在怀疑微血管疾病的患者中,运动心电图的预后重要性
Morten Kraen1, Shahnaz Akil2, Bo Hedén2
1Department of Clinical Physiology, Skåne University Hospital, Lund University, Lund, Sweden morten.kraen@med.lu.se.
Heart (British Cardiac Society)
|February 14, 2026
概括
运动时的ST段抑郁症ECG在胸痛患者中对冠状动脉微血管功能障碍 (CMD) 的预后价值有限. 然而,减少运动能力仍然是主要心脏不良事件 (MACE) 的关键独立风险因素.
科学领域:
- 心脏病学 心脏病学
- 诊断成像 诊断成像 诊断成像
- 临床研究 临床研究
背景情况:
- 冠状动脉微血管功能障碍 (CMD) 与预后不佳和具有挑战性的非侵入性诊断有关.
- 之前的研究表明,在特定患者群体的运动心电图 (前心电图) 上,ST段抑郁症的高正预测值 (PPV) 是高的.
研究的目的:
- 评估前心电图 (ECG) 发现的预后价值,在怀疑心血管疾病的胸痛患者中,在使用心肌 perfusion SPECT (MPS) 排除心上狭窄后.
主要方法:
- 一个单一中心的观察性研究包括1021名接受MPS和ex-ECG的患者.
- 在MPS或不确定的前电图上患有缺血的患者被排除在外,留下760人进行分析.
- 主要不良心脏事件 (MACE) 通过国家登记处在平均8.5年内进行跟踪.
主要成果:
- 在最终队列的17% (n=760) 观察到异常的前心电图.
- 虽然卡普兰-梅尔曲线显示分离 (p=0.01),但异常的前电图并不是多变量调整后MACE的独立预测因子 (HR 1.1,p=0.6).
- 对MACE异常前电图的预后PPV很低 (25%),在没有已知的冠状动脉疾病的患者中进一步下降 (17%).
结论:
- 在前心电图上缺血性ST段变化对疑似CMD的患者中MACE的预后价值有限.
- 减少运动能力成为MACE的独立风险因素.
- 当在临床实践中有必要时,Ex-ECG仍然可能对功能评估有价值.
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