Pic A, Broustet J P
Arch Mal Coeur Vaiss. 1984 Jan;77(1):54-63.
Two hundred and fifteen patients were examined: 20 athletes, 40 subjects with radiologically normal coronary arteries (NCA) and 155 patients with one or more coronary artery stenoses (82 without, 73 with previous myocardial infarction). Exercise testing was by bicycle ergometry. The ECG recordings obtained by a computerised system had stable base lines and variations in QRS amplitude related to respiration were eliminated. The changes in amplitude of the R wave (delta R) and QRS complex (delta QRS) during exercise are interesting, especially in lead CM5. The amplitude decreases or remains the same in athletes (delta R = -1.3 +/- 3.2 mm; delta QRS = 0.7 +/- 3.4 mm) and in patients with NCA (delta R = -0.2 +/- 2.5 mm; delta QRS = 0.5 +/- 3.1 mm). This contrasted with the coronary group in whom these amplitudes increased significantly (delta R = 1.5 +/- 2.9 mm; delta QRS = 3.1 +/- 3.2 mm, p less than 0,001). These variations did not give indications of ischaemia of another region or of the presence of an aneurysm in patients with previous infarction. The greatest variations in amplitude were observed in patients with signs of previous inferior infarction. Can this method provide diagnostic information in patients without previous myocardial infarction? If positive delta R and delta QRS are defined as increases of at least 1 mm on exercise, the diagnostic value of these changes (sensitivity: delta R = 58.5%, delta QRS = 78%; specificity: delta R = 67.5%, delta QRS = 57.5%) is comparable with the classical signs of: pain (sensitivity: 63%; specificity: 75%) and ST depression of over 1 mm in CM5 (sensitivity: 72%; specificity: 62.5%). In conclusion, in patients without previous myocardial infarction, the reliability of exercise stress testing in diagnosing coronary artery disease can be increased when the following three parameters are taken into consideration: pain, ST segment, delta R or delta QRS or both. When all three signs are negative, the stress test can be considered negative (the 82 coronary patients had at least one positive sign). The positivity of one sign alone corresponds to a normal coronary circulation in the majority of cases. The presence of 2 or 3 positive signs is very much in favour of coronary artery disease.
对215名患者进行了检查：20名运动员、40名冠状动脉放射学检查正常（NCA）的受试者以及155名有一处或多处冠状动脉狭窄的患者（82名无既往心肌梗死，73名有既往心肌梗死）。运动测试采用自行车测力计。通过计算机系统获得的心电图记录基线稳定，与呼吸相关的QRS波幅变化已消除。运动期间R波（δR）和QRS复合波（δQRS）的波幅变化很有意思，尤其是在CM5导联。运动员（δR = -1.3±3.2 mm；δQRS = 0.7±3.4 mm）和NCA患者（δR = -0.2±2.5 mm；δQRS = 0.5±3.1 mm）的波幅降低或保持不变。这与冠状动脉疾病组形成对比，该组中这些波幅显著增加（δR = 1.5±2.9 mm；δQRS = 3.1±3.2 mm，p＜0.001）。这些变化未提示既往梗死患者存在其他区域缺血或动脉瘤。既往有下壁梗死体征的患者波幅变化最大。该方法能否为无既往心肌梗死的患者提供诊断信息？如果将运动时δR和δQRS阳性定义为至少增加1 mm，这些变化的诊断价值（敏感性：δR = 58.5%，δQRS = 78%；特异性：δR = 67.5%，δQRS = 57.5%）与以下经典体征相当：疼痛（敏感性：63%；特异性：75%）和CM5导联ST段压低超过1 mm（敏感性：72%；特异性：62.5%）。总之，对于无既往心肌梗死的患者，当考虑以下三个参数时，运动负荷试验诊断冠状动脉疾病的可靠性可提高：疼痛、ST段、δR或δQRS或两者。当所有三个体征均为阴性时，负荷试验可视为阴性（82名冠状动脉疾病患者至少有一个阳性体征）。仅一个体征阳性在大多数情况下对应冠状动脉循环正常。出现2个或3个阳性体征则非常支持冠状动脉疾病。
