Monserrat L, Peteiro J, Vázquez J M, Vázquez N, Castro Beiras A
Servicio de Cardiología, Hospital Juan Canalejo, La Coruña.
Rev Esp Cardiol. 1998 Mar;51(3):211-7. doi: 10.1016/s0300-8932(98)74735-9.
To assess the diagnostic value of exercise echocardiography in patients with complete left bundle branch block and clinical suspicion of coronary artery disease.
Among 1,176 exercise echocardiograms performed from May of 1994 to November of 1996, 92 showed complete left bundle branch block in the resting electrocardiogram. We retrospectively analyzed data of 23 patients who had coronary angiography performed within 6 weeks of the exercise echo (19 males and 4 females, age 62 +/- 8, resting ejection fraction 52 +/- 10%). Previous acute myocardial infarction was demonstrated in 8 of them. The development of new or worsening regional dysfunction was considered an ischaemic response on exercise echo; whereas we assumed that there was significant coronary artery disease on the coronariography whether there was > or = 1 vessel disease in patients without previous myocardial infarction or > or = 2 vessel disease in patients with previous infarction.
Ten patients showed multivessel disease (> or = 2 vessels, 6 with previous infarction); 5 one-vessel disease; and 8 non significant coronary artery disease. Exercise echocardiography sensitivity for ischaemia detection in the entire group was 86% (95% confidence interval 67-100%); the specificity was 67% (36-98%), predictive value of a positive test was 80% and predictive value of a negative test was 75%. Sensitivity for the detection of > 50% stenosis in the left anterior descending coronary territory was 92% (76%-100%) and specificity 64% (35%-92%); for right coronary artery sensitivity was 80% (55%-100%) and specificity 77% (54%-100%); and for left circumflex artery sensitivity was 70% (42%-98%) and specificity 69% (44%-94%).
Exercise echocardiography may be useful in the evaluation of patients with left bundle branch block and clinical suspicion of coronary artery disease; with good sensitivity and low specificity.
评估运动超声心动图对完全性左束支传导阻滞且临床怀疑有冠状动脉疾病患者的诊断价值。
在1994年5月至1996年11月期间进行的1176例运动超声心动图检查中，92例静息心电图显示为完全性左束支传导阻滞。我们回顾性分析了23例在运动超声心动图检查后6周内进行冠状动脉造影的患者的数据（19例男性和4例女性，年龄62±8岁，静息射血分数52±10%）。其中8例有既往急性心肌梗死病史。运动超声心动图上新发或加重的局部功能障碍被视为缺血反应；而对于冠状动脉造影，我们认为在无既往心肌梗死的患者中，若有≥1支血管病变，或在有既往梗死的患者中，若有≥2支血管病变，则存在显著冠状动脉疾病。
10例患者显示多支血管病变（≥2支血管，6例有既往梗死病史）；5例单支血管病变；8例冠状动脉疾病不显著。运动超声心动图对整个组缺血检测的敏感性为86%（95%置信区间67 - 100%）；特异性为67%（36 - 98%），阳性试验预测值为80%，阴性试验预测值为75%。检测左前降支冠状动脉区域狭窄>50%的敏感性为92%（76% - 100%），特异性为64%（35% - 92%）；右冠状动脉敏感性为80%（55% - 100%），特异性为77%（54% - 100%）；左旋支动脉敏感性为70%（42% - 98%），特异性为69%（44% - 94%）。
运动超声心动图可能有助于评估有左束支传导阻滞且临床怀疑有冠状动脉疾病的患者；具有良好的敏感性但特异性较低。
