JP2005103224A - Electrocardiogram analyzing apparatus for diagnosing ischemic heart disease in treadmill exercise test - Google Patents
Electrocardiogram analyzing apparatus for diagnosing ischemic heart disease in treadmill exercise test Download PDFInfo
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- 208000031225 myocardial ischemia Diseases 0.000 title claims abstract description 15
- 238000000034 method Methods 0.000 claims abstract description 14
- 238000004458 analytical method Methods 0.000 claims description 3
- 238000003745 diagnosis Methods 0.000 claims description 3
- 230000035945 sensitivity Effects 0.000 description 5
- 230000000747 cardiac effect Effects 0.000 description 3
- 230000007423 decrease Effects 0.000 description 3
- 206010002383 Angina Pectoris Diseases 0.000 description 1
- 241000208011 Digitalis Species 0.000 description 1
- 206010020772 Hypertension Diseases 0.000 description 1
- 206010020880 Hypertrophy Diseases 0.000 description 1
- 201000008803 Wolff-Parkinson-white syndrome Diseases 0.000 description 1
- 206010000891 acute myocardial infarction Diseases 0.000 description 1
- 230000003177 cardiotonic effect Effects 0.000 description 1
- 238000007796 conventional method Methods 0.000 description 1
- 238000007887 coronary angioplasty Methods 0.000 description 1
- 210000004351 coronary vessel Anatomy 0.000 description 1
- 238000010586 diagram Methods 0.000 description 1
- 201000010099 disease Diseases 0.000 description 1
- 208000037265 diseases, disorders, signs and symptoms Diseases 0.000 description 1
- 230000000694 effects Effects 0.000 description 1
- 238000011156 evaluation Methods 0.000 description 1
- 230000003902 lesion Effects 0.000 description 1
- 208000010125 myocardial infarction Diseases 0.000 description 1
- 230000002966 stenotic effect Effects 0.000 description 1
- 208000011580 syndromic disease Diseases 0.000 description 1
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Abstract
Description
トレッドミル運動負荷試験とは、虚血性心疾患（狭心症、心筋梗塞）の診断を行うために、患者に心電図を装着監視し、ベルトの上を歩かすことで徐々に運動負荷を加え、負荷前後の心電図変化を確認することで虚血性心疾患の有無を判定する検査である。トレッドミル運動負荷試験の判定結果は重要であり、陽性であれば冠動脈に狭窄病変があることが予想され、急性心筋梗塞を発症する前に心臓カテーテル検査を行い、冠動脈形成術を行う必要がある。しかし、トレッドミル運動負荷試験結果の精度が低いと、虚血性心疾患を見逃したり、不必要に心臓カテーテル検査が行われる危険性がある。この発明はトレッドミル運動負荷試験における虚血性心疾患診断のための新しい心電図解析装置に関するものである。 The treadmill exercise load test is a diagnosis of ischemic heart disease (angina, myocardial infarction). This is a test for determining the presence or absence of ischemic heart disease by checking changes in the electrocardiogram before and after loading. Results of treadmill exercise test are important. If positive, coronary artery is expected to have a stenotic lesion, and cardiac catheterization and coronary angioplasty should be performed before acute myocardial infarction . However, if the accuracy of the treadmill exercise test result is low, there is a risk that an ischemic heart disease may be missed or an unnecessary cardiac catheter test may be performed. The present invention relates to a new electrocardiogram analyzer for diagnosis of ischemic heart disease in a treadmill exercise test.
従来の方法では、虚血性心疾患であれば運動負荷により心電図のＳＴのレベルは低下するので、このＳＴの変化を読みとることで陽性か否か判定していた（標準判定法）。しかし、このＳＴレベルはジギタリス（強心剤）服用中の患者、高血圧症により心肥大を認める患者、ＷＰＷ症候群の患者、その他健康人女性の一部でも変化するため、これらの患者での標準判定法によるＳＴ低下の評価は虚血性心疾患を判定を複雑にし、鑑別が困難となる問題があった。ＳＴ／ＨＲｓｌｏｐｅと呼ばれ、運動負荷中のＳＴ低下度を心拍数で補正し、虚血性心疾患の診断精度を上げようとする方法も考案されたが、多くの追試論文により診断精度は必ずしも優れてはいないことが判明している。（Ｆｌｅｔｃｈｅｒ ＧＦ：Ｃｉｒｃｕｌａｔｉｏｎ１０４：１６９４，２００１）。 In the conventional method, since the ST level of the electrocardiogram decreases due to exercise load in the case of ischemic heart disease, it is determined whether or not it is positive by reading this ST change (standard determination method). However, this ST level also changes in patients taking digitalis (cardiotonic), patients with hypertension, hypertrophy, WPW syndrome, and some other healthy women. Evaluation of ST reduction has a problem in that ischemic heart disease is complicated to determine and difficult to distinguish. Although it was called ST / HRslope, a method was also devised to improve the accuracy of ischemic heart disease by correcting the degree of ST decrease during exercise with the heart rate. Has not been found. (Fletcher GF: Circulation 104: 1694, 2001).
したがって、トレッドミル運動負荷試験では、虚血性心疾患を正しく診断するために、より感度、特異度ともに精度の高い心電図解析方法が必要である。本発明は、この問題を解決するためのものである。 Therefore, in the treadmill exercise stress test, an electrocardiogram analysis method with higher sensitivity and specificity is necessary in order to correctly diagnose ischemic heart disease. The present invention is intended to solve this problem.
その構成を説明すると、
（イ）レッドミル運動負荷中の心電図のＳＴレベルの変化を１５秒毎に計測する。
（ロ）Ｘ軸方向に時間経過を、Ｙ軸方向にＳＴレベルを示す座標に（イ）の数値をプロットする。
（ハ）（ロ）のプロット上の、負荷終了時から負荷終了前の５ポイントめと負荷終了時から負荷終了後の５ポイントめをそれぞれ線で結び、Ｘ軸と形成される角度をθＥ、Ｙ軸と形成される角度をθＲとする。
（ニ）（ハ）で求められたθＥとθＲの数値を掛け合わせ、得られた数値をＢｉ−Ａｎｇｌｅ Ｓｃｏｒｅと命名、Ｂｉ−Ａｎｇｌｅ Ｓｃｏｒｅの数値が１５００以上を心筋虚血陽性と診断する。
以上のように解析する。Explaining its configuration:
(A) The change in the ST level of the electrocardiogram during red mill exercise load is measured every 15 seconds.
(B) The numerical value of (a) is plotted on the coordinates indicating the time passage in the X-axis direction and the ST level in the Y-axis direction.
(C) On the plot of (b), connect the fifth point from the end of the load to the end of the load and the fifth point from the end of the load to the end of the load with a line, respectively, and the angle formed with the X axis is θE, The angle formed with the Y axis is denoted by θR.
(D) Multiplying the numerical values of θE and θR obtained in (c), naming the obtained numerical value Bi-Angle Score, and diagnosing Bi-Angle Score numerical value 1500 or more as positive for myocardial ischemia.
Analyze as above.
次に本発明の実施の形態を実際の検討結果をもとに説明する。トレッドミル運動負荷にてＳＴ低下の認められた患者７３名に対して、心臓カテーテル検査を行い虚血性心疾患を診断し、標準判定法とＳＴ／ＨＲ ｓｌｏｐｅ法、Ｂｉ−Ａｎｇｌｅ Ｓｃｏｒｅ法でそれぞれの診断精度を調査、比較を行った。その結果、標準判定法の感度、特異度は６８．４％と３４．３％であり、ＳＴ／ＨＲ ｓｌｏｐｅ法の感度、特異度は７１．１％と６５．７％であった。これに対し、Ｂｉ−Ａｎｇｌｅ Ｓｃｏｒｅ法では感度、特異度は８１．６％と８８．６％であり、従来の方法論よりＢｉ−Ａｎｇｌｅ Ｓｃｏｒｅ法は感度、特異度ともに優れた診断精度であることが判明した。 Next, an embodiment of the present invention will be described based on actual examination results. 73 patients with ST decrease observed in treadmill exercise load were subjected to cardiac catheterization to diagnose ischemic heart disease. Each of them was evaluated by standard judgment method, ST / HR slope method and Bi-Angle Score method. The diagnostic accuracy was investigated and compared. As a result, the sensitivity and specificity of the standard judgment method were 68.4% and 34.3%, and the sensitivity and specificity of the ST / HR slope method were 71.1% and 65.7%. On the other hand, the sensitivity and specificity are 81.6% and 88.6% in the Bi-Angle Score method, and the Bi-Angle Score method has better diagnostic accuracy in both sensitivity and specificity than the conventional methodology. found.
したがって、本発明であるＢｉ−Ａｎｇｌｅ Ｓｃｏｒｅ法をもとに、トレッドミル運動負荷試験の判定がなされることにより、多くの病院にて精度の高い虚血性心疾患の診断が可能となり、疾患の見逃しや不必要な追検査および処方などが改善されることが期待できる。 Therefore, by determining the treadmill exercise stress test based on the Bi-Angle Score method of the present invention, it is possible to diagnose ischemic heart disease with high accuracy in many hospitals, and overlook the disease. And unnecessary follow-up and prescription can be expected to improve.
Claims (1)
（ロ）Ｘ軸方向に時間経過を、Ｙ軸方向にＳＴレベルを示す座標に（イ）の数値をプロットする。
（ハ）（ロ）のプロット上の、負荷終了時から負荷終了前の５ポイントめと負荷終了時から負荷終了後の５ポイントめをそれぞれ線で結び、Ｘ軸と形成される角度をθＥ、Ｙ軸と形成される角度をθＲとする。
（ニ）（ハ）で求められたθＥとθＲの数値を掛け合わせ、得られた数値をＢｉ−Ａｎｇｌｅ Ｓｃｏｒｅと命名、Ｂｉ−Ａｎｇｌｅ Ｓｃｏｒｅの数値が１５００以上を心筋虚血陽性と診断する。
以上の方法にて解析される、トレッドミル運動負荷試験における虚血性心疾患診断のための新しい心電図解析方法(A) The change in the ST level of the electrocardiogram during treadmill exercise load is measured every 15 seconds.
(B) The numerical value of (a) is plotted on the coordinates indicating the time passage in the X-axis direction and the ST level in the Y-axis direction.
(C) On the plot of (b), connect the fifth point from the end of the load to the end of the load and the fifth point from the end of the load to the end of the load with a line, respectively, and the angle formed with the X axis is θE, The angle formed with the Y axis is denoted by θR.
(D) Multiplying the numerical values of θE and θR obtained in (c), naming the obtained numerical value Bi-Angle Score, and diagnosing Bi-Angle Score numerical value 1500 or more as positive for myocardial ischemia.
New ECG analysis method for ischemic heart disease diagnosis in treadmill exercise stress test analyzed by the above method
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Cited By (3)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| JP2010057678A (en) * | 2008-09-03 | 2010-03-18 | Fukuda Denshi Co Ltd | Electrocardiogram analyzer, electrocardiogram analyzing method and electrocardiogram analyzing program |
| JP2010057677A (en) * | 2008-09-03 | 2010-03-18 | Fukuda Denshi Co Ltd | Biological data processing apparatus, biological data processing method and biological data processing program |
| JP2013173043A (en) * | 2013-06-12 | 2013-09-05 | Fukuda Denshi Co Ltd | Biological information processing device, exercise electrocardiographic testing system and biological information processing program |
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Cited By (3)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| JP2010057678A (en) * | 2008-09-03 | 2010-03-18 | Fukuda Denshi Co Ltd | Electrocardiogram analyzer, electrocardiogram analyzing method and electrocardiogram analyzing program |
| JP2010057677A (en) * | 2008-09-03 | 2010-03-18 | Fukuda Denshi Co Ltd | Biological data processing apparatus, biological data processing method and biological data processing program |
| JP2013173043A (en) * | 2013-06-12 | 2013-09-05 | Fukuda Denshi Co Ltd | Biological information processing device, exercise electrocardiographic testing system and biological information processing program |
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