| Objective: When coronary atherosclerotic plaque leads to vascular lu men stenosis to a certain extent,myocardial ischemia will occur under the conditi on of increased myocardial oxygen consumption.Based on the above mechani sm,the treadmill exercise test(TET),as a functional testing method,U ses graded exercise to increase myocardial load and oxygen consumption,t o infer whether there is coronary artery stenosis based on whether myocardial i schemia can be induced,which is a common screening method for diagnosing cor onary heart disease.In this study,we analyzed the correlation between positive of the TET and negative of the simultaneous coronary angiogram(CAG),i.e.,fa lse positive of the TET,in clinically suspected patients with tired angina pectoris of coronary heart disease.Methods:From December 2017 to September 2019,370 patients admitted to the department of cardiology of the 967 hospital of the people’s liberation army(PLA)with suspected coronary heart disease due to fatigue chest pain and c hest tightness were enrolled,including 260 males and 110 females,aged 60.3+8.1 years.According to the CAG results,the patients were divided into the CAG positive group(n=299 cases)and the CAG negative group(n=71 case s).Baseline data and CAG data of all patients were collected,and the recorded d ata were statistically analyzed.Logistic regression analysis was performed to eva luate the influencing factors of TET positive and TET false positive.Results:(1)Compared with the consistent results of TET and CAG,among 370 patients,the positive results of the treadmill exercise test showed that there we re 299 patients with different degrees of stenosis that could be clearly diagnose d as coronary heart disease according to the CAG diagnosis results,and 71 pa tients without obvious stenosis or lumen diameter stenosis <50% were non-cor onary heart disease.The accuracy of TET in diagnosing cad was 80.8% and t he false positive rate was 19.2%.The accuracy of TET in diagnosing cad in m en was 87.7%(228/260 cases)and the false positive rate was 12.3%(23/260cases).The accuracy of TET in diagnosing cad in women was 64.5%(71/110 cases)and 35.5%(39/110 cases).(2)Baseline data of the two groups were compared.There were no statistically significant differences between the two groups in body mass index,blood pre ssure,heart rate,smoking,drinking,hypertension,diabetes,hyperlipidemia,drug use before exercise,blood test,left ventricular ejection fraction,and TET’s bull’s eye compliance rate(all p < 0.05).Women in the CAG negative group ac counted for more,were younger,and had more chest pain caused by emotional agitation,and it took longer to reach the bull ’s-eye rate.The difference was statistically significant compared with those in the CAG positive group(all P<0.05).(3)Influence factor analysis of TET’s "false positive" : univariate chi-square te st analysis showed that age,female,exercise time and mood were the ca uses of chest pain as the correlation factors of TET’s positive and CAG negative(all P <0.05).Logistic multi-factor regression analysis showed that women,age,ldl-c index and exercise time were independent influencing factors for false positive results of the plate exercise test,and there were significant statistical differences between the two groups(P <0.05).Conclusion:1.Exercise plate test is an ideal non-traumatic diagnostic method f or the diagnosis of coronary heart disease.2.The sensitivity and specificity of tre admill exercise test are affected by a variety of factors,especially gender,and th ere is a significant correlation between the two.The positive rate of treadmill ex ercise test and the negative rate of coronary angiography in women is higher,sothe diagnosis of coronary heart disease should be cautious.(4)According to the previous views,positive plate exercise test and negativ e coronary angiography were defined as "false positive".With the deepening understanding of coronary microcirculation,as a functional examination method,the results of plate exercise test should not be evaluated by the results o f coronary angiography,an anatomical examination method."false positiv e" diagnosis should be canceled,and the improvement of microcirculation fu nction in these patients should be paid more attention. |
PDF Full Text Request