无冠状动脉病变女性胸痛患者血流动力学改变与运动试验结果的关系及临床意义

Comparative research on relationship between haemodynamic change and result of exercise test in female patients with chest pain and without significant coronary artery disease

目的探讨无冠状动脉病变女性胸痛患者血流动力学改变与运动试验结果的关系,以及心脏X综合征的可能病理生理机制。方法选取因发作性心绞痛样胸痛症状疑诊冠心病(CHD)女性患者,选择性冠状动脉造影(SCAG)检查正常,左室射血分数(LVEF)>55%的患者65例,根据次极量踏车运动试验(SBET)Bruce方案结果,分为运动试验阳性组39例与阴性组26例,对比分析两组间升主动脉脉压(PP)与脉压指数(PPI)、左心室舒张末压(LVEDP)及左心室舒张末压指数(LVEDPI)等血流动力学指标变化。结果①阳性组平均年龄及绝经患者数高于阴性组(P<0.05);但CHD危险因素两组间差异无统计学意义(P>0.05)。②升主动脉PP与PPI在两组间差异无统计学意义(P>0.05)。③阳性组LVEDP显著高于阴性组(P=0.008),而LVEDPI显著低于后者(P=0.0001)。结论SCAG正常的女性胸痛患者,PP或PPI指标并不能反映其对运动反应的冠脉血流储备,女性心脏X综合征可能与雌激素水平下降有关。此类患者LVEDP增加和LVEDPI降低可能与心内膜下心肌缺血或冠脉血流储备下降有关,指标LVEDPI较LVEDP反应可能更为敏感。

Objective To study on relationship between haemodynamic change and result of exercise test in female patients with chest pain and without significant coronary artery disease, and pathophysiological mechanism of cardiac syndrome X. Methods The study was performed in 65 consecutive women admitted with paroxysmal chest pain suspected coronary heart disease（CHD）, normal selected coronary arteriogram （SCAG） and Ieft ventricular ejection fraction （LVEF）〉55%. According to the results of submaximal bicycle exercise test （SBET, Bruce programme）, 39 patients were in positive group, and another 26 patients were in negative group. Hemodynamic parameters measured by standard 6Fr pigtail catheter, menopause cases and risk factors of CHD were statistically analyzed by t and correcting chi-square test between the two groups. Hemodynamic parameters involved in pulse pressure （PP） and pulse pressure index （PPI） of ascending aorta, left ventricular end systolic pressure （LVESP）, left ventricular end diastolic pressure （LVEDP） and left ventricular end diastolic pressure index and so on. Results （ 1 ）Mean ages and menopause cases in positive group were higher than in negative group（P〈0.05 ）. Risk factors of CHD were not significant between the two groups （P〉0.05）. （2）PP and PPI values of ascending aorta were not significant between the two groups（P〉0.05 ）. （3）LVEDP and LVEDPI value in positive group were significantly higher and lower than those in negative group （P=0.008 and P=0.0001）, respectively. Conclusion For that female patients with paroxysmal chest pain and normal SCAG, PP or PPI level does not respond to their coronary blood reserve to exercise, and postmenopausal patients maybe more likely to have had results of positive SBET and damaged left ventricle diastolic function. The results suggested that cardiac syndrome X in female patients maybe associated with their lower level of estrogen, and that elevated LVEDP of the patients maybe associated with subendocardial ischemia or decreased coronary blood reserve. LVEDPI value appears to be more sensitive than LVEDP.