Degre S, Longo B, Thirion M, Stoupel E, Sobolski J, Berkenboom G, Vandermoten P, Brion J C
Cardiology. 1981;68 Suppl 2:178-85. doi: 10.1159/000173334.
Specificity and sensitivity of exercise ECG were compared to exercise stress thallium 201 scanning and coronary arteriograms in 70 male patients with typical or atypical chest pain complaints, without previous myocardial infarction. 50 patients (group I) did not receive any treatment; 20 patients (group II) received digitalis as preventive treatment of atrial arrhythmias or for no particular reason. Only subjects with concordant results in radionuclide and angiography examinations were considered as coronary artery disease patients. Exercise stress tests were performed sitting on the bicycle ergometer using a progressive loading profile (30 W for 3 min), to the symptom-limited capacity (VO2SL). Positive exercise ECG were confirmed on ST decrease (1.5 mm) or on absence or increase in R-wave-amplitude modifications (V5). In the group I patients, ECG-ST-modification sensitivity, specificity, predictive value (+) and efficiency were, respectively, 92, 82, 86 and 88%. R-wave-variation sensitivity, specificity, predictive value (+) and efficiency were, respectively, 41, 74, 65 and 56%. In the group II patients, ST-depression sensitivity, specificity, predictive value (+) and efficiency were, respectively, 100, 33, 59 and 65%. R-wave-variation sensitivity, specificity, predictive value (+) and efficiency were, respectively, 50, 70, 63 and 60%. It was concluded that R-wave-amplitude variations induced lower false positive responses than ST-segment depression in patients under digitalis treatment. False negative responses were unfortunately 50% using the R-wave criterion. Exercise ECG was finally judged as a poor indicator of CAD in patients under digitalis treatment.
在70例无既往心肌梗死病史、有典型或非典型胸痛主诉的男性患者中，将运动心电图的特异性和敏感性与运动应激铊201扫描及冠状动脉造影进行了比较。50例患者（I组）未接受任何治疗；20例患者（II组）接受洋地黄治疗，用于预防房性心律失常或无特殊原因。仅将放射性核素和血管造影检查结果一致的受试者视为冠心病患者。运动应激试验采用递增负荷方案（3分钟30瓦），在自行车测力计上坐位进行，直至症状限制能力（VO2SL）。运动心电图阳性通过ST段压低（1.5毫米）或R波振幅改变（V5导联）缺失或增加来确认。在I组患者中，心电图ST段改变的敏感性、特异性、预测值（+）和效率分别为92%、82%、86%和88%。R波改变的敏感性、特异性、预测值（+）和效率分别为41%、74%、65%和56%。在II组患者中，ST段压低的敏感性、特异性、预测值（+）和效率分别为100%、33%、59%和65%。R波改变的敏感性、特异性、预测值（+）和效率分别为50%、70%、63%和60%。得出的结论是，在接受洋地黄治疗的患者中，R波振幅改变引起的假阳性反应低于ST段压低。遗憾的是，使用R波标准时假阴性反应为50%。最终判定运动心电图在接受洋地黄治疗的患者中是冠心病的不良指标。
