平板运动试验对前降支近中段临界病变治疗的指导意义

Treadmill exercise test in guiding treatment of coronary intermediate lesions in proximal or middle left anterior descending artery

摘要:

目的 探讨平板运动试验在治疗冠状动脉前降支（LAD）近中段临界病变过程中的指导意义。方法 选择2012年6月至2014年3月在沈阳军区总医院心血管内科住院患者中，冠状动脉造影提示仅LAD近中段存在临界狭窄（直径狭窄30%～70%）病变、其他冠状动脉无明显狭窄的冠心病患者8例，男6例（75%），女2例（25%），年龄44～68（54.88±8.95）岁。入院后3d内行冠状动脉造影检查，若发现仅LAD近中段存在临界病变，则造影术后行平板运动试验。若平板运动试验阳性，则对前降支病变进行介入干预；若平板运动试验阴性，则药物保守治疗。结果 冠状动脉造影直径狭窄程度为30%～70%，平板运动试验阳性者2例，均实施介入治疗，阴性者6例，均采取药物保守治疗。所有患者均进行临床随访，随访时间为1个月～1年。接受介入治疗的2例患者未再出现胸痛等不适症状。接受药物保守治疗的患者胸痛症状亦得到缓解，无严重心脏不良事件发生。结论 平板运动试验在指导LAD近中段临界病变治疗过程中有重要作用。

Abstract:

Objective To determine the guiding value of treadmill exercise test (TET) in the treatment of coronary intermediate lesions in proximal or middle left anterior descending artery (LAD). Methods Eight coronary heart disease patients with moderate coronary artery stenosis (diameter stenosis 30%?70%) in proximal or middle LAD and without obvious lesions in other coronary arteries admitted in our department from June 2012 to March 2014 were enrolled in this study. The patients were 6 males (75%) and 2 females (25%), at an age of (54.88±8.95) (ranging from 44 to 68) years. Coronary angiography was carried out on the patients within 3d after admission. TET would be done if the patient was found to have coronary intermediate lesions only in the proximal or middle LAD. The patient would be treated with intervention if the positive result was found in TET. Otherwise the patient would be treated with the optimal drug strategy. Results Among the patients with the diameter stenosis of 30%?70%, TET was positive in 2 patients who were treated with intervention. The 6 patients negative to TET were treated with the optimal drug strategy. During the follow-up of 1 month to 1 year, the 2 patients accepting intervention had no any discomfort such as chest pain, and the 6 patients with drug treatment also felt well and reported no serious adverse cardiac event. Conclusion TET plays an important role in guiding the treatment of coronary intermediate lesions in proximal and middle LAD.