Blumenthal D S, Weiss J L, Mellits E D, Gerstenblith G
Am J Med. 1981 May;70(5):1005-10. doi: 10.1016/0002-9343(81)90850-0.
The ability of a strongly positive stress test to predict left main coronary artery disease in people with suspected coronary artery disease but with minimal or no angina was investigated in 40 such patients. Nine had a history of myocardial infarction but no angina. Thirty-one had mild angina or a history of mild angina. The stress electrocardiograms were analyzed according to criteria known to be associated with left main coronary artery disease in moderately or severely symptomatic patients; (1) early S-T segment changes (stage I or II of exercise), (2) 2 mm or more S-T segment depression, (3) downsloping S-T segments, (4) associated exercise-induced hypotension, (5) prolonged S-T segment changes after the test (greater than or equal to 8 minutes) and (6) anterior and inferior S-T segment depression. The prevalence of left main coronary artery disease was 35 percent and that of any severe coronary artery disease 75 percent. The criterion of anterior and inferior electrocardiographic changes with exercise was most predictive of left main coronary artery disease (P less than 0.01 by chi 2). Exercise electrocardiography is useful in the prediction of left main or other severe coronary artery disease even when performed in patients who have minimal angina or in those who are asymptomatic after myocardial infarction.
在40例疑似冠心病但心绞痛轻微或无心绞痛的患者中，研究了强阳性负荷试验预测左主干冠状动脉疾病的能力。其中9例有心肌梗死病史但无心绞痛。31例有轻度心绞痛或轻度心绞痛病史。根据已知与中度或重度症状性患者左主干冠状动脉疾病相关的标准分析负荷心电图；（1）早期S-T段改变（运动I期或II期），（2）S-T段压低2mm或更多，（3）S-T段下斜型，（4）运动诱发的低血压，（5）试验后S-T段改变持续时间延长（大于或等于8分钟）以及（6）前壁和下壁S-T段压低。左主干冠状动脉疾病的患病率为35%，任何严重冠状动脉疾病的患病率为75%。运动时心电图前壁和下壁改变的标准对左主干冠状动脉疾病的预测性最强（χ2检验P<0.01）。即使在心绞痛轻微的患者或心肌梗死后无症状的患者中进行运动心电图检查，运动心电图对预测左主干或其他严重冠状动脉疾病也是有用的。
