Shaw L J, Peterson E D, Shaw L K, Kesler K L, DeLong E R, Harrell F E, Muhlbaier L H, Mark D B
Center for Cardiovascular Epidemiology, Division of Cardiology, Emory University, Atlanta, GA, USA.
Circulation. 1998 Oct 20;98(16):1622-30. doi: 10.1161/01.cir.98.16.1622.
Exercise testing is useful in the assessment of symptomatic patients for diagnosis of significant or extensive coronary disease and to predict their future risk of cardiac events. The Duke treadmill score (DTS) is a composite index that was designed to provide survival estimates based on results from the exercise test, including ST-segment depression, chest pain, and exercise duration. However, its usefulness for providing diagnostic estimates has yet to be determined.
A logistic regression model was used to predict significant (>/=75% stenosis) and severe (3-vessel or left main) coronary artery disease, and a Cox regression analysis was used to predict cardiac survival. After adjustment for baseline clinical risk, the DTS was effectively diagnostic for significant (P<0.0001) and severe (P<0.0001) coronary artery disease. For low-risk patients (score >/=+5), 60% had no coronary stenosis >/=75% and 16% had single-vessel >/=75% stenosis. By comparison, 74% of high-risk patients (score <-11) had 3-vessel or left main coronary disease. Five-year mortality was 3%, 10%, and 35% for low-, moderate-, and high-risk DTS groups (P<0.0001).
The composite DTS provides accurate diagnostic and prognostic information for the evaluation of symptomatic patients evaluated for clinically suspected ischemic heart disease.
运动试验有助于评估有症状患者，以诊断严重或广泛的冠状动脉疾病，并预测其未来发生心脏事件的风险。杜克运动平板评分（DTS）是一个综合指标，旨在根据运动试验结果提供生存估计，包括ST段压低、胸痛和运动持续时间。然而，其在提供诊断估计方面的有用性尚未确定。
采用逻辑回归模型预测显著（≥75%狭窄）和严重（三支血管或左主干）冠状动脉疾病，并采用Cox回归分析预测心脏生存情况。在对基线临床风险进行调整后，DTS对显著（P<0.0001）和严重（P<0.0001）冠状动脉疾病具有有效的诊断价值。对于低风险患者（评分≥+5），60%没有≥75%的冠状动脉狭窄，16%有单支血管≥75%的狭窄。相比之下，74%的高风险患者（评分<-11）患有三支血管或左主干冠状动脉疾病。低、中、高风险DTS组的五年死亡率分别为3%、10%和35%（P<0.0001）。
综合DTS为评估临床疑似缺血性心脏病的有症状患者提供了准确的诊断和预后信息。
