Michaelides A P, Vyssoulis G P, Paraskevas P G, Skouros C G, Tsiamis E G, Toutouzas P K
University Cardiac Unit, Hippokrateion General Hospital, Athens, Greece.
J Electrocardiol. 1993 Jul;26(3):197-206. doi: 10.1016/0022-0736(93)90038-f.
To evaluate the clinical significance of observed R wave amplitude changes in exercise-induced supraventricular extrasystoles in comparison to the preceding sinus beat, 94 patients catheterized for possible coronary artery disease (CAD) were studied. Significant CAD was documented in 63 patients--34 with myocardial infarction (group A1) and 29 without (group A2)--whereas 31 patients had normal coronary arteries or coronary lesions less than 30% (group B). All patients underwent treadmill stress testing using the Bruce protocol within a month after cardiac catheterization. R wave amplitude increased or remain unchanged in extrasystole (R(x-s) > or = 0) in patients with CAD, while it decreased (negative R(x-s) in patients without significant CAD (P < .0001). In patients with CAD R(x-s) values were positively related to the number of obstructed coronary arteries (P < .01), while no significant difference was found between groups A1 and A2. The correlations of R wave amplitude changes in extrasystoles were significant with coronary obstruction score values (r = .82 and .85 in groups A1 and A2, respectively) and with left ventricular ejection fraction values (r = -.88, -.86 and -.90 in groups A1, A2, and B, respectively). R(x-s) > or = 0 value had a sensitivity of 79% and a specificity of 90% for CAD detection, while sensitivity was higher (89%) and specificity was lower (57%) for the prediction of left ventricular dysfunction. It is concluded that R(x-s) > or = 0 value is indicative of CAD, multivessel disease, and poor left ventricular performance, while its negative value is combined with minimal or no CAD and normal ejection fraction values.
为了评估运动诱发的室上性期前收缩中观察到的R波振幅变化相对于先前窦性搏动的临床意义，对94例因可能患有冠状动脉疾病（CAD）而接受心导管检查的患者进行了研究。63例患者被记录有显著CAD——34例有心肌梗死（A1组），29例无心肌梗死（A2组）——而31例患者冠状动脉正常或冠状动脉病变小于30%（B组）。所有患者在心脏导管检查后一个月内使用布鲁斯方案进行平板运动试验。CAD患者的期前收缩中R波振幅增加或保持不变（R(x-s)≥0），而无显著CAD的患者R波振幅降低（R(x-s)为负值）（P<0.0001）。CAD患者的R(x-s)值与阻塞冠状动脉的数量呈正相关（P<0.01），而A1组和A2组之间未发现显著差异。期前收缩中R波振幅变化与冠状动脉阻塞评分值（A1组和A2组分别为r = 0.82和0.85）以及左心室射血分数值（A1组、A2组和B组分别为r = -0.88、-0.86和-0.90）显著相关。R(x-s)≥0值检测CAD的敏感性为79%，特异性为90%，而预测左心室功能障碍时敏感性较高（89%），特异性较低（57%）。结论是，R(x-s)≥0值提示CAD、多支血管病变和左心室功能不良，而其负值则与极少或无CAD以及正常射血分数值相关。
