| Backgroud:Ischemic heart disease (IHD) is a common type of coronary heart disease and is becoming the number one killer threat to human life. In the past years,IHD had a higher incidence in elderly people, but according to recent clinical studies found that IHD is moving in the younger individual, mostly thirty years old adults (the pressure of life,the fast pace of life and irregular eating habits, are increasing).For the diagnosis,treatment and the pathogenesis of IHD,the reseachers can’t be come to one agreement. With the popularity of technology of interventional diagnosis and treatment of coronary artery, it has been found that many patients with evidence of myocardial ischemia have been found normal through coronary angiography.On the contrary, quite a number of patients with severe coronary artery stenosis and even chronic occlusion through coronary angiography,but there is no evidence of angina pectoris and myocardial ischemia. So there is no direct corresponding relationship between chronic coronary artery stenosis and ischemia.At present, with the popularity of coronary CT, a growing number of clinicians only choose coronary CT and ignored which is an important noninvasive test method in the evaluation of myocardial ischemia and the diagnosis of coronary heart disease (CHD) in the clinical.Objective:This study is to make the coronary artery stenosis patients with CT to do the exercise treadmill test, and according to the result decide whether to do the coronary angiography examination or coronary interventional therapy. And expounded the correlation of the degree of coronary stenosis and myocardial ischemia.Methods:Select42patients with stable angina which were treated in our hospital from October2013to August2014, According to the eight-year scientific diagnostic criteria:the past three months, the onset of angina attack frequency, duration, the degree of labor-induced chest pain and symptom relief after sublingual nitrates time remained stable; seizures associated with temporary ECG ST depression or T wave changes, after the attack, electrocardiogram gradually returned to normal, necrotic myocardial enzymes changed dynamically without myocardial and CT coronary vessels shown with different degrees of stenosis, lesion reference vessel diameter (RD) is larger than2.5mm. Exclusion criteria:acute coronary syndrome onset of ST-segment elevation or elevated cardiac enzymes in patients; severe liver and kidney dysfunction, cancer patients; patients allergic to contrast agents, heparin, etc.; various reasons can not tolerate coronary CT examination patients; with heart failure and left ventricular ejection fraction less than30%of the patients. All patients underwent coronary CT examination, the evaluation of the Coronary CT image with reference to the New York Heart Association coronary stenosis determination method, it was to be divided into three groups, as follows:Group A:Stenosis<50%(3cases of male and2female, mean age64.85±10.69). Group B:Stenosis50%-75%(7males and5females, mean age66.27±11.88). Group C:Stenosis>75%(17males and8females, mean age65.00±10.48).We need record the basic clinical data of all patients, and compare the patients’ age, sex, hypertension, diabetes, cardiac ejection fraction and other clinical baseline characteristics. All patients underwent exercise treadmill test, we observe the positive rate of exercise treadmill test of each group, thus elaborate the correlation of coronary stenosis and myocardial ischemia.Results:1. All patients completed the exercise treadmill test. It showed no significant difference in patients clinical baseline characteristics of age, gender, hypertension, diabetes, cardiac ejection fraction, etc.2.The lesion of three group: The single-vessel disease and multi-vessel disease and percentage of the number of cases of three group were respectively:1cases (20.00%),4cases (80.00%);2cases (16.67%),10cases (83.33%);3cases (12.00%),22cases (88.00%), P>0.05, it had no statistically significant difference of three groups in lesion; Diameter stenosis: group A32.07±4.03, group B67.64±4.2, group C85.71±4.47, P<0.05, it had statistically significant difference.3.After exercise treadmill test, There was only one patient came back positive of exercise treadmill test in group A and seven in group B and twenty two in Group C, so there was three patients came negative of exercise treadmill test in group C, It show that when coronary stenosis<50%, we cannot completely rule out myocardial ischemia; and coronary stenosis50%-75%, it may also have severe myocardial ischemia, this study showed that there are seven cases with ischemic symptoms; the same when coronary stenosis>75%, we cannot fully determine the myocardial ischemia on patients, and this test showed that it had three patients without of myocardial ischemia symptoms.Conclusions:1. The coronary artery stenosis<50%, also had symptoms of myocardial ischemia; Coronary artery stenosis in50%-75%, may have severe myocardial ischemia symptoms; At the same time, coronary artery stenosis>75%, also could have no myocardial ischemic symptoms, the two have no positive correlation.2. Exercise treadmill test plays an important role in the diagnosis of myocardial ischemia and provide strong evidence for interventional therapy. |
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