运动试验阳性无冠状动脉病变者血流动力学变化的临床意义  

Clinical signification of haemodynamic changes in patients with positive exercise test and without significant coronary artery disease

作　　者：邓鹤秋[1] 王琳[1] 董杏芳 张桂林[1] 黄贵华[1] 杜衡吉 吕红松[1] 

机构地区：[1]解放军第458医院心内科,广州510602 [2]广州军区空军电子对抗团卫生队,广州510900

出　　处：《岭南心血管病杂志》2006年第1期25-27,共3页South China Journal of Cardiovascular Diseases

摘　　要：目的探讨运动试验阳性但无显著冠状动脉病变患者血流动力学变化的临床意义。方法选取因发作性胸痛症状拟诊冠心病入院,选择性冠状动脉造影正常,左心室射血分数超过0．55的病人85例,根据次极量踏车运动试验(Bruce方案)结果,分为运动试验阳性组58例与阴性组27例,分析两组间升主动脉脉压(pulse pressure,PP)与脉压指数(pulse pressure index,PPI)、左心室舒张末压(left ventricular end diastolic pressure,LVEDP)及左心室舒张末压指数(left ventricular end diastolic pressure index,LVEDPI) 等血流动力学指标变化的临床意义。结果①运动试验阳性与阴性组间的病人一般资料如年龄、性别、是否伴有高血压及左心室射血分数差异无统计学意义(P>0．05);②升主动脉PP与PPI在两组间差异无统计学意义(P>0．05);③LVEDP在运动试验阳性组显著高于阴性组(P<0．01),而LVEDPI则前者显著低于后者(P<0．01)。结论有胸痛症状而选择性冠状动脉造影正常者,PP或PPI指标并不能反映其冠状动脉血流储备,同时伴有LVEDP增加者易出现运动试验阳性,提示X综合征者的LVEDP增加可能与心内膜下心肌缺血有关,LVEDPI较LVEDP反应可能更为敏感。Objectives To investigate the clinical significance of haemodynamic changes in patients with positive exercise test and without significant coronary artery disease. Methods The study was performed in 85 consecutive patients with suspected coronary heart disease （CHD） admitted who had chest pain, normal selected coronary angiography（SCAG） and left ventricular ejection fraction （LVEF）〉55%. According to the results of submaximal bicycle exercise test （Bruce program）, 58 patients were in the positive group, and another 27 patients were in the negative group （control group）. All haemodynamic parameters were measured by standard 6Fr pigtail catheter and statistically analysed by t and chi-square test between the two groups. Haemodynamic parameters involved in pulse pressure （PP） and pulse pressure index （PPI） of ascending aorta, left ventricular end systolic pressure （LVESP）, left ventricular end diastolic pressure （LVEDP） and left ventricular end diastolic pressure index [LVEDPI=（LVESP-LVEDP）/LVESP] and so on. Results ①General information such as sex, age, LVEF, and with or without hypertension had no statistical significance between positive and control group （P〉0.05）.②PP and PPI values of ascending aorta were not significant between the two groups（52.6±14.9 vs 50.4±12.2,P〉0.05）.③LVEDP value in positive group was significantly higher than those in control group（14.8±6.3 vs 10.6±4.5 mmHg, P=0.003）, and LVEDPI value in positive group was significantly lower than those in control group（0.82±0.06 vs 0.87±0.05,P=0.0001）. Conclusions For that patients with chest pain and normal SCAG, PP or PPI level does not respond to coronary blood reserve to exercise of the patients, and the patients with abnormal LVEDP values maybe more likely to have had a positive stress test. The results suggested that elevated LVEDP in patients with cardiac syndrome X may be associated with subendocardial ischemia, and LVEDPI value appears to be more sensitive than LVEDP for

关 键 词：冠状动脉疾病 运动试验 升主动脉 脉压指数 左心室舒张末压 

分 类 号：R541.4[医药卫生—心血管疾病]