The Research Of The Clinical Value Based On CI In Diagnosis Of CHD

Objective:1.To evaluate the diagnostic value of chronotropic incompetence(CI) in diagnosing coronary heart disease(CHD).2.To analyze the feasibility of each index sign of HRV and LVF in identifying the clinical features of CI for improving the clinical application of CI in identifying CHD.Methods:73 patients suspected with CHD were referred for a routine treadmill exercise test and subsequently underwent selective coronary angiography within 3 weeks.1.Left ventricular systolic function(EF,FS value) and the diastolic function parameters(Ea,Aa,Ea/Aa values) were observed by using color echocardiograph.2.Frequency domain analyse and time domain analyse methods were performed to calculate 5-minute short-range HRV. 3.Chronotropic function was detected by symptom-limited treadmill exercise test in all patients.4.According to the result of CAG,73 cases were divided into 2 groups:CAG positive group and CAG negative group,then it was compared that ST and CI criterion were used in diagnosis of CHD.Furtherly, all patients were divided into 4 groups:CI true positive group,CI false-positive group,CI false-negative group,CI true-negative group,and it was studied that HRV and LVF were used in identifying the clinical features of CI.Results:The incidence rate of CI in CAG positive group and CAG negative group were 68.8%versus 24.4%(P＜0.01).The sensitivity of CI,CI+ST and ST criterion in detecting CHD was 68.8%,65.6%versus 71.9%(P＞0.05);The specificity,75.6%,85.4%versus 56.1%(P＜0.05);The accuracy,72.6%, 76.7%versus 63.0%(P＜0.05).The analysis of LVF showed that Ea,Ea/Aa values of CI true positive group,CI false-negative group,respectively,were lower than the CI false positive group,CI true-negative group,Aa value reversed,and there was statistical difference in four groups(P＜0.05),on the other hand EF,FS were in the normal range in different groups,there were no statistical difference(P＞0.05).The analysis of HRV showed that SDNN, RMSSD,LF,HF of CI true positive group,CI false-negative group, respectively,were lower than the CI false positive group,CI true-negative group,LF/HF values reversed,and there was statistical difference in four groups(P＜0.05).Conclusion:1.CI was associated with the number and degree of diseased vessels,the more serious pathological change of vessels,the higher incidence of CI.. 2.CI is a valuable method for the diagnosis of CHD.The specificity and accuracy of CI were significantly higher than those of ST criteria in identifying CHD,and the sensitivity was no difference.. 3.Ea,Aa,Ea/Aa of LVF index sign have a identified value on the clinical significance of CI,but EF,FS of LVF index sign have no identified value. 4.SDNN,RMSSD,LF,HF,LF/HF of HRV index sign have a identified value on the clinical significance of CI.