Value of Exercise ECG for Risk Stratification in Suspected or Known CAD in the Era of Advanced Imaging Technologies.
Value of Exercise ECG for Risk Stratification in Suspected or Known CAD in the Era of Advanced Imaging Technologies.
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DOI：
10.1016/j.jcmg.2015.09.006
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发表时间：
2015-11
期刊：
影响因子：
--
通讯作者：
Beller GA
中科院分区：
文献类型：
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作者：
Bourque JM;Beller GA
运动负荷心电图（ExECG）未被充分利用，作为能够运动的心电图可解释患者的初始测试模式。尽管负荷心肌成像技术提供了有价值的诊断和预后信息，但来自ExECG的变量可以产生大量的风险分层数据，可以补充成像变量，也可以不进行同步成像。除运动诱发缺血性ST段压低外，AVR导联ST段抬高、运动后心率恢复异常、未能达到目标心率和运动能力差等标志物可改善ExECG的风险分层。例如，在ExECG上达到≥10个METS的患者的诱导性缺血发生率非常低，预后良好。相比之下，心脏成像技术增加了高风险人群（如功能能力差、糖尿病、慢性肾病）的诊断和预后价值。对有症状的疑似冠心病患者进行最佳检查选择需要以患者为中心的方法，考虑风险/获益比和成本效益。
Exercise stress electrocardiography (ExECG) is underutilized as the initial test modality in patients with interpretable electrocardiograms able to exercise. Although, stress myocardial imaging techniques provide valuable diagnostic and prognostic information, variables derived from ExECG can yield substantial data for risk stratification, either supplementary to imaging variables, or without concurrent imaging. In addition to exercise-induced ischemic ST depression, such markers as ST segment elevation in lead AVR, abnormal heart rate recovery post-exercise, failure to achieve target heart rate, and poor exercise capacity improve risk stratification of ExECG. For example, patients achieving ≥10 METS on ExECG have a very low prevalence of inducible ischemia and an excellent prognosis. In contrast, cardiac imaging techniques add diagnostic and prognostic value in higher risk populations (e.g. poor functional capacity, diabetes, chronic kidney disease). Optimal test selection for symptomatic patients with suspected coronary artery disease requires a patient-centered approach factoring in the risk/benefit ratio and cost-effectiveness.