State of the art in stress testing and ischaemia monitoring.
State of the art in stress testing and ischaemia monitoring.
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DOI：
10.1023/a:1016364622124
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发表时间：
2002-09-01
期刊：
影响因子：
--
通讯作者：
Stern, Shlomo
中科院分区：
文献类型：
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作者：
Stern, Shlomo
心电图仍然是检测心肌缺血最广泛使用的方法。心绞痛和冠状动脉危险因素患者静息12导联心电图ST段异常似乎明确提示缺血性心脏病和不良预后。运动试验时ST段抑制是缺血性心脏病的一线刺激试验，尽管其平均敏感性仅为68%，特异性略高（77%）。运动试验缺血性ST反应患者胸痛的存在与否并不改变未来缺血性事件的风险。然而，恢复期ST段降低与急性冠状动脉事件和冠状动脉死亡的风险增加有关，而恢复期的无症状缺血甚至比运动期间更能预测。ST段下降的幅度并没有被证明能反映缺血的程度。因此，新的方法正在研究中，如增加R和Q波振幅标准，最大ST/心率斜率，心率相关的ST下降变化的线性回归分析和ST段振幅和斜率变化的积分。在门诊情况下出现阵发性ST段下降，即使没有伴有胸痛，也是短暂性缺血的表现，这类发作似乎代表预后不良。在医院环境中，通过持续监测检测到ST抑郁与临床预后相关。冠状动脉监护室入院后的前6-9小时ST段监测提供了重要的在线预后信息，并显著改善了早期风险分层。这种连续ST段监测克服了静态监测的一些局限性，因为它提高了捕捉ST段偏差最大值的可能性，以及早期表现为反复ST段抬高的再闭塞发作。
Electrocardiography remains the most widely used method for detecting myocardial ischemia. ST segment abnormalities in the resting 12-lead electrocardiogram in subjects with angina and coronary risk factors seem to definitely indicate ischemic heart disease and an adverse prognosis. ST depression during exercise testing is the first line provocative test for ischemic heart disease although it has a mean sensitivity of only 68% and a slightly higher specificity (77%). The presence or absence of chest pain in patients with an ischemic ST response to exercise testing does not change the risk of future ischemic events. However, ST depression during the recovery period is associated with increased risk both for acute coronary events and coronary death, whereas silent ischemia during recovery is an even stronger predictor than during exercise. The amplitude of ST depression has not been documented to reflect the magnitude of ischemia. Therefore, new methods are under investigation such as adding R and Q wave amplitude criteria, maximal ST/heart rate slope, linear regression analysis of the heart rate related change in ST depression and a score integrating ST segment amplitude and slope changes. The demonstration of episodic ST segment depressions in the ambulatory setting, even without accompanying chest pain, are an expression of transient ischemia and such episodes seem to represent a poor prognosis. In the hospital setting, ST depression detected by continuous monitoring is related to the clinical outcome. ST segment monitoring during the first 6-9 hours after coronary care unit admission provides important prognostic information on-line and considerably improves early risk stratification. Such continuous ST monitoring overcomes some of the limitations of static monitoring, as it improves the likelihood of capturing the maximal point of ST deviation, as well as early episodes of reocclusion that are manifest as recurrent ST elevation.