Irace L, Aquino D, Scialdone A, Perna B, Sannino A, Elettrico C, Iacono A
Facoltà di Medicina e Chirurgia, II Università degli Studi di Napoli.
Minerva Cardioangiol. 1993 May;41(5):177-85.
ST elevation during ergometric stress test (EST) is relatively rare. Its prevalence depends upon the tested population but occurs more frequently in patients who have had myocardial infarction or variant angina. This phenomenon is very rare in patients with typical exertional angina and its pathogenesis is still unclear.
We studied a group of 75 consecutive patients with exertional angina who underwent EST and coronary angiography. A symptom limited EST was performed in the upright position on a cycloergometer with load increases of 25 watts every 3 minutes and 12 leads were monitored during all test. Coronary angiography was performed according to Judkins technique. From these patients, according to Froelicher's criteria, a group of 49 patients (age 32-68, mean 51.6 years), without myocardial infarction and/or left ventricular asynergy, was selected.
All patients had a coronary artery disease (16 patients with 3 vessels, 11 patients with 2 vessels and 22 patients with 1 vessel disease). The EST was positive for ST depression in 31 patients (63.3%) and for ST elevation in 5 patients (10.1%), while 13 patients (26.6%) had a non diagnostic EST. The ST elevation occurs in V1-V2 and it was associated in all cases with a stenosis in the left anterior descending (LAD) artery. Therefore we divided the 19 patients with LAD stenosis into two subgroups: subgroups A (9 patients, mean age 49.6 years) with LAD stenosis > or = 90% and subgroups B with LAD stenosis between 70% and 90%. ST elevation occurs in 5 patients (55.5%) of subgroup A and in no patient of the subgroup B. Moreover, in the subgroup A ST elevation seems to be related to the anatomic localization of the stenosis: in fact it appears in 83.3% of patients with LAD stenosis located before the onset of the first diagonal branch.
From these data it can be desumed that ST elevation in V1-V2 that occurs in patients with exertional angina and without myocardial infarction or variant angina is strongly predictive of a very important LAD stenosis.
运动负荷试验（EST）期间出现ST段抬高相对少见。其发生率取决于受试人群，但在心肌梗死或变异型心绞痛患者中更常见。这种现象在典型劳力性心绞痛患者中非常罕见，其发病机制仍不清楚。
我们研究了一组连续75例接受EST和冠状动脉造影的劳力性心绞痛患者。在直立位的自行车测力计上进行症状限制性EST，每3分钟负荷增加25瓦，所有测试期间监测12导联。根据Judkins技术进行冠状动脉造影。从这些患者中，根据Froelicher标准，选择了一组49例患者（年龄32 - 68岁，平均51.6岁），无心肌梗死和/或左心室运动失调。
所有患者均患有冠状动脉疾病（16例三支血管病变，11例两支血管病变，22例单支血管病变）。EST中31例患者（63.3%）ST段压低阳性，5例患者（10.1%）ST段抬高阳性，13例患者（26.6%）EST结果未明确诊断。ST段抬高出现在V1 - V2导联，所有病例均与左前降支（LAD）动脉狭窄相关。因此，我们将19例LAD狭窄患者分为两个亚组：A亚组（9例，平均年龄49.6岁）LAD狭窄≥90%，B亚组LAD狭窄在70%至90%之间。A亚组5例患者（55.5%）出现ST段抬高，B亚组无患者出现。此外，在A亚组中，ST段抬高似乎与狭窄的解剖定位有关：实际上，在第一对角支起始前LAD狭窄的患者中，83.3%出现ST段抬高。
从这些数据可以推测，劳力性心绞痛且无心肌梗死或变异型心绞痛患者中出现的V1 - V2导联ST段抬高强烈提示存在非常重要的LAD狭窄。
