Marwick T H, Torelli J, Harjai K, Haluska B, Pashkow F J, Stewart W J, Thomas J D
Department of Cardiology, Cleveland Clinic Foundation, Ohio 44195, USA.
J Am Coll Cardiol. 1995 Nov 1;26(5):1180-6. doi: 10.1016/0735-1097(96)81472-0.
This study examined the influence of left ventricular hypertrophy on the accuracy of exercise electrocardiography and echocardiography for detection of coronary artery disease.
Electrocardiographic repolarization abnormalities caused by left ventricular hypertrophy compromise the diagnostic accuracy of exercise electrocardiography but not of exercise echocardiography. The relative merits of these investigations are less well defined in patients with hypertrophy but without electrocardiographic (ECG) changes.
We prospectively evaluated 147 consecutive patients without prior myocardial infarction undergoing both exercise echocardiography and coronary arteriography. Coronary stenoses > 50% diameter were present in 62 patients (42%). Positive test results were defined by a new or worsening wall motion abnormality or > 0.1 mV of ST depression. Echocardiographic left ventricular hypertrophy (mass > 131 g/m2 in men, > 100 g/m2 in women) was identified in 68 patients. A subgroup with clinically suspected hypertrophy was defined according to the presence of ECG evidence of hypertrophy, hypertension or aortic stenosis.
The overall sensitivity of exercise echocardiography exceeded that of exercise electrocardiography (71% vs. 54%, p = 0.06). Echocardiographic hypertrophy had no significant effect on the sensitivity of either test. The specificity of exercise echocardiography exceeded that of exercise electrocardiography (91 vs. 74%, p = 0.01). In patients with hypertrophy, the specificity of exercise echocardiography exceeded that of exercise electrocardiography (95% vs. 69%, p < 0.01), whereas among patients without hypertrophy, the specificities (respectively, 87% and 78%) were more comparable. The accuracy of exercise echocardiography exceeded that of the exercise ECG in the overall group (82% vs. 65%, p = 0.002) and in patients with hypertrophy (85% vs. 60%, p = 0.004), but this difference was less prominent in patients without hypertrophy (80% vs. 69%, p = NS). In patients with clinically suspected hypertrophy, exercise echocardiography demonstrated a higher sensitivity, specificity and accuracy than exercise electrocardiography. The cost incurred in the identification of coronary disease was least with a strategy involving use of the exercise echocardiogram instead of routine exercise testing in patients with known or clinically suspected left ventricular hypertrophy.
Exercise echocardiography is more accurate than exercise electrocardiography for the detection of coronary artery disease in patients with known or clinically suspected left ventricular hypertrophy.
本研究探讨左心室肥厚对运动心电图及超声心动图检测冠状动脉疾病准确性的影响。
左心室肥厚引起的心电图复极异常会损害运动心电图的诊断准确性，但不会影响运动超声心动图的诊断准确性。在肥厚但无心电图（ECG）改变的患者中，这些检查的相对优势尚不太明确。
我们前瞻性评估了147例无既往心肌梗死病史且同时接受运动超声心动图和冠状动脉造影的连续患者。62例患者（42%）存在直径>50%的冠状动脉狭窄。阳性检测结果定义为新出现或加重的室壁运动异常或ST段压低>0.1 mV。68例患者经超声心动图检查发现左心室肥厚（男性质量>131 g/m²，女性>100 g/m²）。根据是否存在肥厚的ECG证据、高血压或主动脉狭窄，定义了一个临床疑似肥厚的亚组。
运动超声心动图的总体敏感性超过运动心电图（71%对54%，p = 0.06）。超声心动图显示的肥厚对两种检查的敏感性均无显著影响。运动超声心动图的特异性超过运动心电图（91%对74%，p = 0.01）。在肥厚患者中，运动超声心动图的特异性超过运动心电图（95%对69%，p < 0.01），而在无肥厚患者中，特异性（分别为87%和78%）更具可比性。运动超声心动图在总体组（82%对65%，p = 0.002）和肥厚患者（85%对60%，p = 0.004）中的准确性超过运动心电图，但在无肥厚患者中这种差异不太显著（80%对69%，p = 无显著性差异）。在临床疑似肥厚的患者中，运动超声心动图的敏感性、特异性和准确性均高于运动心电图。对于已知或临床疑似左心室肥厚的患者，采用运动超声心动图而非常规运动试验的策略，识别冠状动脉疾病的成本最低。
对于已知或临床疑似左心室肥厚的患者，运动超声心动图在检测冠状动脉疾病方面比运动心电图更准确。
