Clinical Study Of ST-T Segment Changes In Electrocardiogram During Drug Loading Myocardial Perfusion Imaging

Objective:Study on the value of ST-T segment changes in the diagnosis of coronary heart disease by drug loading myocardial perfusion imaging(MPI).Methods:45 patients with suspected coronary heart disease in our hospital were randomly divided into adenosine group or newtype selective adenosine receptor A2 a agonist drug group,and resting electrocardiogram,resting/drug load myocardial perfusion imaging and coronary angiography(CAG)were completed,and at the time of myocardial imaging,the electrocardiogram at 0,3,6,and 10 minutes during the injection of adenosine and newtype drug injections was collected.The results of coronary angiography were “gold standard”,and to analyze the value of drug load MPI and drug load induced ECG ST-T segment changes in the diagnosis of coronary heart disease.Results:CAG was used as the "gold standard" for the diagnosis of coronary heart disease,25 cases of adenosine group,14 cases of coronary heart disease,8 cases of males and 6 cases of females;11 cases of non-coronary heart disease,4 cases of males and 7 cases of females;There were 20 cases in the newtype drug group,8 cases of coronary heart disease diagnosed by coronary angiography,3 males and 5 females;12 non-coronary heart disease patients,7 males and 5 females.①Diagnostic efficacy analysis: sensitivity,specificity,positive predictive value,negative predictive value,and coincidence rate of adenosine load MPI and adenosine stress ECG were 79% vs 29%,55% vs 91%,69% vs 80%,67% vs 50%,respectively,68% vs 56%,the sensitivity and positive predictive value of the two were compared,P<0.05;the sensitivity,specificity,positive predictive value,negative predictive value and coincidence rate of newtype drug load MPI and newtype drug ECG wererespectively 88% vs 75%,75% vs 92%,70% vs 86%,90% vs 85%,80% vs 85%,P>0.05;the sensitivity and coincidence rate of newtype drug ECG were higher than adenosine ECG,P<0.05;The AUC value of newtype drug load MPI and ECG>0.8(P<0.05);②Analysis of combined diagnostic efficacy results: the sensitivity,specificity,positive predictive value,negative predictive value,and coincidence rate of adenosine MPI combined with electrocardiogram,adenosine MPI combined with left heart volume function parameters and the three combined were 79% vs 93% vs 93%,45% vs 45% vs 36%,65% vs 68% vs68%,63% vs 83% vs 80%,64% vs 72% vs 68%,P> 0.05;③The relationship between the diagnostic efficacy of adenosine load MPI and the number and degree of vascular lesions:The sensitivity of adenosine stress MPI in the diagnosis of coronary heart disease was 50%vs 100% vs 100% in single,double and multivessel disease,P>0.05;the sensitivity of adenosine load MPI in the diagnosis of coronary heart disease was 40% vs 100% vs 80%in mild,moderate and severe stenosis,P>0.05;⑤Changes in hemodynamics(SBP,DBP,HR)before and after drug loading: after the drug loading,SBP decreased,HR increased,and the increase of HR was higher than that of non-coronary heart disease group,P>0.05;?Changes in left ventricular function parameters(EDV,ESV,LVEF)before and after drug loading: after drug loading,EDV and ESV increased,EF decreased,and EF in coronary heart disease group in newtype drug group decreased significantly compared with non-coronary heart disease group,P<0.05;⑥ Adenosine MPI diagnostic efficacy and gender relationship: The detection rate of MPI in female was higher than that in male: 83%vs 75%.The value of negative ECG exclusion c oronary heart disease in male was higher than that of female: 100% vs 86%;⑦ 10 patients with mild adverse reactions in the adenosine group,3 patients with significant blood pressure drop,ECG ST-T down ≥ 0.2mv and discontinued drug trials;5 patients in the newtype drug group mild adverse reactions,no adverse events occurred in all subjects.Conclusion:1.Adenine load MPI combined with ECG ST-T segment changes and left heart volume function parameters can improve the detection rate of coronary heart disease;2.The novel adenosine A2 a receptor agonist drug is not inferior to adenosine,and it can beused as a clinical load test drug for an alternative method of exercise load test.