Kodama Y
Department of Bioclimatology and Medicine, Kyushu University, Beppu, Japan.
Fukuoka Igaku Zasshi. 1995 Jul;86(7):304-16.
To establish the diagnostic criteria for myocardial ischemia, Holter monitoring and coronary angiography were performed on 46 cases (24 males (51.8 +/- 9.3 years), 22 females (47.5 +/- 10.5 years)). These patients were retrospectively selected from about 12000 patients who had the Holter monitorings from 1980 to 1993. The criteria for the entry were 1) reliable trend recordings of heart rate and 2) reliable recording of ST trend with accurate 1 mV calibration. The coronary stenosis greater than 75% in diameter was considered to be significant. Results were as follows: 1) ST trend pattern was classified into typical type, atypical type and box type. There were no significant differences in the incidence of typical and atypical types between ischemic and nonischemic groups, 2) Diagnostic accuracy of the criteria for myocardial ischemia, that is, the horizontal or downsloping ST segment depression with 0.1 mV at the point of 80 msec from the J point lasting for 1 minute, was higher in male than in female: the sensitivity was 93.3% and the specificity was 55.6% for men respectively, whereas the sensitivity was 66.7% and the specificity was 37.5% for women respectively, 3) Diagnostic accuracy of the ST/Heart rate ratio was 80.0% for the sensitivity and 64.7% for the specificity, indicating an improvement of specificity, 4) Maximal ST segment depression was accompanied by pain by 88.8% in true positive group (significant ST segment depression with significant coronary stenosis), whereas that was 28.6% in false positive group (significant ST segment depression without significant coronary stenosis), 5) Comparison of the degree of maximal ST segment depression, duration and frequency between computer and manual measurement showed a good correlation for the degree of maximal ST segment depression, whereas the duration and the frequency showed no significant correlations. The above results suggest that combined evaluation of the ST segment depression criteria (downsloping or horizontal ST segment depression greater than 1 mm at the point of 80 msec from the J point) and the ST/Heart rate criteria (1.4 microV/beats/min) is useful for the diagnosis of myocardial ischemia using Holter monitoring.
为确立心肌缺血的诊断标准，对46例患者（24例男性，年龄51.8±9.3岁；22例女性，年龄47.5±10.5岁）进行了动态心电图监测和冠状动脉造影。这些患者是从1980年至1993年期间约12000例行动态心电图监测的患者中回顾性选取的。入选标准为：1）心率趋势记录可靠；2）ST段趋势记录可靠且校准准确至1mV。冠状动脉直径狭窄大于75%被认为具有显著性。结果如下：1）ST段趋势模式分为典型型、非典型型和盒型。缺血组和非缺血组典型型和非典型型的发生率无显著差异；2）心肌缺血诊断标准（即J点后80毫秒处ST段水平或下斜型压低0.1mV持续1分钟）的诊断准确性男性高于女性：男性的敏感性分别为93.3%，特异性为55.6%，而女性的敏感性分别为66.7%，特异性为37.5%；3）ST/心率比值的诊断准确性敏感性为80.0%，特异性为64.7%，表明特异性有所提高；4）真阳性组（ST段显著压低且冠状动脉显著狭窄）中88.8%的最大ST段压低伴有疼痛，而假阳性组（ST段显著压低但无显著冠状动脉狭窄）中这一比例为28.6%；5）计算机测量和手工测量的最大ST段压低程度、持续时间和频率比较显示，最大ST段压低程度相关性良好，而持续时间和频率无显著相关性。上述结果表明，联合评估ST段压低标准（J点后80毫秒处下斜型或水平型ST段压低大于1mm）和ST/心率标准（1.4μV/次/分钟）有助于利用动态心电图监测诊断心肌缺血。
