Ellestad M H, Famularo M A, Paliwal Y K
Herz. 1982 Apr;7(2):76-90.
Exercise testing, after having established the indication (Tables 1 and 2) is not only an important method for detection of coronary artery disease, it also enables delineation of exercise capacity and permits assessment of medical and surgical treatment. A subnormal increase in heart rate or blood pressure, or even a decrease in blood pressure, during exercise may frequently be found in patients with known coronary artery disease or in those at high risk of developing subsequent coronary events. Downsloping ST segment depression is highly specific for the presence of coronary artery disease; the specificity of upsloping ST segment depression can be increased on requiring this pattern to consist of a 2 mm depression 0.08 s beyond the J point. Consideration of the QTc interval may also be useful in patients with upsloping ST segment depression. Marked ST segment depression and early onset of ST segment depression during exercise is related to increasing severity of the disease while the duration of ST segment depression bears no certain relevance. ST segment elevation may be associated with transmural myocardial ischemia, left ventricular aneurysm or variant angina. An increase in the R wave amplitude appears indicative of multiple vessel disease, while a reduction in septal Q wave amplitude is suggestive of left anterior descending coronary artery occlusion. The current concept of testing asymptomatic patients for coronary artery disease has low predictive value. Post-myocardial infarction exercise testing is an objective method for evaluation of prognosis and guiding management. In the assessment of the results of aorto-coronary bypass surgery, the finding of persistent angina and/or ST segment depression during exercise is indicative of residual ischemia; normalization of the exercise ECG in the presence of a high-level exercise capacity is usually associated with good coronary perfusion. In order to provide maximum diagnostic utility, exercise testing must take into consideration other clinical findings as well as the prevalence of disease in the respective population. With respect to the coronary angiographic findings as well as the incidence of coronary events, the predictive value of exercise testing may be notably increased on consideration of multiple clinical and exercise variables. The exercise test has evolved into a clinically important noninvasive method for the evaluation of the functional aspects of the heart.
在确定适应症后（表1和表2），运动试验不仅是检测冠状动脉疾病的重要方法，还能描绘运动能力并允许评估药物和手术治疗。已知患有冠状动脉疾病的患者或有发生后续冠状动脉事件高风险的患者在运动期间常出现心率或血压异常升高，甚至血压下降。下斜型ST段压低对冠状动脉疾病的存在具有高度特异性；要求上斜型ST段压低在J点后0.08秒出现2毫米压低时，其特异性可增加。对于上斜型ST段压低的患者，考虑QTc间期可能也有用。运动期间明显的ST段压低和ST段压低的早期出现与疾病严重程度增加有关，而ST段压低的持续时间与疾病严重程度无明确相关性。ST段抬高可能与透壁性心肌缺血、左心室室壁瘤或变异型心绞痛有关。R波振幅增加似乎提示多支血管病变，而间隔Q波振幅降低提示左前降支冠状动脉闭塞。目前对无症状患者进行冠状动脉疾病检测的概念预测价值较低。心肌梗死后运动试验是评估预后和指导治疗的客观方法。在评估主动脉冠状动脉搭桥手术的结果时，运动期间持续心绞痛和/或ST段压低的发现提示残余缺血；在运动能力较高的情况下运动心电图正常化通常与良好的冠状动脉灌注相关。为了提供最大的诊断效用，运动试验必须考虑其他临床发现以及相应人群中的疾病患病率。关于冠状动脉造影结果以及冠状动脉事件的发生率，考虑多个临床和运动变量时，运动试验的预测价值可能会显著提高。运动试验已发展成为一种临床上重要的非侵入性方法，用于评估心脏的功能方面。
