| Background and objective: Coronary atherosclerotic plaque is the main cause of coronary artery stenosis.When the lumen is narrowed to a certain extent,myocardial ischemia will occur under the condition of increased myocardial oxygen consumption.Patients often show fatigue chest pain symptoms.At this time,if ECG is performed,the dynamic ischemic changes of ST-T can be captured.Based on the above mechanism,ECG treadmill exercise test can increase myocardial load and oxygen consumption through graded exercise,and judge whether there is coronary artery stenosis according to whether it can induce ECG dynamic ischemia change(with or without chest pain symptoms),which is a common auxiliary means to diagnose coronary heart disease.However,in clinical practice,it is often seen that ECG treadmill exercise test is negative and coronary angiography shows obvious stenosis of the lumen.For a long time,this contradiction has been defined as "false negative".In this study,we analyzed the related factors of patients with typical tired chest pain,negative treadmill exercise test and positive coronary angiography,and discussed the possible mechanism and clinical significance.Methods: from January 2018 to December 2019,179 patients who were the 967 Hospital of Joint Logistics Support Force of People's Liberation Army hospital due to tiring chest pain,who underwent ECG treadmill exercise test and coronary angiography at the same time and had positive coronary angiography were selected,including 118 males and 61 females,with an average age of 60.79 ± 5.90 years.According to the results of treadmill exercise test,the patients were divided into two groups: positive group(100 cases)and negative group(79 cases).Data of patients were collected:(1)baseline data,including gender,age,body mass index,blood pressure,heart rate,smoking,drinking,hypertension,diabetes,hyperlipidemia,medication before ECG treadmill exercise test,blood test,left ventricular ejection fraction,etc.;(2)data of symptom characteristics of chest pain,including time distribution of chest pain onset,activity content of induced chest pain,etc.;(3)ECG treadmill exercise test related data,including the implementation time(morning,afternoon)of ECG treadmill exercise test and the coincidence between the time of treadmill exercise test and the onset time of chest pain outside the hospital;(4)and coronary imaging and other data,including the number,location,degree of diseased vessels,etc.Statistical analysis was made on the recorded data,and logistic regression analysis was used to screen out the related factors of negative treadmill exercise test and positive coronary angiography.Results: 1.Comparison of baseline data between the two groups: there was no significant difference between the two groups in terms of gender,age,body mass index,blood pressure,heart rate,smoking,drinking,hypertension,diabetes,hyperlipidemia,medication before ECG treadmill exercise test,blood test,left ventricular ejection fraction and other general baseline data(P > 0.05).2.Comparison of symptoms of chest pain: the proportion of chest pain in the morning of positive group and negative group was 67.0% and 37.9%,the difference was statistically significant(The difference was statistically significant(P < 0.05),(2)47.0% and 37.9% of the patients had chest pain on the level fast walk,and(3)30.0%and 31.6% and 23.0% of the patients had chest pain on the up slope and emotional excitement,respectively,and the difference was statistically significant(P < 0.05).3.Comparison of ECG treadmill exercise test data: the ratio of treadmill exercise test in the morning was 60.0% in the positive group and 39.2% in the negative group(1),the difference was statistically significant(P < 0.05),(2)the ratio of the time of treadmill exercise test to the time of chest pain outside the hospital was 40.0% in the positive group and 18.9% in the negative group,the difference was statistically significant(P <0.05)Statistical significance(P < 0.05). 4.Comparison of coronary image data: there was no significant difference between the two groups in the number of lesions and involved parts(P > 0.05);there was one or more lesions in the two groups in the degree of stenosis in 50-70%,the negative group was higher than the positive group(43% vs.20%),the difference was statistically significant(P < 0.05).5.Logistic univariate regression analysis: it showed that the time of ECG treadmill exercise test in the afternoon,the time of treadmill exercise test did not coincide with the time of tiredness chest pain outside the hospital,the chest pain occurred in emotional excitement,the degree of stenosis was 50-70%,and the single vessel lesions were the related factors leading to the negative test of ECG treadmill exercise.6.Logistic regression analysis showed that the time of treadmill exercise was not consistent with the time point of chest pain,and 50-70% of coronary stenosis was the independent predictor of treadmill exercise test negative.Conclusion: 1.Negative treadmill exercise test and positive coronary angiography are common in patients with chest pain.The rate of false negative treadmill exercise test is as high as 44.1%.2.Negative treadmill exercise test and positive coronary angiography were related to many factors,among which the time of treadmill exercise test did not coincide with the time point of onset of chest pain outside the hospital,and the degree of coronary stenosis was 50-70%.3.Coronary imaging should be the first choice for patients with typical tiredness chest pain to avoid misdiagnosis.4.ECG treadmill exercise test is a functional examination method.Its negative means that there is no myocardial ischemia at the time of exercise,while coronary angiography is an anatomical examination method,and the positive does not necessarily lead to myocardial ischemia.Therefore,for patients with ECG treadmill exercise test negative and coronary angiography positive,the causes of fatigue chest pain,including further coronary function,should be further clarified Learn to test,truly realize the work. |
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