Liu Y B, Huang P J, Su C T, Chieng P U, Wu C C, Ho Y L
Department of Internal Medicine, National Taiwan University Hospital, Taipei, ROC.
Cardiology. 1998 Mar;89(3):229-34. doi: 10.1159/000006792.
The S-T segment/heart rate (ST/HR) slope has been proposed as a more accurate electrocardiographic criterion for the diagnosis of coronary artery disease, but studies comparing the diagnostic value of the ST/HR slope with exercise thallium imaging are scant. The aims of this study were to assess the diagnostic accuracy of the ST/HR slope, conventional S-T segment criteria and exercise thallium imaging in detecting coronary artery disease and to evaluate the effect of exercise level on the sensitivity and specificity of these three techniques. Ninety consecutive patients underwent treadmill testing and exercise thallium single-photon emission computed tomography (SPECT) simultaneously. All 90 patients also underwent coronary angiography within 1 month of the exercise test. We found that exercise thallium SPECT had a significantly higher diagnostic accuracy than either the ST/HT slope or conventional S-T segment criteria (thallium imaging 82%, ST/HR slope 67%, conventional S-T segment criteria 63%). The overall accuracy of the ST/HR slope was slightly but insignificantly greater than conventional S-T segment criteria (ST/HR slope 67%, conventional S-T segment criteria 63%; p = 0.639). In 50 patients with a lower exercise level, defined as not achieving 85% of their maximal predicted heart rate, the accuracy of the ST/HR slope was insignificantly greater (ST/HR slope 72%, conventional S-T segment criteria 66%; p = 0.517). In 40 patients with adequate exercise, the accuracy rate was the same (60%) for both the ST/HR slope and conventional S-T segment criteria. We conclude that exercise thallium imaging is more accurate than the ST/HR slope in diagnosing coronary artery disease and that the accuracy of the ST/HR slope is marginally better than conventional S-T segment criteria only in patients with a lower exercise level, and not in those with adequate exercise.
S-T段/心率（ST/HR）斜率已被提议作为诊断冠状动脉疾病更准确的心电图标准，但比较ST/HR斜率与运动铊显像诊断价值的研究较少。本研究的目的是评估ST/HR斜率、传统S-T段标准和运动铊显像在检测冠状动脉疾病方面的诊断准确性，并评估运动水平对这三种技术敏感性和特异性的影响。连续90例患者同时进行平板运动试验和运动铊单光子发射计算机断层扫描（SPECT）。所有90例患者在运动试验后1个月内也接受了冠状动脉造影。我们发现，运动铊SPECT的诊断准确性显著高于ST/HT斜率或传统S-T段标准（铊显像82%，ST/HR斜率67%，传统S-T段标准63%）。ST/HR斜率的总体准确性略高于传统S-T段标准，但差异无统计学意义（ST/HR斜率67%，传统S-T段标准63%；p = 0.639）。在50例运动水平较低（定义为未达到最大预测心率的85%）的患者中，ST/HR斜率的准确性略高，但差异无统计学意义（ST/HR斜率72%，传统S-T段标准66%；p = 0.517）。在40例运动充分的患者中，ST/HR斜率和传统S-T段标准的准确率相同（均为60%）。我们得出结论，运动铊显像在诊断冠状动脉疾病方面比ST/HR斜率更准确，并且ST/HR斜率的准确性仅在运动水平较低的患者中略优于传统S-T段标准，在运动充分的患者中则不然。
