Joy M, Trump D W
Br Heart J. 1981 Jan;45(1):48-55. doi: 10.1136/hrt.45.1.48.
Sixteen thousand resting electrocardiograms were performed on 14000 United Kingdom professional aircrew and air traffic control officers over a two-year period; 103 asymptomatic men with minor ST segment and T wave changes at rest were assessed by exercise electrocardiography and 19 responded abnormally. Five subjects had proven coronary artery disease, one hypertrophic obstructive cardiomyopathy, and one left ventricular dilatation on echocardiography. Eleven subjects were not investigated, of whom three had strongly positive exercise responses. One subject had a false positive response and assuming a false negative response of less than 2 per cent, then a sensitivity of 80.0 per cent, a specificity of 89.1 per cent, a predictive value for the exercise electrocardiogram of 44.46 per cent and for the resting electrocardiogram of 7.8 per cent is obtained. T wave changes induced by hyperventilation were common (53.4% of all). Ten (18.2%) subjects with hyperventilation-induced T wave changes responded abnormally to exercise, three having angiographically proven coronary artery disease lending little support to the contention that the two entities rarely coexist. In spite of the low return from routine electrocardiograms in a population with a low prevalence of coronary artery disease, three-eighths of those with significant coronary artery disease presented with minor ST segment and T wave changes on their resting electrocardiograms.
在两年时间里，对14000名英国职业机组人员和空中交通管制人员进行了16000次静息心电图检查；对103名静息时ST段和T波有轻微改变的无症状男性进行了运动心电图评估，其中19人反应异常。5名受试者被证实患有冠状动脉疾病，1名患有肥厚性梗阻性心肌病，1名经超声心动图检查发现左心室扩张。11名受试者未接受进一步检查，其中3人运动反应强烈阳性。1名受试者出现假阳性反应，假设假阴性反应低于2%，则运动心电图的敏感性为80.0%，特异性为89.1%，运动心电图的预测值为44.46%，静息心电图的预测值为7.8%。过度换气诱发的T波改变很常见（占所有情况的53.4%）。10名（18.2%）有过度换气诱发T波改变的受试者运动反应异常，其中3人经血管造影证实患有冠状动脉疾病，这几乎无法支持这两种情况很少同时存在的观点。尽管在冠状动脉疾病患病率较低的人群中，常规心电图的回报较低，但八分之三患有严重冠状动脉疾病的患者静息心电图显示ST段和T波有轻微改变。
