【摘要】 目的　探讨负荷实验QRS延长指标诊断冠心病 (CAD)的最佳导联选择。方法　经冠状动脉造影确诊的CAD病人 37例 (CAD组 )及健康成人 5 2例 (正常组 )均行经食道心房调搏负荷实验 (TEAPT) ,测定I导联、V4及V5导联静息QRS间期 (QRSr)、负荷峰值QRS间期 (QRSp)及 12导联心电图ST段压低水平 ,比较各导联QRS延长指标 (QRSp r)间及与ST段压低标准间的诊断效能。 结果　CAD组的QRSp r值显著长于正常组 (t≥ 4 .5 9,P<0 .0 0 1)。以QRSp r在正常组的 99%上限值 3ms为界限值 ,在I导联、V4导联、V5导联及“三导联”(任一导联阳性则为阳性 )中 ,以QRSp r值在V5导联的诊断效能最好 ,且与ST段压低标准相比 ,其诊断冠心病的敏感性和准确性显著提高 (分别为 78.4 %对 5 6 .8% ,89.9%对 77.5 % ,P <0 .0 5 )。结论　V5导联之QRSp r是TEAPT诊断CAD的一项较好的新指标。更多还原

【Abstract】 Objective The aim of the study was to evaluate the best lead selection when QRS prolongation indexes were used to diagnose coronary artery disease(CAD) in cardiac stress test. Methods Thirty seven cases had coronary artery disease diagnosed by coronary arteriography( CAD group) and 52 cases were healthy adults(normal group). Transesophageal atrial pacing stress test(TEAPT)wereperformed in all 89 cases. QRS duration on lead I, lead V 4 and lead V 5 at rest(QRSr) and load peak(QRSp) and ST segment depression on 12 leads was measured respectively. Diagnostic power of the QRS prolongation indexes(QRSp r)and ST segment depression were compared. Results QRSp r in CAD group was significantly increased than that in normal group(t≥4.59,P<0.001).The 99% superior limit value was 3ms in group normal. Using the superior limit value as diagnostic criterion, among lead I?lead V 4?lead V 5 and "Three-leads"(The diagnostic criterion is a positive result was found on any lead.),the diagnostic power of QRSp r on lead V 5 was the best. Its sensitivity and accuracy was significantly higher than that of ST depression.(78.4% vs 56.8%,89.9% vs 77.5%,P<0.05 respectively). Conclusions The TEAPT induced QRS prolongation on lead V 5 is a new index in diagnosing CAD更多还原