Lozner E C, Morganroth J
Circulation. 1977 Nov;56(5):799-802. doi: 10.1161/01.cir.56.5.799.
Thirty-seven subjects (10 asymptomatic and 27 symptomatic) who had undergone maximal treadmill exercise tests and coronary arteriography were selected to determine whether the predictive value of ST-segment depression as a marker of coronary artery disease (CAD) in asymptomatic subjects could be enhanced. All subjects had greater than or equal to 2 mm ST-segment depression during testing. Three of the ten asymptomatic subjects had significant CAD (predictive accuracy 30%) and all had greater than or equal to 2 mm ST depression in the one-minute recovery tracing. ST-segment depression resolved by one minute in all seven subjects without CAD. All 27 symptomatic subjects had CAD (predictive accuracy 100%) and 26 of 27 had greater than or equal to 1 mm (21/24 greater than or equal to 2 mm) ST depression in the one-minute recovery tracing. The age, maximum heart rate and exercise tolerance did not differ significantly between the symptomatic and asymptomatic subjects. Thus the predictive accuracy for CAD in asymptomatic subjects is not enhanced by increasing the degree of ST depression required for a positive exercise test. The predictive value may be enhanced if ST depression persists for greater than or equal to 2 minutes into recovery. These data suggest that by using new criteria accurate identification of asymptomatic patients with CAD by exercise testing may be practical.
选取37名接受过最大运动平板试验和冠状动脉造影的受试者（10名无症状，27名有症状），以确定无症状受试者中ST段压低作为冠状动脉疾病（CAD）标志物的预测价值是否可以提高。所有受试者在测试期间ST段压低均≥2mm。10名无症状受试者中有3名患有显著CAD（预测准确率30%），且在1分钟恢复期心电图中均有≥2mm的ST段压低。7名无CAD的受试者中，ST段压低在1分钟内均消失。所有27名有症状受试者均患有CAD（预测准确率100%），27名中有26名在1分钟恢复期心电图中有≥1mm（21/24≥2mm）的ST段压低。有症状和无症状受试者在年龄、最大心率和运动耐量方面无显著差异。因此，通过增加运动试验阳性所需的ST段压低程度，无症状受试者CAD的预测准确率并未提高。如果ST段压低在恢复期持续≥2分钟，预测价值可能会提高。这些数据表明，通过使用新的标准，通过运动试验准确识别无症状CAD患者可能是可行的。
