查詢結果分析
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頁籤選單縮合
題名 | Clinical Strategy for Coronary Microvascular Dysfunction in Patients with Chest Pain of Unknown Cause--the Role of Treadmill Exercise Testing=臨床評估不明原因胸痛病人之細小冠狀動脈功能--運動心電圖測試所扮演的角色 |
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作者 | 陳肇文; 徐迺雄; 丁紀臺; 李文領; 林幸榮; 張茂松; | 書刊名 | Acta Cardiologica Sinica |
卷期 | 15:2 1999.04[民88.04] |
頁次 | 頁81-92 |
分類號 | 415.3023 |
關鍵詞 | 胸痛; 冠狀血流貯備力; 細小冠狀動脈功能不良; 心肌缺氧; Chest pain; Coronary flow reserve; Coronary microvascular dysfunction; Myocardial ischemia; |
語文 | 英文(English) |
中文摘要 | 背景:目前已知一部分冠狀動脈攝影正常的胸痛病人,可因細小冠狀動脈功能不良 造成心肌缺氧的現象。至於運動心電圖測試是否可在臨床上偵測出這類病人有無心肌缺氧的 現象仍有所爭議。於是我們以二階段方式來評估運動心電圖測試的結果是否真可用來診斷這 類病人細小冠狀動脈功能異常之存在。 方法: 共有一系列 112 名冠狀動脈攝影正常的復發 性胸痛病人接受評估。經過一連串心臟、腸胃、精神及神經學方面的檢查,其中有 68 名 ( 占 61%) 之胸痛原因可被確定診斷。 另外 5 名病人則在再度接受心導管檢查後被診斷為 有輕度冠狀動脈狹窄。他們均被排除於後續研究之外。因此,共有 43 名病人因找不到胸痛 的原因 (共 40 名 ) 或因對胸痛原因的治療反應不佳 (共 3 名 ) 而接受運動心電圖測試 及冠狀血流力學檢查。這些病人之大心靜脈血流於靜脈注射 dipyridamole 前後被重覆測定 。結果: 比較 22 名運動心電圖測試出現心肌缺氧變化的病人和另外 21 名無心肌缺氧變化 的病人可以發現他們之間的冠狀血流在靜態下並無差異。然而前者於靜脈注射 dipyridamole 之後所得到的最大冠狀血流卻明顯低於後者。 和後者比較,前者 (即有心肌 缺氧心電圖變化者 ) 在注射 dipyndamole 後之最小冠狀血流阻力較南而冠狀血流貯備力則 較低。在這群不明原因的胸痛病人中,以運動心電圖測試結果來診斷細小冠狀動脈功能不良 (即冠狀血流貯備力 <2.5) 的靈敏度為 100%, 特異性為 84%,正預測率為 82%,及負預測 率為 100%。 結論: 本研究之結果顯示: 臨床上冠狀動脈血管攝影正常卻反覆胸痛之病人, 大部分仍可找到特定原因。當其他胸痛原因被排除之後,運動心電圖測試結果若出現心肌缺 氧變化則可做為細小冠狀動脈功能不良之指標。 |
英文摘要 | Background: Coronary microvascular dysfunction might contribute to myocardial test (TET) was proposed for its clinical role in detecting myocardial ischemia in this heterogeneous patient group. We use a two-step strategy to assess whether the results of TET could be related to coronary microvascular dysfunction in such patients. Methods: A total of 112 patients with recurrent chest pain and normal coronary angiograms were evaluated. In 68 (61%) of them, cardiac or non-cardiac causes of chest pain were first identified by serial cardiac, gastroenterological, psychological, and neurological evaluations. Among them, 4 patients (1 anxiety disorder, 1 esophageal motility disorder and 2 esophageal reflux) failed to respond to the given treatment. These 4 patients and another 44 patients who had no identifiable cause for chest pain were then admitted and undertook coronary angiograms for further evaluation. Great cardiac venous flow (GCVF) was measured both before and after dipyridamole infusion. Results: Baseline hemodynamics did not differ between the 22 patients with and the 21 without exercise-induced myocardial ischemia. After dipyridamole infusion, maximum GCVF was significantly lower, minimum coronary vascular resis- tance higher, and coronary flow reserve lower in the former than the latter group. In these patients with chest pain of unknown cause, the sensitivity of TET to detect a reduced CFR < 2.5 was 100%, specificity 84%, positive predictive rate 82%, and negative rate 100%. Conclusion: The results suggest that ischemic-like ECG during exercise was related to coronary microvascular dysfunction in patients with recurrent angina, while other causes of chest pain were unlikely. |
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