PCI术后冠心病患者运动靶心率简易计算法与无氧阈法的一致性评价  

Consistency evaluation of target heart rate determined by anaerobic threshold and by resting heart rate in patients with coronary artery disease after percutaneous coronary intervention

作　　者：牛素平 郭琳[2] 郭丹杰[1] 范晓绵 丁荣晶[2] Niu Suping;Guo Lin;Guo Danjie;Fan Xiaomian;Ding Rongjing(Research Department,Peking University People′s Hospital,Beijing 100044,China;Department of Cardiology,Peking University People′s Hospital,Beijing 100044,China)

机构地区：[1]北京大学人民医院科研处,北京100044 [2]北京大学人民医院心血管内科,北京100044

出　　处：《中华心血管病杂志》2022年第5期480-485,共6页Chinese Journal of Cardiology

摘　　要：目的评价对于接受经皮冠状动脉介入治疗(PCI)的冠心病患者,简易计算法所得的靶心率与通过心肺运动试验(CPET)所得的无氧阈靶心率的一致性。方法该研究为诊断性试验。纳入2011年10月至2021年4月北京大学人民医院心内科收治的初次行PCI的冠心病患者,并进一步根据性别、年龄(<60岁组和≥60岁组)、是否曾发生心肌梗死(心肌梗死组和心绞痛组)及是否应用β受体阻滞剂分组,进行亚组分析。通过电子病历系统收集患者的一般临床资料及CPET测得的静息心率和无氧阈心率。分别通过简易计算法(静息心率+20或30次/min)和无氧阈法(无氧阈心率-10次/min)计算运动靶心率,采用配对t检验对二者进行差异性检验,通过计算组内相关系数(ICC)和Bland-Altman法检验二者的一致性。结果共纳入患者439例,年龄(56.2±8.8)岁,体重指数(25.77±2.34)kg/m^(2),男性382例(87.0%)。入选患者测得的无氧阈靶心率为(90.0±11.8)次/min,简易靶心率(静息心率+20次/min)为(91.0±8.4)次/min,二者差异无统计学意义(P=0.091),简易靶心率(静息心率+30次/min)为(101.0±8.4)次/min,与无氧阈靶心率比较差异有统计学意义(P<0.001)。后续研究中将“静息心率+20次/min”视为简易靶心率。无氧阈靶心率与简易靶心率一致性检验的ICC值为0.529,95%CI 0.458~0.593,P<0.001。Bland-Altman法评价结果示,简易靶心率与无氧阈靶心率的比值为1.03±0.11,95%一致性界限(LOA)为0.812~1.245。年龄<60岁组患者(n=247)简易靶心率与无氧阈法靶心率一致性检验的ICC值为0.492,Bland-Altman法评价的结果示简易靶心率与无氧阈靶心率的比值为1.02±0.11,LOA为0.814~1.234;年龄≥60岁组患者(n=192)简易靶心率与无氧阈法靶心率一致性检验的ICC值为0.566,Bland-Altman法评价结果示简易靶心率与无氧阈靶心率的比值为1.03±0.11,LOA为0.810~1.260。男性患者(n=382)简易靶心率与无氧阈靶心率一致性检验的IObjective To evaluate the consistency on the determination of target heart rate by simple calculation method based on resting heart rate and by anaerobic threshold method in cardiopulmonary exercise test(CPET)for patients with coronary artery disease after percutaneous coronary intervention(PCI).Methods This study was a diagnostic test.Patients with coronary artery disease who underwent the first PCI in the Department of Cardiology of Peking University People′s Hospital from October 2011 to April 2021 were enrolled.Patients were further divided into subgroups according to gender,age(<60 years group and≥60 years group),with or without myocardial infarction history(myocardial infarction group and angina pectoris group)and whetherβblockers were applied.The general clinical data of patients,resting heart rate(RHR)and anaerobic threshold heart rate in CPET were collected through the electronic medical record system.The simple target rate(RHR plus 20 or 30 bpm)and the target rate calculated by anaerobic threshold(anaerobic threshold heart rate minus 10 bpm)were both calculated in each patient.Consistency test of target heart rate derived by above the two methods was shown by intra-class correlation(ICC)and Bland-Altman plots.Results A total of 439 patients were included,age was(56.2±8.8)years,body mass index was(25.77±2.34)kg/m^(2),there were 382 males(87.0%).The target heart rate determined by anaerobic threshold method was(90.0±11.8)bpm,and the simple target heart rate determined by RHR plus 20 bpm was(91.0±8.4)bpm.There was no significant difference on the target heart rate derived from the two calculation methods(P=0.091).The simple target heart rate determined by RHR plus 30 bpm was(101.0±8.4)bpm,which was significant higher than that determined by anaerobic threshold method(P<0.001).In the following analysis,RHR plus 20 bpm was defined as the simple target heart rate.The ICC value of target heart rate determined by anaerobic threshold and resting rate plus 20 bpm was 0.529(95%CI 0.458-0.593,P<0.001).Bla

关 键 词：冠心病 血管成形术 经腔 经皮冠状动脉 运动处方 靶心率 

分 类 号：R541.4[医药卫生—心血管疾病]