心肺运动试验过程中峰值氧脉搏与冠心病主要不良心血管事件相关性分析

Correlation analysis of peak oxygen pulse and major adverse cardiovascular events in coronary heart disease during cardiop ulmonary exercise test

目的探讨心肺运动试验(CPET)过程中峰值氧脉搏与冠心病主要不良心血管事件(MACE)的相关性。方法选取北部战区总医院心血管内科自2015年11月至2021年9月收治的3800例出院前完成CPET的冠心病患者为研究对象。根据CPET过程中峰值氧脉搏将患者分为Q1组(峰值氧脉搏<7.9 ml/beat,n=906)、Q2组(7.9 ml/beat≤峰值氧脉搏≤9.6 ml/beat,n=950)、Q3组(9.6 ml/beat<峰值氧脉搏<11.3 ml/beat,n=975)、Q4组(峰值氧脉搏≥11.3 ml/beat,n=969)。记录并比较4组患者的临床资料、化验及手术相关信息、心肺功能、临床不良事件。采用COX回归分析与Kaplan-Meier生存分析评估峰值氧脉搏与预后的相关性。结果4组患者男性、吸烟史、饮酒史、陈旧性心肌梗死、卒中史、高血压病史比例,以及年龄、心率、舒张压、射血分数、体质量指数比较,差异均有统计学意义(P<0.05)。4组患者血红蛋白、N端B型钠尿肽原、甘油三酯、高密度脂蛋白、总胆固醇、血清肌酐、SYNTAX评分,以及接受经皮冠状动脉介入治疗、使用替格瑞洛、β受体阻滞剂、血管紧张素受体拮抗剂、钙通道阻断剂比例比较,差异均有统计学意义(P<0.05)。4组患者峰值心率、峰值代谢当量、无氧阈代谢当量、峰值公斤摄氧量、无氧阈时公斤摄氧量、分钟最大通气量、氧通气当量、二氧化碳通气当量、运动中峰值收缩压、运动中峰值舒张压、二氧化碳通气当量斜率、Borg评分、心率储备、呼吸储备及运动时长比较,差异均有统计学意义(P<0.05)。4组患者临床不良事件发生率比较,差异无统计学意义(P>0.05)。Kaplan-Meier生存分析显示,Q4组患者的MACE累计发生率高于Q1组(P<0.05)。结论CPET过程中峰值氧脉搏与冠心病预后呈正相关,峰值氧脉搏≥11.3 ml/beat的冠心病患者预后较好。

Objective To investigate the correlation between peak oxygen pulse and major adverse cardiovascular events(MACE)in coronary heart disease during cardiopulmonary exercise test(CPET).Methods A total of 3800 patients with coronary heart disease who completed CPET before discharge were selected from the Department of Cardiology of the General Hospital of Northern Theater Command from November 2015 to September 2021.According to the peak oxygen pulse during CPET,they were divided into group Q1(peak oxygen pulse<7.9 ml/beat,n=906),group Q2(7.9 ml/beat≤peak oxygen pulse≤9.6 ml/beat,n=950),group Q3(9.6 ml/beat<peak oxygen pulse<11.3 ml/beat,n=975)and group Q4(peak oxygen pulse≥11.3 ml/beat,n=969).The clinical data,laboratory and surgical information,cardiopulmonary function and clinical adverse events of the 4 groups were recorded and compared.COX regression analysis and Kaplan-Meier survival analysis were used to evaluate the correlation between peak oxygen pulse and prognosis.ResultsThere were significant dfferences in male,smoking history,drinking history,old myocardial infarction history stroke history,hypertension history,age,heart rate,diastolic blood pressure,ejection fraction and body mass index among 4 groups(P<O.05).There were statistically significant differences in hemoglobin,N-terminal pro-B-type natriuretic peptide,triglyceride,high-density lipoprotein,total cholesterol,serum creatinine,SYNTAX score,and the proportions of percutaneous coronary intervention,ticagrelorβ-blocker,angiotensin receptor antagonist,and calcium channel blocker among 4 groups(P<0.05).Comparison of peak heart rate,peak metabolic equivalent,anaerobic threshold metabolic equivalent,peak oxygen uptake in kg,oxygen uptake in kg at anaerobic threshold,min maximum gas volume,ventilatory equivalent for O,,ventilatory equivalent for CO_(2),peak systolic blood pressure during exercise,peak diastolic blood pressure during exercise,slope of ventilatory equivalent for COz,Borg score,heart rate reserve,respiratory reserve and exercise duration of patients in 4 groups,the differences were statistically significant(P<0.05).There was no significant difference in the incidence of clinical adverse events among 4 groups(P>0.05).Kaplan-Meier survival analysis showed that the cumulative incidence of MACE in Q4 group was higher than that in Q1 group(P<0.05).Conclusion The peak oxygen pulse is positively correlated with the prognosis of coronary heart disease during CPET,and the prognosis of coronary heart disease patients with peak oxygen pulse≥11.3 ml/beat is better.