心肺运动试验中踏车运动试验阳性及可疑阳性冠心病患者临床及介入治疗特征

Characteristics of clinical and interventional treatments in coronary heart disease patients with positive and suspected positive from bicycle ergometer testing within cardiopulmonary exercise testing

目的探讨心肺运动试验中踏车运动试验阳性及可疑阳性的冠心病患者临床及介入治疗特征。方法选取自2020年9月1日至2021年1月31日于北部战区总医院心血管内科住院并于心脏康复中心行心肺测试的465例冠心病患者为研究对象。根据心肺运动测试中运动试验结果将患者分为阳性及可疑阳性组(n=146)与阴性组(n=319)。比较两组患者的一般资料、冠状动脉造影及介入治疗情况。随访主要不良心血管事件(MACE),包括死亡、心肌梗死及再次血运重建。结果两组患者的年龄、性别、高血压、糖尿病、入院诊断、左室舒张末期内径、左室射血分数、低密度脂蛋白、扩血管药物的应用方面,以及抑郁症筛查量表评分、广泛性焦虑量表评分比较,差异均无统计学意义(P>0.05);阳性及可疑阳性组患者β受体阻滞剂应用比例低于阴性组,差异有统计学意义(P<0.05)。两组冠状动脉靶病变部位、本次入院手术类型及支架总数比较,差异均无统计学意义(P>0.05)。阳性及可疑阳性组患者的MACE事件发生率及再次血运重建比例均高于阴性组,差异有统计学意义(P<0.05);两组死亡及心肌梗死发生率比较,差异无统计学意义(P>0.05)。结论β受体阻滞剂的应用可能降低术后心肺运动测试阳性及可疑阳性的发生率;心肺运动测试阳性及可疑阳性患者再次接受血运重建的概率增加。

Objective To investigate the clinical and interventional treatment characteristics of coronary heart disease patients with positive and suspected positive treadmill exercise test in cardiopulmonary exercise test.Methods A total of 465 patients with coronary heart disease who were hospitalized in the Department of Cardiology of General Hospital of Northern Theater Command and underwent cardiopulmonary test in the Cardiac Rehabilitation Center were selected as the study objects from September 1,2020 to January 31,2021.Patients were divided into positive and suspected positive group(n=146)and negative group(n=319)according to the results of exercise tests in cardiopulmonary exercise tests.The general data,coronary angiography and interventional therapy were compared between the two groups.Major adverse cardiovascular events(MACE)were followed up,including death,myocardial infarction,and revascularization.Results There were no significant differences in age,sex,hypertension,diabetes,admission diagnosis,left ventricular end-diastolic diameter,left ventricular ejection fraction,low density lipoprotein,application of vasodilators,depression screening scale score and generalized anxiety Scale score between two groups(P>0.05).The proportion ofβ-blocker application in positive and suspected positive group was lower than that in negative group,and the difference was statistically significant(P<0.05).There was no significant difference in the target location of coronary artery disease,the type of surgery and the total number of stents between the two groups(P>0.05).The incidence of MACE events and the proportion of revascularization in positive and suspected positive group were higher than those in negative group,with statistical significance(P<0.05).There was no significant difference in the incidence of death and myocardial infarction between the two groups(P>0.05).Conclusion The use ofβ-blockers may reduce the incidence of positive and suspected positive cardiopulmonary exercise tests after surgery.Patients with positive and suspected positive cardiopulmonary exercise tests are more likely to receive revascularization.