摘要： 目的 探讨慢性冠脉综合征(CCS)患者左心室舒张功能与心肺适能(CRF)的关系。方法 收集2018年1月至2021年3月中国医科大学附属第一医院老年心血管内科住院且完成心肺运动试验(CPET)检查的91例CCS患者临床资料。根据CPET测得的峰值代谢当量(Peak MET),将患者分为CRF低水平组(Peak MET<5.0 METs)、中水平组(Peak MET 5.0~<7.0 METs)和高水平组(Peak MET ≥ 7.0 METs),比较3组间的临床数据。采用二元logistic回归分析患者心室功能与CRF减低的关系。根据二尖瓣舒张早期血流峰值速度与二尖瓣环舒张早期峰值速度之比(E/e')的三分位数,将患者分为E/e'<9.0组、E/e' 9.0~<10.8组、E/e' ≥ 10.8组,比较3组CPET各项指标。绘制受试者操作特征(ROC)曲线,分析E/e'预测CCS患者CRF减低的诊断价值。结果 CRF低水平组年龄高于CRF中、高水平组(均P<0.05)。二尖瓣环间隔处舒张早期峰值速度(Septal e')在CRF低、中、高水平组间依次增加(均P<0.05); CRF高水平组二尖瓣环间隔处舒张早期峰值速度(Lateral e')均明显高于CRF低、中水平组(均P<0.05),CRF高水平组二尖瓣口舒张早期峰值速度(E)与二尖瓣口舒张晚期峰值速度(A)的比值(E/A)明显高于CRF低水平组(P<0.05),CRF低水平组E/e'均明显高于CRF中、高水平组(均P<0.05)。峰值氧脉搏(Peak VO₂/HR)、峰值摄氧量(Peak VO₂)、氧摄取效率斜率(OUES)在CRF低、中、高水平组间依次递增(均P<0.05);而二氧化碳通气当量斜率(VE/VCO₂slope)在CRF低、中、高水平组间依次递减(均P<0.05)。E/e'(OR=1.311,95%CI:1.050~1.637,P<0.05)、年龄(OR=1.084,95%CI:1.024~1.148,P<0.05)是CCS患者CRF减低的独立危险因素。E/e'<9.0组、E/e' 9.0~<10.8组、E/e' ≥ 10.8组Peak VO₂/HR、Peak VO₂、Peak MET、OUES比较差异均有统计学意义(均P<0.05);而3组间VE/VCO2slope比较无统计学差异(P>0.05)。E/e' ≥ 10.8组Peak VO₂/HR、Peak VO₂、PeakMET、OUES均明显低于E/e'<9.0组(均P<0.05)。E/e'预测CCS患者CRF减低的ROC曲线下面积为0.704(95%CI:0.594~0.813,P<0.05)。E/e'=9.63时,预测CCS患者CRF减低的敏感度为84.4%,特异度为54.2%。结论 CCS患者CRF减低时,左心室舒张功能也相应减低。E/e'是CCS患者CRF减低的独立危险因素,且E/e'对预测CCS患者CRF减低具有较好的评估价值。

慢性冠脉综合征患者左心室舒张功能与心肺适能的相关性

罗巧玲^1,2, 陈思娇¹

1. 中国医科大学附属第一医院老年心血管内科, 沈阳 110001;
2. 重庆市第十三人民医院呼吸内科, 重庆 400000

收稿日期:2021-07-15出版日期:2022-07-30发布日期:2022-06-27
通讯作者:陈思娇E-mail:chensj@cmu1h.com
作者简介:罗巧玲(1993-),女,硕士研究生.
基金资助:大学生创新创业训练计划(201910159166)


关键词: 慢性冠脉综合征, 心肺运动试验, 心肺适能, 左心室舒张功能
Abstract: Objective To evaluate the relationship between the left ventricular diastolic function and cardiorespiratory fitness (CRF) in patients with chronic coronary syndrome (CCS). Methods Ninety-one patients with CCS who completed a cardiopulmonary exercise test (CPET) from January 2018 to March 2021 in the First Hospital of China Medical University were selected for our research. All the patients' clinical data were collected. CCS patients were split into three groups by peak metabolic equivalent (MET) results:a low CRF group (Peak MET<5.0 METs),medium CRF group (Peak MET 5.0-<7.0 METs),and high CRF group (Peak MET ≥ 7.0 METs). Binary logistic regression was used to analyze the relevance between the diastolic function and reduced CRF in CCS patients. We divided CCS patients into three groups considering tri-sectional quantiles of E/e',the ratio of peak E-wave velocity to peak mitral annular velocity. The diagnostic value of E/e' for CRF reduction was estimated by the receiver operating characteristic (ROC) curve. Results The average age of patients with CCS in the low CRF group was higher than that in the medium and high CRF groups (all P< 0.05). The proportion of old myocardial infarction was also higher in the low CRF group (P< 0.05). The e' velocity of the septal annulus (Septal e') in low,medium,and high CRF groups was increased in turn (P< 0.05). The e' velocity of the lateral annulus (Lateral e') in the high CRF group was significantly higher than that in low and medium CRF groups (P< 0.05). The E/A,the ratio of peak E-wave velocity and peak A-wave velocity,was significantly higher in the high CRF group than in the low CRF group (P< 0.05). E/e' was significantly higher in the low CRF group than in the medium and high CRF groups (P< 0.05). The peak oxygen uptake vs. heart rate (Peak VO₂/HR),peak oxygen uptake (Peak VO₂),and slope of oxygen uptake efficiency (OUES) showed an increasing trend in the low,medium,and high CRF groups (all P< 0.05) ; the slope of the carbon dioxide ventilation equivalent (VE/VCO₂ slope) in the low,medium,and high CRF groups showed a decreasing trend (P< 0.05). E/e' (OR=1.311,95%CI:1.050-1.637) and age (OR=1.084,95%CI:1.024-1.148) were independent hazard factors for CRF reduction in CCS patients (all P< 0.05). There were significant differences in the Peak VO₂/HR,Peak VO₂,Peak MET,and OUES among the low (E/e'< 9.0),medium (E/e' 9.0-<10.8),and high (E/e' ≥ 10.8) groups (all P< 0.05). There was no significant difference in VE/VCO 2 slope among the three groups (P> 0.05). Peak VO₂/HR,Peak VO₂,Peak MET,and OUES in the high (E/e' ≥ 10.8) group were significantly lower than those in the low (E/e'< 9.0) group (all P< 0.05). The area under the ROC curve of E/e',which may forecast CRF reduction in CCS patients,was 0.704 (95%CI:0.594-0.813,P< 0.05). When E/e' was 9.63,the sensitivity was 84.4% and specificity was 54.2%. Conclusion The left ventricular diastolic function of CCS patients decreased when CRF decreased. E/e' was an independent hazard factor for CRF reduction in patients with CCS. E/e' had a good predictive value for the decrease of CRF in patients with CCS.
Key words: chronic coronary syndrome, cardiopulmonary exercise test, cardiopulmonary fitness, left ventricular diastolic function
PDF全文下载地址:

https://journal.cmu.edu.cn/CN/article/downloadArticleFile.do?attachType=PDF&id=3028