心脏变时功能不全对冠心病严重度的预测价值

Chronotropic incompetence predicts angiographic severity in patients with coronary artery disease

目的探讨变时功能不全与冠心病严重度的关系。方法经选择性冠状动脉造影确诊的91例冠心病患者分为单支病变组(30例)、双支病变组(31例)和三支病变组(30例),所有患者完成亚极量运动负荷试验并计算变时功能指标运动最高心率与预测最大心率值之比(rHR)和心率储备率(HRR)。结果rHR和HRR在双支病变和三支病变组显著低于单支病变组(P<0.01),而双支病变和三支病变组间比较差异无显著性(P>0.05);冠心病患者中HRR<0.72预测多支病变的OR为4.67(95%CI1.8～12.1),预测冠脉狭窄≥75%的OR为3.06(95%CI1.1～8.3)。结论冠心病多支病变患者变时功能降低更严重,变时功能不全可能对冠心病多支病变和冠脉狭窄程度有预测价值。

Objective To investigate the relationship between the chronotropic incompetence and angiographic severity of coronary disease. Methods 91 patients with atherosclerotic herat disease（CHD） were diagnosised by coronary angiography and were divided to 3 groups：CHD group with only one coronary artery involved （CHD1 group,30 patients） ,CHD group with two coronary artery involved （CHD2 group, 31 patients） ,CHD group with three coronary artery involved （CHD3 group,30 patients）. A month before coronary angiography, symptom-limited exercise treadmill tests had been accomplished, the chronotropic response had been measured and expressed as ratio of heart rate reserve（HRR） and the percent maximal age-predicted heart rate achieved （rHR）. Results rHR and HRR were very significantly lower （all P〈 0.01 ） in CHD2 and CHD3 group than that in CHD1 group,but similar between between CHD2 group and CHD3 group（ P 〉 0.05 ）. HRR 〈 0.72 can predicts multi-branches stenosis（ OR 4.67, P 〈 0.01 ） and I〉 75 % coronary artery stenesis （ OR 3.06,P 〈 0.01 ） in CHD patients. Conclusion Chronotropic effect was impaired severiously in CHD patients with multi-branches stenesis and ≥75% coronary artery stenesis, and chmnotropic incompetence can predicts angiographic severity in CHD patients.