运动试验血流动力学反应异常辅助诊断冠心病  

Abnormalities hemodynamic response to exercise test sub-diagnosis coronary artery disease

作　　者：沈毅[1] 沈爱东[1] 李虹伟[1] 郑平渝[1] 顾复生[1] 李莉[1] 沈潞华[1] 马立永[2] 赵淑艳 

机构地区：[1]首都医科大学附属北京友谊医院心脏中心,北京100050 [2]北京平谷区医院内科,北京101200 [3]河北省大厂县人民医院功能科,河北大厂065300

出　　处：《临床和实验医学杂志》2008年第2期29-32,共4页Journal of Clinical and Experimental Medicine

摘　　要：目的探讨心电图平板运动试验后,收缩压恢复延迟与冠脉病变程度的相关性及二者之间的半量化关系。方法经症状限制性运动试验检查,并于30d内行冠脉造影患者。运动后收缩压恢复延迟定义为:运动后3min收缩压除以运动后1min收缩压比值大于1.0(即:收缩压恢复比值rSBPR3min/1min≥1.0)。冠脉病变程度的量化指标:应用杜克预后评分方法(分值范围0～100分),将积分≥42分确定为重度冠脉病变。结果入选164例[年龄(57±8)岁,男性82%],重度冠脉病变患者73例(44%)。研究显示:收缩压恢复比值与冠脉病变严重程度杜克预后评分明显相关(r=0.84,P<0.001),其升高值与冠脉狭窄程度呈正相关。线性回归分析在运动试验各组参数中,收缩压恢复比值(rSB-PR)对预测冠状动脉病变程度的作用最大(β=0.24,P=0.002,R2=0.06)。冠脉造影阳性组的收缩压恢复比值较冠脉造影阴性组明显增高(P组内<0.05),但与是否合并高血压病无关(P组间>0.05)。结论应用收缩压恢复比值异常升高(rSBPR3min/1min≥1.0),可以预测冠脉病变及其病变严重程度,运动后收缩压恢复延迟与重度冠脉病变明显相关。运动试验血流动力学反应异常可辅助诊断冠心病。Objective To investigate the characteristics of delayed decline in systolic blood pressure （SBP） after electrocardiogram treadmill exercise test （ETT） in related to the extent of angiographic coronary artery disease （ CAD）. Methods Among adults who underwent symptom - limited ETT positive and who underwent coronary angiographic within 30 days. A delayed decline in SBP during recovery was defined as a ratio of SBP at 3 min of recovery divided by that at 1 min of recovery exceeded 1.0 （ i. e. , SBP recovery 3 min/1 min ratio ≥ 1.0）. Angiographic severity of CAD was a assessed using the Duke CAD Prognostic Severity Index（ on a scale of 0 - 100） ,with a score≥42 considered to be indicative of severe CAD. Results There were 164 subjects eligible for analyses （age 57 ± 8 years,82% male ）, Severe angiographic coronary disease （score≥42） was noted 73 （44%）. There are association noted between a delayed decline in SBP during recovery （ rSBPR≥1.0） and severe angiographic coronary disease （ weight score） [ r = 0.84, P 〈 0. 001 ] , and the increase value of SBP had a positive correlation with the extent of coronary artery lesion. In Linear regression analyses a delayed decline in SBP during recovery is greatest effective predictive of severe angiographic coronary disease （ β = 0.24, P = 0. 002, R^2 = 0.06）. The rSBPR 3min/1 min in patients with CAD exceeded that of the control subjects independently of the presence of hypertension （ PHT 〉 0.05, PCAD 〈 0.05 ）. Conclusion Postexereise ratio of systolic blood pressure can predict coronary artery disease and its severity. A delayed decline in SBP during recovery is associated with a greater likelihood of severe angiographic coronary. Abnormalities hemodynamic response to exercise test sub - diagnosis coronary artery disease.

关 键 词：运动试验 收缩压恢复比 冠脉造影 冠心病 

分 类 号：R541.4[医药卫生—心血管疾病]