VALUE OF NORMAL ELECTROCARDIOGRAPHIC FINDINGS IN PREDICTING RESTING LEFT-VENTRICULAR FUNCTION IN PATIENTS WITH CHEST PAIN AND SUSPECTED CORONARY-ARTERY DISEASE
VALUE OF NORMAL ELECTROCARDIOGRAPHIC FINDINGS IN PREDICTING RESTING LEFT-VENTRICULAR FUNCTION IN PATIENTS WITH CHEST PAIN AND SUSPECTED CORONARY-ARTERY DISEASE
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DOI：
10.1016/0002-9343(89)90439-7
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发表时间：
1989-06-01
影响因子：
5.9
通讯作者：
GIBBONS, RJ
中科院分区：
文献类型：
--
作者：
OKEEFE, JH;ZINSMEISTER, AR;GIBBONS, RJ
左心室功能的表征在管理冠状动脉疾病患者中是重要的。虽然有许多方法可用于评估左心室功能，但大多数都是昂贵的，侵入性的，或两者兼而有之。在这项研究中，我们检查了正常或接近正常的静息心电图结果预测静息左心室射血分数的能力，通过静息放射性核素血管造影测量，在874例胸痛和可疑的冠状动脉疾病。对4，410例马约诊所患者进行了回顾性分析，这些患者接受了静息和运动放射性核素心室造影术，以评价胸痛和已知或疑似冠状动脉疾病;其中，874例患者符合本研究的入选标准。在与放射性核素研究相同的评价中获得15导联心电图，由在实验室工作的心脏病专家或心脏病学实习生进行解读。在590名无心肌梗塞病史和完全正常的静息心电图结果而无非特异性ST-T波异常的患者中，平均左心室射血分数为0.63 ± 0.05。0.004，559例患者（95%）静息射血分数正常（定义为0.50或更高）。非特异性ST-T波异常（P < 0.001）和较小程度的心肌梗死史（P =0.06）是静息射血分数异常的独立预测因素。在185例非特异性ST-T波异常且无心肌梗死病史的患者中，平均左心室射血分数为0.61 ± 0.001。在36例有非特异性ST-T波异常和心肌梗塞病史的患者中，平均左心室射血分数为0.53 ± 0.009。静息射血分数正常者占72%。因此，在疑似冠心病但无既往心肌梗死病史的患者中，静息12导联心电图完全正常的结果是左心室功能正常的可靠（95%）预测因素。如果观察到非特异性ST-T波异常，特别是如果有既往梗死病史，心电图结果的预测价值就会降低。
Characterization of left ventricular function is important in managing patients with coronary artery disease. Although many methods are available to assess left ventricular function, most are either expensive, invasive, or both. In this study, we examined the ability of normal or near-normal resting electrocardiographic findings to predict resting left ventricular ejection fraction, measured by resting radionuclide angiography, in 874 patients with chest pain and suspected coronary artery disease. A retrospective review was undertaken of 4,410 Mayo Clinic patients who underwent rest and exercise radionuclide ventriculography for the evaluation of chest pain and known or suspected coronary artery disease; of these, 874 patients met the inclusion criteria for the current study. A 15-lead electrocardiogram, which was interpreted by the cardiologist or cardiology trainee working in the laboratory, was obtained at the same evaluation as the radionuclide study. In 590 patients with no previous history of a myocardial infarction and entirely normal resting electrocardiographic results without non-specific ST-T wave abnormalities, the mean left ventricular ejection fraction was 0.63 .+-. 0.004, and 559 patients (95%) had a normal resting ejection fraction (defined as 0.50 or more). both nonspecific ST-T wave abnormalities (P < 0.001) and, to a lesser degree, a history of myocardial infarction (P =0.06) were independent predictors of an abnormal resting ejection fraction. In 185 patients with non-specific ST-T wave abnormalities and no history of myocardial infarction, the mean left ventricular ejection fraction was 0.61 .+-. 0.009, and 85% had a normal resting ejection fraction, In 36 patients with nonspecific ST-T wave abnormalities and a history of myocardial infarction, the mean left ventricular ejection fraction was 0.53 .+-. 0.021,and 72% had a normal resting ejection fraction. Thus, an entirely normal result on a resting 12-lead electrocardiogram in patients with suspected coronary disease but no history of a previous myocardial infarction is a reliable (95%) predictor of normal left ventricular function. If non-specific ST-T wave abnormalities are noted, particularly if there is a history of a previous infarction, the predictive value of the electrocardiographic findings is diminished.