心肺运动试验相关指标与冠心病患者心血管疾病预后的关系  

Relationship between cardiopulmonary exercise testing and the prognosis of cardiovascular disease in coronary heart disease patients

作　　者：李宇珊 张剑 任强 梁延春 张权宇 韩雅玲 Li Yushan;Zhang Jian;Ren Qiang;Liang Yanchun;Zhang Quanyu;Han Yaling

机构地区：[1]解放军北部战区总医院心血管内科,沈阳110016

出　　处：《中华心血管病杂志》2024年第9期1044-1050,共7页Chinese Journal of Cardiology

基　　金：国家自然科学基金(32071116);辽宁省科学技术计划项目(2022JH2/101500028)。

摘　　要：目的探究对冠心病患者主要不良心血管事件(MACE)有预测价值的心肺运动试验指标。方法本研究为回顾性队列研究, 连续纳入2015年11月至2021年9月就诊于解放军北部战区总医院心血管内科且在出院前进行了心肺运动试验的冠心病患者。收集所有纳入患者的人口学信息、既往病史、心肺运动试验指标等基线资料并进行随访。根据随访期间有无MACE发生分为MACE组和对照组。采用多因素Cox比例风险回归模型分析对冠心病患者MACE有预测价值的心肺运动试验指标。结果共纳入冠心病患者3 800例, 年龄(57.2±8.8)岁, 男性2 920例(76.84%), 随访时间为1 237(695, 1 596)d, 其中MACE组390例(10.26%), 对照组3 410例(89.74%)。校正后的多因素Cox回归分析显示较高水平的无氧阈代谢当量是冠心病患者发生MACE的独立保护因素(HR=0.75, 95%CI:0.62~0.90, P=0.002), 较高水平的二氧化碳通气当量是冠心病患者发生MACE的独立危险因素(HR=1.05, 95%CI:1.02~1.07, P=0.001)。结论心肺运动试验指标中, 高水平无氧阈代谢当量是冠心病患者发生MACE的独立保护因素, 高水平二氧化碳通气当量是冠心病患者发生MACE的独立危险因素。ObjectiveTo investigate the predictive value of cardiopulmonary exercise test(CPET)indexes for major adverse cardiovascular events(MACE)in patients with coronary heart disease(CHD).MethodsThis study was a retrospective cohort study.CHD patients were consecutively enrolled who procedure CPET before discharge from the Department of Cardiology,General Hospital of Northern Theater Command from November 2015 to September 2021 were enrolled.Demographic information,past medical history,CPET indexes and other baseline data were collected and the patients were followed up.Patients were divided into a MACE group and a control group according to the presence or absence of MACE.A multivariate Cox proportional hazard regression model was used to analyze the CPET indexes with predictive value for MACE in CHD patients.ResultsA total of 3800 patients were eligible for the criterion,age(57.2±8.8)years,2920(76.84%)males.During a follow-up of 1237(695,1596)days,390(10.26%)patients were in MACE group,and 3410(89.74%)patients were in control group.In adjusted multivariable analysis,higher metabolic equivalent of tasks(MET)at anaerobic threshold(AT)is an independent protective factor for MACE in patients with CHD(HR=0.75,95%CI 0.62-0.90,P=0.002),higher VE/VCO 2 is an independent risk factor for MACE in CHD patients(HR=1.05,95%CI 1.02-1.07,P=0.001).ConclusionIn CPET,high MET at AT is an independent protective factor for MACE in patients with CHD,and high VE/VCO 2 is an independent risk factor for MACE in CHD patients.

关 键 词：冠心病 心肺运动试验 主要不良心血管事件 预后 

分 类 号：R541.4[医药卫生—心血管疾病]