ECG. Changes in R-wave amplitude and ST segments during exercise were evaluated to determine the sensitivity and specificity of each as a predictor of coronary artery disease (CAD). ST segment changes had a sensitivity of 49%, and a specificity of 74%. The sensitivity increased to 55% when infarcts were excluded. R-wave amplitude changes had a sensitivity of 68% and a specificity of 84%. The sensitivity increased to 78% when infarcts were excluded. An index formed by the sum of the change in R-wave amplitude and the magnitude of ST segment change yielded a sensitivity of 76% and specificity of 78%. The sensitivity increased to 84% when infarcts were excluded. There was no statistical difference between specificities for each criteria. Of those patients with an R-wave amplitude decrease, 69% had no coronary artery atherosclerosis, while 31% had significant lesions. Of those patients with no change or an increase in R-wave amplitude, 83% had coronary artery atherosclerosis, while 17% were normal. Of the 83% with coronary artery atherosclerosis, 81% had two and three vessel disease, while only 19% had single vessel disease. No change or an increase in R-wave amplitude during treadmill stress testing is a more reliable indicator of CAD in our laboratory than ST segment changes.
对108例非连续入选病例的冠状动脉造影和跑步机负荷试验进行了独立回顾。16例患者（15%）心电图有梗死表现。评估运动期间R波振幅和ST段的变化，以确定每项指标作为冠状动脉疾病（CAD）预测指标的敏感性和特异性。ST段变化的敏感性为49%，特异性为74%。排除梗死病例后，敏感性增至55%。R波振幅变化的敏感性为68%，特异性为84%。排除梗死病例后，敏感性增至78%。由R波振幅变化与ST段变化幅度之和构成的指数，敏感性为76%，特异性为78%。排除梗死病例后，敏感性增至84%。各标准的特异性之间无统计学差异。在R波振幅降低的患者中，69%无冠状动脉粥样硬化，31%有显著病变。在R波振幅无变化或升高的患者中，83%有冠状动脉粥样硬化，17%正常。在有冠状动脉粥样硬化的83%患者中，81%有双支和三支血管病变，只有19%有单支血管病变。在我们实验室，跑步机负荷试验期间R波振幅无变化或升高是比ST段变化更可靠的CAD指标。
