目的 观察变异型心绞痛患者12导联24h动态心电图ST段改变与冠状动脉造影提示冠状动脉狭窄的相关性.方法 对25例动态心电图显示ST段抬高的变异型心绞痛患者进行冠状动脉造影检查,将两者结果进行对比分析.结果 25例动态心电图发现与症状相关的ST段抬高的患者中,17例患者68％冠状动脉造影证实存在＞50％冠状动脉狭窄动态心电图判断的痉挛血管、LAD 20例、LCX 2例,RCA 4例,其中1例LAD及RCA同时发生.其中动态心电图提示LAD痉挛的20例患者,8例未见冠状动脉存在＞50％以上狭窄.对于7例双支或多支病变者,仅有1例动态心电图诊断与CAG结果完全符合.结论 动态心电图ST段改变对变异性心绞痛诊断有重要价值,此类患者常合并有冠状动脉病变,以LAD最多见.%Objective To observe the relationship between ST-segment changes by 12-lead Holter and coronary artery stenosis lesion by angiogram in patients with variant angina. Methods A total of 25 variant angina patients who were detected transient symptom-related ST-segment elevation by Holter were enrolled to perform angiogram. The relationship between ST-segment changes by Holter and coronary artery stenosis lesion by angiogram were compared. Results Among the 25 patients with symptom-related ST segment elevation, 17 patients (68% ) were found to have more than 50% stenosed lesion under angiogram. The most frequent target coronary artery was left anterior decending artery ( 16/25). The other eight patients with less than 50% coronary artery stenosis presented coronary spasm recorded by Holter monitoring. Five out of thirteen paitents with single vessel coronary artery disease assessed by Holter monitoring were confirmed to have more than 50% coronary artery stenosis under angiography. For those patients with multi-vessel coronary artery disease, only one patient was verified that the ECC changes was consistent with angiography. It suggested that consistency of ST-segment elevation by Holter monitoring were much higher in single vessel coronary artery disease while lower in multi-vessel coronary artery disease. Conclusion ST-segment changes found by Holter are important for the diagnosis vi variant angina.
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