| 万秋华,郭 涛,李建美,叶雪瑞,张旭睿,杨鑫伟,黎继升,李永春.心肺运动试验在预测冠状动脉病变中的应用[J].中国康复医学杂志,2024,(7):989~994 |
| 心肺运动试验在预测冠状动脉病变中的应用 点此下载全文 |
| 万秋华 郭 涛 李建美 叶雪瑞 张旭睿 杨鑫伟 黎继升 李永春 |
| 云南省阜外心血管病医院，昆明医科大学附属心血管病医院，云南省昆明市，650000 |
| 基金项目：云南省教育厅科学研究基金项目（2021J0293）；云南省阜外心血管病医院院级科研基金项目（202002AA310100-11） |
| DOI：10.3969/j.issn.1001-1242.2024.07.012 |
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| 摘要： |
| 摘要
目的：探讨心肺运动试验指标在冠心病患者中对冠状动脉病变程度的预测价值，为冠心病患者应用无创检测手段预测冠脉病变程度提供客观依据，以及为冠心病患者制定运动处方予以客观指导。
方法：入选2020年3月—2022年5月期间，在昆明医科大学附属心血管病医院就诊的冠心病患者53例，均完善冠脉造影检查及心肺运动试验（cardiopulmonary exercise test， CPET）检查，根据冠状动脉造影进行SYNTAX（synergy between percutaneous coronary intervention with Taxus and cardiac surgery， SYNTAX）评分，依据评分结果分为低分组（SYNTAX≤22分）30例和中高分组（SYNTAX＞22分）23例，收集患者的一般资料，性别、年龄、BMI、并发症等，采集患者的心肺运动试验指标。
结果：相较于中高分组而言，低分组最大摄氧量（maximum oxygen uptake， VO2max）、最大摄氧量占预计值的百分比（maximum oxygen uptake as a percentage of the predicted value， VO2max%P）、最大代谢当量（maximum metabolic equivalent， METSmax）、最大心率（maximum heart rate， HRmax）、最大心率占预计值的百分比（maximum heart rate as a percentage of predicted value， HR%P）更高，组间差异有显著性意义（P＜0.05）；相较于中高分组而言，低分组心率储备（heart rate reserve， HRR）更低，组间差异具有显著性意义（P＜0.05）；SYNTAX评分与VO2max、VO2max%P、最大公斤摄氧量（maximum oxygen uptake in kilograms， VO2max/kg）、METSmax、HRmax、HR%P呈负相关，与HRR呈正相关（P＜0.05）；HRR在预测冠心病中敏感性最高。
结论：SYNTAX评分低分组即冠脉病变较轻的冠心病患者VO2max、VO2max%P、VO2max/kg、METSmax、HRmax、HR%P值更高，提示该组患者心肺储备功能更好，运动能力更强，高分组即冠脉病变较重的冠心病患者HRR更高，患者运动过程中最大心率与目标心率差距更大，更难达到目标心率。 |
| 关键词：心肺运动试验 SYNTAX评分 冠心病 |
| Application of cardiopulmonary exercise test in predicting coronary artery disease Download Fulltext |
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| Yunnan Fuwai Cardiovascular Hospital， Kunming City， Yunnan Province， 650000 |
| Fund Project: |
| Abstract: |
| Abstract
Objective： This paper explores the predictive value of indicators of cardiopulmonary exercise test in the degree of coronary artery disease in patients with coronary heart disease. It provides an objective basis for predicting the degree of coronary artery disease by non-invasive detection methods in patients with coronary heart disease，and provides objective guidance for formulating exercise prescriptions for patients with coronary heart disease.
Method： Fifty-three patients with coronary heart disease who were treated in the Affiliated Cardiovascular Hospital of Kunming Medical University from March 2020 to May 2022 were selected to complete coronary angiography and cardiopulmonary exercise test. According to the coronary angiography results and the SYNTAX score，the patients were divided into low group （SYNTAX≤22 points） with 30 cases and medium-high group （SYNTAX>22 points） with 23 cases. The general information of the patients such as gender， age， BMI and comorbidities were collected， and the indicators of cardiopulmonary exercise test were collected.
Result： Compared with the medium-high group， maximum oxygen uptake （VO2max）， maximum oxygen uptake as a percentage of the predicted value （VO2max%P）， maximum metabolic equivalent （METSmax）， maximum heart rate （HRmax） and maximum heart rate as a percentage of predicted value （HR%P） of the low group were higher， and the difference between the two groups was statistically significant with p-value less than 0.05. Compared with the medium-high group， the heart rate reserve （HRR） in the low group was lower， and the difference between the two groups was statistically significant with p-value less than 0.05. The SYNTAX score was negatively correlated with VO2max， VO2max%P， maximum oxygen uptake in kilograms （VO2max/kg）， METSmax， HRmax and HR%P， and positively correlated with HRR with P-value less than 0.05. HRR has the highest sensitivity in predicting coronary heart disease.
Conclusion： The low group with low SYNTAX scores and mild coronary lesions has higher VO2max， VO2max%P， VO2max/kg， METSmax， HRmax and HR%P values， suggesting that the patients in this group have better cardiopulmonary reserve function and better exercise capacity. The high group with severe coronary artery disease has higher HRR， and the gap between the maximum heart rate and the target heart rate during exercise is larger， which means it is more difficult for patients in the high group to reach the target heart rate. |
| Keywords:cardiopulmonary exercise test synergy between percutaneous coronary intervention with Taxus and cardiac surgery score coronary heart disease |
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