Crawford M H, Mendoza C A, O'Rourke R A, White D H, Boucher C A, Gorwit J
Ann Intern Med. 1978 Jul;89(1):1-5. doi: 10.7326/0003-4819-89-1-1.
To assess the value of continuous ambulatory electrocardiogram (ECG) monitoring for detecting coronary artery disease in symptomatic patients, we evaluated 70 patients with chest pain and normal resting ECGs prospectively by calibrated ambulatory monitoring, graded treadmill exercise, and selective coronary cineangiography. Ischemic-type ST-wave changes were detected by monitoring in 24 of the 39 patients with coronary artery disease (62% sensitivity). Twenty-six of the 39 patients had a positive treadmill (67% sensitivity). Of the 31 patients without coronary disease on angiography, 19 had negative monitoring studies (61% specificity). The treadmill was negative in 23 of these 31 patients (75% specificity). When the results of both tests were combined, 85% of the cases of coronary artery disease were detected, but only 52% of the patients without disease had negative studies. We conclude that continuous ambulatory monitoring is of limited value for detecting or excluding coronary artery disease in symptomatic patients with normal resting ECGs.
为评估动态心电图（ECG）监测对有症状患者检测冠状动脉疾病的价值，我们通过校准动态监测、分级平板运动试验和选择性冠状动脉造影，对70例胸痛且静息心电图正常的患者进行了前瞻性评估。在39例冠状动脉疾病患者中，通过监测发现24例有缺血型ST段改变（敏感性62%）。39例患者中有26例平板运动试验阳性（敏感性67%）。在血管造影显示无冠状动脉疾病的31例患者中，19例监测结果为阴性（特异性61%）。这31例患者中有23例平板运动试验阴性（特异性75%）。当两项检查结果联合应用时，85%的冠状动脉疾病病例被检测出来，但在无疾病的患者中只有52%的检查结果为阴性。我们得出结论，对于静息心电图正常的有症状患者，动态监测在检测或排除冠状动脉疾病方面价值有限。
