肥厚型心肌病患者的心肺功能评估和相关因素研究

Assessment of Cardiopulmonary Exercise Capacity in Patients With Hypertrophic Cardiomyopathy

目的:探究肥厚型心肌病(HCM)患者的心肺功能评估和相关因素。方法:连续入选2018年4月至2019年8月期间在中国医学科学院阜外医院功能检测中心行心肺运动试验(CPET)的HCM患者129例为HCM组,另选择与HCM组性别、年龄、体重匹配的健康者113例为正常对照组。HCM组和正常对照组均在医生的监督下进行症状限制性极量CPET。收集记录HCM患者的NYHA心功能分级、血N末端B型利钠肽原(NT-proBNP)、一般情况及心电图、24 h动态心电图、超声心动图等检查结果。结果:与正常对照组相比,HCM组的峰值摄氧量[peak VO_(2),(19.2±4.3)ml/(min·kg)vs.(26.1±5.8)ml/(min·kg),P=0.000]、无氧阈[(11.2±1.9)ml/(min·kg)vs.(13.9±2.9)ml/(min·kg),P=0.000]及氧脉搏[(10.9±2.9)ml/次vs.(12.1±2.6)ml/次,P=0.001]均减低;而HCM组的二氧化碳通气当量斜率(30.5±5.6 vs.27.7±5.4,P=0.000)明显升高。HCM组的峰值收缩压[(164.4±31.1)mmHg vs.(175.3±21.6)mmHg,P=0.002,1 mmHg=0.133 kPa)、峰值舒张压[(83.5±23.13)mmHg vs.(89.5±21.8)mmHg,P=0.040]以及静息心率[(73.4±14.6)次/min vs.(79.1±11.9)次/min,P=0.001]、峰值心率[(132.4±24.7)次/min vs.(153.6±18.3)次/min,P=0.000]均较正常对照组降低。Peak VO_(2)与NYHA心功能分级(R=-0.310,P=0.004)及NT-proBNP(R=-0.297,P=0.015)的相关性均有统计学意义。年龄(B=-0.129,P=0.000)、女性(B=-3.152,P=0.000)、左心室高电压(B=1.820,P=0.003)、最大左心室室壁厚度(B=-0.144,P=0.029)及合并肺动脉高压(B=-3.581,P=0.002)是peak VO_(2)的独立相关因素。结论:CPET可客观、准确地评估HCM患者心肺运动功能。性别、年龄、最大左心室室壁厚度、左心室高电压及肺动脉高压是HCM患者Peak VO_(2)的独立相关因素。

Objectives:This study sought to assess the functional capacity with cardiopulmonary exercise testing(CPET)in patients with hypertrophic cardiomyopathy(HCM),and explored the factors leading to the reduced functional tolerance in HCM patients.Methods:The study sample included consecutive 129 HCM patients who underwent CPET in Fuwai hospital from April 1,2018 to July 31,2019 and complete clinical assessment,including electrocardiography,Holter and echocardiography.One hundred and thirteen healthy age-,gender-and weight-matched volunteers were enrolled as control group.Results:Compared with control group,peak VO_(2)(P=0.000),AT(P=0.000),O_(2)P(P=0.001)and peak heart rate(P=0.000)were significantly decreased in HCM group,while VE/VCO_(2)(P=0.000)was significantly increased in HCM group.Patients in HCM group had a higher peak SBP(P=0.002),DBP(P=0.004),rest HR(P=0.001)and peak HR(P=0.000)as compared to those in control group.Peak VO_(2)was significantly associated with NYHA functional class(P=0.004),and also significant associated with NT-proBNP(P=0.015).Linear multiple regression analysis showed that the factors independently associated with peak VO_(2)included age(B=0.000),female(P=0.000),increased QRS voltages(P=0.003),maximal wall thickness(P=0.029)and pulmonary hypertension(P=0.002).Conclusions:CPET can objectively and quantitatively evaluate the cardiopulmonary exercise capacity in patients with HCM.The peak VO_(2)is independently associated with age,sex,increased QRS voltages,maximal wall thickness and pulmonary hypertension in HCM patients.