运动压力测试期间缺血,冠状动脉血管功能障碍的迹象?
Diantha J M Schipaanboord1, Tijn P J Jansen2, Luuk Scherpenhuijzen2
1Laboratory of Experimental Cardiology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
International journal of cardiology. Heart & vasculature
|January 14, 2025
概括
运动心电压力测试 (EST) 是高度特定的诊断冠状动脉血管功能障碍 (CVDys) 在患有心痛和非阻塞性冠状动脉疾病的患者. 它是冠状动脉 (CAS) 的一个有价值的指标,在较小程度上,冠状动脉微血管功能障碍 (CMD).
科学领域:
- 心脏病学 心脏病学
- 诊断成像 诊断成像 诊断成像
- 血管医学 血管医学
背景情况:
- 冠状动脉微血管功能障碍 (CMD) 可能导致运动压力测试 (EST) 中的错误阳性.
- 患有心痛和非阻塞性冠状动脉疾病 (ANOCA) 的患者表现出各种冠状动脉动脉功能障碍 (CVDys),包括冠状动脉 (CAS) 和CMD.
- 在CVDys的整个频谱中,EST的诊断实用性需要调查.
研究的目的:
- 评估运动心电压力测试 (EST) 对冠状动脉血管功能障碍 (CVDys) 的整个谱的诊断价值.
- 评估EST在识别特定心血管疾病内型的准确性,即冠状动脉 (CAS) 和冠状动脉微血管功能障碍 (CMD).
主要方法:
- 对105名接受冠状动脉功能测试 (CFT) 和EST的患者进行了回顾性分析.
- 审查了EST报告,其中缺血是由显著的ST段抑郁所定义的.
- 对CVDys及其内型计算了灵敏度,特异性,正预测值 (PPV) 和负预测值 (NPV).
主要成果:
- 在105名患者中,22%的患者在EST期间经历了缺血. 90%的患者被诊断为CVDys,51名患者被诊断为单独的CAS,7名患者被诊断为CMD.
- 对于整体心血管疾病,EST诱导的缺血症表现出高特异性 (100%) 和PPV (100%).
- 对CAS的特异性和PPV高 (分别为94.4%和95.5%),而对于CMD,它们较低 (分别为85.5%和59.1%).
结论:
- 在EST期间的缺血症对于在ANOCA患者中诊断冠状动脉血管功能障碍 (CVDys) 具有高度特异性.
- EST作为冠状动脉 (CAS) 的可靠指标.
- EST的特异性较低,但对于在这个患者群体中识别冠状动脉微血管功能障碍 (CMD) 仍然很有价值.
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