外科手術症例における虚血性心疾患のスクリーニング方法としての経食道心房負荷心電図の有用性の検討

概要

論文の詳細を見る
Preoperative screening for ischemic heart disease (IHD) is important to avoid perioperative myocardial infarction (PMI) resulting in severe complications. This study evaluated a screening method for IHD using transesophageal atrial pacing (TEP) loaded test. In preoperative assessment, screening for IHD by TEP loaded test was performed in 319 patients from 1994 to 2001. Coronary angiography (CAG) was performed in 124 patients among these patients. Screening for IHD by TEP was 68% in sensitivity, 63% in specificity, and 72% in accuracy. Combined coronary revascularization was performed, if Leaman's conoranry score calculated by CAG findings was greater thanlO, or left main trunk or proximal left anterior artery was involved. There were 23 TEP-false negative patients (TEP-negative, CAG positive). In 4 patients out of TEP-false negative patients, combined coronary artery bypass grafting was performed to prevent perioperative myocardial infarction. ECG at rest in these 4 patients revealed abnormality suggesting myocardial ischemia. There were no complications attributable to IHD observed in all 319 patients screened by ECG at rest and TEP loaded test. In vascular surgical patients, CAG was not performed in 123 patients (55%). In patients with surgically indicated disease, it is suggested that preoperatively screening method for IHD by ECG at rest and TEP loaded test is useful to detect unnoticed IHD.
岐阜大学の論文
2003-03-31