急性ST段抬高心肌梗死患者早期心肺运动试验的安全性

Safety of early cardiopulmonary exercise test in myocardial infarction patients with acute ST-elevation

目的:评价急性ST段抬高心肌梗死(ST-elevation myocardial infarction,STEMI)患者进行早期心肺运动试验(cardiopulmonary exercise testing,CPET)的安全性。方法:选择2006年7月至2010年12月在北京大学第三医院心血管内科就诊的初次发生急性STEMI并行CEPT的患者302例,回顾性分析患者CPET的安全性及其相关影响因素。结果:入选患者平均年龄(55.5±11.0)岁,男性占88.1%。提前终止运动试验者占41.7%,其原因以因感到疲劳而要求终止者最为常见(67.5%),检测过程中无严重心律失常、晕厥或猝死。完全血运重建和不完全血运重建患者提前终止运动的比例分别为35.1%和49.6%(P=0.040)。以是否提前终止运动试验为因变量,将患者的性别、年龄、是否为前壁STEMI、超声心动图测定的心脏结构和功能指标、是否为多支冠状动脉病变、是否为不完全血运重建治疗和是否合并高血压病、高脂血症、糖尿病和吸烟等危险因素作为自变量建立Logistic回归方程,结果显示,提前终止运动试验与不完全血运重建(P=0.013,OR=1.869,95%CI 1.139～3.067)和左室舒张末期内径(left ventricular end-diastolic dimension,LVEDD)(P=0.018,OR=1.064,95%CI 1.011～1.121)有相关性,而与上述其他因素无关。结论:对急性STEMI患者进行早期心肺运动试验安全可行,不完全血运重建和左室舒张末内径是提前终止运动试验的独立危险因素。

Objective：To investigate the safety of cardiopulmonary exercise testing（CPET） early after acute ST-elevation myocardial infarction（STEMI）.Methods： We retrospectively reviewed 302 patients who underwent CPET early after STEMI in a single exercise laboratory.Demographic data,presence of concomitant diseases,characteristics of AMI,angiography findings and the safety of CPET were evaluated.Results： 41.7% of the tests were reported to have stopped earlier than expected.The most common limiting symptoms were generalized fatigue（67.5%）.None of the tests terminated because of severe arrhythmia,syncope or sudden death.In contrast to patients with incomplete revascularization（IR）,the rate of stopping earlier than expected was lower in complete revascularization（CR） patients（35.1% vs.49.6%,P=0.040）.After being adjusted by the subjects＇ demographic features,clinical characteristics and cardiovascular risk factors,IR（P=0.013,OR=1.869,95%CI 1.139 to 3.067） and left ventricular end-diastolic dimension（LVEDD,P=0.018,OR=1.064,95%CI 1.011 to 1.121） were independent risk factors for the limiting symptoms of CPET.Conclusion： The experience of this laboratory shows that CPET is relatively safe in patients early after STEMI.IR and LVEDD are independent risk factors for the limiting symptoms of CPET.