Greenberg P S, Ellestad M H
Angiology. 1980 Apr;31(4):230-7. doi: 10.1177/000331978003100402.
The treadmill stress test and antiographic records of 18 patients with left bundle block on resting ECG were reviewed retrospectively. Thirteen of the patients had significant coronary artery disease defined as greater than or equal to 70% cross-sectional narrowing of one or more vessels, while 5 patients were hemodynamically and angiographically normal. The R-wave and ST-segment response to exercise were determined in each case and compared. A positive R-wave response was an exercise-induced increase or no change in amplitude over the baseline level, while a positive ST-segment response was greater than or equal to 2 mm of excerise-induced depression over the baseline level. The sensitivity for the R-wave response was 69% (9 of 13), the specificity was 100% (5 of 5), and the predictive value was 100% (9 of 9). For ST depression these values were 46% (6 of 13), 40% (2 of 5)8 and 67% (6 of 9). Although the number of patients in this study is small--a reflection of the fact that ST depression in the presence of left bundle branch block with exercise is associated with many false positive responses and hence less referral for stress testing--it appears that the R-wave response to exercise in the presence of left bundle branch block can accurately detect coronary artery disease.
回顾性分析了18例静息心电图显示左束支传导阻滞患者的平板运动试验和血管造影记录。其中13例患者患有严重冠状动脉疾病，定义为一支或多支血管的横截面积狭窄大于或等于70%，而5例患者在血流动力学和血管造影方面正常。确定并比较了每例患者运动时的R波和ST段反应。阳性R波反应是指运动诱发的振幅相对于基线水平增加或无变化，而阳性ST段反应是指运动诱发的压低相对于基线水平大于或等于2mm。R波反应的敏感性为69%（13例中的9例），特异性为100%（5例中的5例），预测值为100%（9例中的9例）。对于ST段压低，这些值分别为46%（13例中的6例）、40%（5例中的2例）和67%（9例中的6例）。尽管本研究中的患者数量较少——这反映了在左束支传导阻滞伴运动时ST段压低与许多假阳性反应相关，因此接受运动试验的转诊较少这一事实——但似乎左束支传导阻滞患者运动时的R波反应能够准确检测冠状动脉疾病。
