Preoperative assessment value of treadmill experimental Duke score of coronary artery disease in patients with non-cardiac surgery / 中国综合临床

Objective To analysis of treadmill exercise test Duke score(DTS) in patients with coronary heart disease than the evaluation functions of heart operation perioperative cardiac events.Methods One hundred and eighty-four patients with coronary heart disease,45 ～ 75 years of medium-sized non cardiac operation,were chose from May,2010 to May,2011 in our hospital,Cardiac ultrasound,treadmill exercise test were taken before operation,preoperative examination department of internal medicine disease history and physical examinations.According to the Duke score,they were divided into DTS in low risk group (5 ≤ Duke ≤ 15,n =124),medium risk group DTS(DTS:(-10≤Duke≤5,n =60),the exclusions of patients with high-risk DTS group,and the high-risk group of patients were excluded.Comparative analysis of operations,the main type of Department of internal medicine disease history,intraoperative and postoperative major cardiovascular complications.Results In the two groups of operation type and the type of anesthesia and cardiovascular disease,there is no significant difference (P ＞ 0.05) ; in DTS low risk group the age (59.2 ± 4.1) years,preoperative cardiac dysfunction were 2 cases,left ventricular ejection fraction ＜ 0.50 were 2 case (1.6％),diabetes history 12 case(9.6％),with angina pectoris symptoms of 51 case(41.1％),ECG ischemic changes in 55 (44.3 ％),in the medium DTS risk group,the age(65.2 ± 2.6)years,preoperative cardiac dysfunction were 8 cases(13.3％),left ventricular ejection fraction of ＜ 0.50 was 5 case (8.3％),diabetes history 23 case (38.3 ％),angina pectoris and 60 case (100％),ECG ischemic changes in 40 case (66.7 ％) (t =2.98,P =0.042,x2 values were 4.93,3.84,4.67,5.24,3.58,P ＜0.05).The low risk group of patients with arrhythmia,hypertension incidence rate were 6.5％ (8/124) and 22.5％ (28/124),medium risk group of patients with arrhythmia,hypertension incidence rate were 11.6％ (7/60) and 18.3％ (11/60),compared with DTS in low risk group,DTS medium risk group of arrhythmia and hypertension odds ratio(Odds Ratio,OR) and 95％ confidence intervals were 1.7 (0.8-3.3),0.8 (0.4-1.4),the P values were 0.062,0.074,has no significant difference.Controlling for age and sex DTS in low risk group postoperative myocardial infarction,cardiogenic pulmonary edema rate were 0.8％ (1/124) and 2.4％ (3/124),medium risk group after DTS myocardial infarction,cardiogenic pulmonary edema rate were 10％ (6/60) and 11.7％ (7/60),compared with DTS in low risk group,DTS medium risk group after myocardial infarction and heart pulmonary edema ratios (Odds Ratio,OR) and 95％ confidence intervals were 19.3 (5.6-66.2),5.7 (2.5-12.9),the P values were 0.002,0.003,had significant diflerence.Conclusion DTS medium risk group patients undergoing non cardiac operation preoperative heart failure,diabetes,angina symptoms,peri operation period of cardiac event rate is high and heavy.

Exercise Treadmill Test in Detecting Asymptomatic Coronary Artery Disease in Type 2 Diabetes Mellitus

BACKGROUND: The present study was designed to develop criteria for screening patients with type 2 diabetes mellitus (T2DM) for asymptomatic coronary artery disease (CAD). METHODS: A total of 213 patients with T2DM without typical angina or chest pain were studied between 2002 and 2007. We also evaluated 53 patients with T2DM who had reported chest discomfort using an exercise treadmill test (ETT). RESULTS: Thirty-one of the 213 asymptomatic patients had positive ETT results. We performed coronary angiography on 23 of the 31 patients with a positive ETT and found that 11 of them had significant coronary stenosis. The main differences between the patients with significant stenosis and those with a negative ETT were age (63.1+/-9.4 vs. 53.7+/-10.1 years, P=0.008) and duration of diabetes (16.0+/-7.5 vs. 5.5+/-5.7 years, P or =60 years) with a long duration of diabetes (> or =10 years). The latter value is similar to that of patients with T2DM who presented with chest discomfort or exertional dyspnea. The PPV of the ETT in symptomatic patients was 76.9%. CONCLUSION: In the interest of cost-effectiveness, screening for asymptomatic CAD could be limited to elderly patients with a duration of diabetes > or =10 years.

Diagnostic performance of 64-slice spiral CT combined with exercise treadmill test for coronary artery disease / 上海交通大学学报（医学版）

Objective To explore the diagnostic performance of 64-slice spiral CT combined with exercise treadmill test for coronary artery disease ( CAD). Methods Eighty-six patients suspected of CAD were divided into low risk group, intermediate risk group and high risk group according to estimated pretest probabilities of CAD. All patients underwent coronary angiography, 64-slice spiral CT and exercise treadmill test. With coronary artery stenosis rate >50% as positive findings, the sensitivity, specificity, positive predictive value ( PPV), negative predictive value ( NPV) and accuracy of 64-slice spiral CT and 64-slice spiral CT combined with exercise treadmill test in diagnosis of CAD were calculated. Results With coronary angiography as the "golden criteria", the sensitivity, specificity, PPV, NPV and accuracy of 64-slice spiral CT in diagnosis of CAD were 95.2% , 88.6% , 88.9% , 95.1% and 91.9% , respectively. The sensitivity of low risk group, intermediate risk group and high risk group was 100% , 100% and 92.6%, specificity was 94.4% , 94.1% and 66.7%, PPV was 80.0%, 91.7% and 89.3%, NPV was 100% , 100% and 75.0%, and accuracy was 95.5% , 96.4% and 86.1%, respectively. The sensitivity, specificity, PPV, NPV and accuracy of 64-slice spiral CT combined with exercise treadmill test in diagnosis of CAD were 97.6%, 97.7%, 97.6%, 97.7% and 97.7%, respectively. Conclusion 64-slice spiral CT combined with exercise treadmill test works well in screening CAD, especially for those with a low or intermediate estimated pretest probability.

Characteristics of QT Interval Dispersion During Exercise-induced Changes of Heart Rate

BACKGROUND: QT interval dispersion (QTD) reflects the regional inhomogeneity of ventricular repolarization, and heart rate variability reflects the autonomic tone of the heart. The relation between QTD and heart rate is not clarified yet. The object of this study was to examine the influence of heart rate on QTD using exercise treadmill test in healthy subjects. METHODS: The influence of heart rate on QTD was studied in 42 young healthy pilots by evaluating the changes in QTD induced by hyperventilation and exercise. QTpeak interval dis-persion (QTp D) was defined as the difference between maximum and minimum QTpeak interval measured on 12 lead ECG at single cardiac beat. Paired t test was used between QTp D at rest, QTp D after hyperventilation and QTp D after exercise to determine the effect of heart rate on QTp D. RESULTS: The QTp D after hyperventilation (37+/-11 msec) was greater compared to QTp D at rest (35 +/-14 msec), but there was no difference (P>0.05). The QTp D after exercise was 31 +/-11 msec at stage 1, 28 +/-13 msec at statge 2 and 31 +/-12 msec at stage 3. and there was the significant difference in QTp D at statge 2 compared to QTp D at rest (P<0.05). CONCLUSION: The QTp D significantly decreased at stage 2 after graded exercise in healthy men. This finding suggests that anti-arrhythmogenic effect associated with decreased QTp D during physiologic exercise is present in apparently healthy men.