老年冠心病患者摄氧效率斜率与左室收缩与舒张功能的关系  

Relationship between Oxygen Uptake Efficiency Slope and Left Ventricular Systolic and Diastolic Function in Elderly Patients with Coronary Heart Disease

作　　者：徐顺霖[1] 汪宇鹏[1] 姚思华 刘丹[1] 赵威[1] 冯新恒[1] 高炜[1] 

机构地区：[1]北京大学第三医院心内科血管医学研究所国家卫生计生委心血管分子生物学与调节肽重点实验室分子心血管学教育部重点实验室,北京100191

出　　处：《中国运动医学杂志》2018年第2期115-120,共6页Chinese Journal of Sports Medicine

摘　　要：目的:回顾性分析介入术后老年冠心病患者心肺运动试验(cardiopulmonary exercise testing,CPET)测定指标,探讨摄氧效率斜率(oxygen uptake efficiency slope,OUES)等参数与心脏超声左室功能的相关性及临床意义。方法:入组65岁及以上老年冠脉介入术后患者,收集其CPET相关参数,获取峰值摄氧量(VO_2peak)、氧脉搏(VO_2/HR)、OUES等心肺耐力(CRF)指标,同时通过心脏超声测定二尖瓣环收缩期峰值速度(Sm),二尖瓣口舒张早期血流速度E与二尖瓣环舒张早期峰值速度Em比值(E/Em)等心脏功能指标,并进一步以Sm≥8 cm/s为正常界限分Sm正常、Sm降低2组,行心肺耐力与心脏功能的相关性分析。结果:入选符合条件患者402例,平均年龄71±5岁,男性283例(70.40%),女性119例(29.60%)。65~69岁202例(50.25%),70~74岁89例(22.14%),年龄≥75岁111例(27.61%)。心绞痛患者227例(56.47%)、急性心肌梗死患者62例(15.42%)、陈旧性心肌梗死患者113例(28.11%)。研究发现心脏收缩功能与CRF相关:Sm与OUES(r=29.220,P=0.001)呈独立正相关。同时,Em与VO_2peak(r=0.176,P<0.001)、OUES(r=0.151,P=0.003)呈正相关;而E/Em与VO_2peak(r=-0.199,P<0.001)、VO_2/HR(r=-0.118,P=0.018)及OUES(r=-0.201,P<0.001)呈负相关。左房压力与VO_2peak(r=-0.187,P<0.001)、VO_2/HR(r=-0.108,P=0.030)及OUES(r=-0.185,P<0.001)呈负相关。左室射血分数、左室舒张末内径未发现与心肺耐力参数有相关性(P>0.05)。结论:心肺运动试验作为评估和指导运动康复的实用方法,CRF参数能够评估运动负荷下心脏功能,其与心脏超声获得的静息心脏收缩与舒张功能指标有明显的相关性。Objective To investigate clinical significance and the correlation between oxygen uptake efficiency slope（OUES） measured by the cardiopulmonary exercise test（CPET） and echocardiographic left ventricular function in elderly patients with coronary heart diseases after the percutaneous coronary intervention. Methods Patients aged 65 years and over after PCI and CPET were enrolled to collect relevant parameters including the peak oxygen consumption（VO2peak）,oxygen pulse（VO2/HR）,OUES and cardiorespiratory fitness（CRF） index,also mitral annulus systolic peak speed（Sm）,early diastolic mitral flow velocity Em and mitral annular early diastolic peak velocity Em ratio（E/Em） using the echocardiography. Patients with systolic velocity of mitral annulus（Sm）≥8 cm/s were assigned to the normal Sm group,while the rest were selected into the lower Sm group. The correlation between the cardiopulmonary fitness and cardiac function was analyzed. Results Four hundred and two patients were enrolled,with an average age of 71 ± 5 years,283 males（70.40%）,and 119 females（29.60%）. Among them,111（27.61%） were 75 years of age or older,202（50.25%） ranging from 65 to 69 and 89（22.14%） between 70 and 74. Totally 227 patients were diagnosed as angina pectoris（56.47%）,62 as acute myocardial infarction（15.42%）,and 113 patients with old myocardial infarction（28.11%）. It was found that the heart systolic function was associated with CRF：Sm and OUES were positively correlated independently（r=29.220,P=0.001）; Em was positively related to VO2peak（r=0.176,P〈0.001） and OUES（r=0.151,P=0.003）. However,E/Em was negatively correlated with VO2peak（r=-0.199,P〈0.001）,VO2/HR（r=-0.118,P=0.018） and OUES（r=-0.201,P〈0.001）. The left atrial pressure was negatively correlated with VO2peak（r=-0.187,P〈0.001）,VO2/HR（r=-0.108,P=0.030） and OUES（r=-0.185,P〈0.001）. Left ventricular ejection fraction and left ventricular end diastolic diameter were not found to b

关 键 词：心肺运动试验 摄氧效率 老年冠心病 心脏功能 二尖瓣环收缩期峰值速度 

分 类 号：R541.4[医药卫生—心血管疾病]