心肺运动试验定量评估PCI前后心肺功能的临床研究
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摘要
目的:探讨症状限制的极限心肺运动试验(cardiopulmonary exercise testing,CPET)在定量评估经皮冠状动脉腔内血管成形术(percutaneous coronary intervention,PCI)前后心肺功能中的临床应用价值。方法:利用CPET对12例正常人及12例冠脉造影术确诊冠心病拟行PCI的患者手术前后心肺功能分别定量评估,利用标准化分析对CPET指标进行解读;并在同期测定左室射血分数(left ventricular ejection fraction,LVEF),比较手术前后CPET指标的变化及与LVEF的相关性。结果:LVEF术前[(42.83±5.92)%]与术后[(45.08±4.76)%]比较,具有统计学差异(P<0.05);CPET核心指标峰值摄氧量、无氧阈值、峰值氧脉搏、摄氧效率平台、二氧化碳通气当量斜率、二氧化碳通气当量最低值、峰值负荷功率、递增功率运动时间正常对照组分别为(1.99±0.19) L/min、(1.22±0.19) L/min、(14.18±2.59) mL/次、(47.10±4.44)、(23.01±2.63)、(25.06±2.43)、(162±17.6) W、(6.47±0.80) min,术前组上述指标分别为(1.41±0.46) L/min、(0.87±0.23) L/min、(11.43±3.29) mL/次、(40.13±5.18)、(27.85±4.81)、(29.55±3.90)、(112.00±51.10) W、(5.28±1.81) min,术前组均低于正常对照组(P<0.05);术后组各指标分别为(1.59±0.33) L/min、(1.02±0.20) L/min、(12.37±2.72) mL/次、(39.20±5.60)、(26.93±2.88)、(29.30±2.82)、(132.00±31.70) W、(6.21±1.05) min,与术前比较,峰值摄氧量、无氧阈值、峰值氧脉搏、峰值负荷功率、递增功率运动时间均提高,具有统计学差异(P<0.05);摄氧效率平台、二氧化碳通气当量斜率、二氧化碳通气当量最低值与术前比较无统计学差异(P>0.05);CPET核心指标与LVEF呈高度相关(r值绝对值为0.579～0.908,均P<0.05)。结论:CPET的核心指标可用于无创定量监测PCI术前后心肺功能的变化情况,具有良好的临床应用价值。
Objective:To investigate the clinical value of symptom-limited cardiopulmonary exercise testing(CPET) in the quantitative evaluation of cardiopulmonary function before and after percutaneous coronary intervention(PCI). Methods:A total of 12 healthy individuals and 12 patients who were diagnosed with coronary heart disease by coronary angiography and planned to undergo PCI were enrolled,and CPET was performed for the quantitative evaluation of cardiopulmonary function before and after PCI. The CPET parameters were interpreted by standardized analysis. Left ventricular ejection fraction(LVEF) was measured at the same time. The changes in CPET parameters after PCI and their correlation with LVEF were analyzed. Results:There was a significant change in LVEF after PCI(42.83%±5.92% vs. 45.08%±4.76%,P<0.05). As for the core CPET parameters,compared with the normal control group, the pre-PCI group had significantly lower peak oxygen uptake(1.41±0.46 L/min vs. 1.99±0.19 L/min,P<0.05),anaerobic threshold(0.87±0.23 L/min vs. 1.22±0.19 L/min,P<0.05),peak oxygen pulse(11.43±3.29 mL/time vs. 14.18±2.59 mL/time,P<0.05),oxygen uptake efficiency plateau(40.13±5.18 vs. 47.10±4.44,P<0.05),peak load power(112.00±51.10 W vs. 162.00±17.60 W,P <0.05),and increasing power movement time(5.28±1.81 min vs. 6.47±0.80 min,P<0.05) and significantly higher slope of ventilatory equivalent for carbon dioxide(27.85±4.81 vs. 23.01±2.63,P<0.05) and minimum ventilatory equivalent for carbon dioxide(29.55±3.90 vs. 25.06±2.43,P<0.05);in the post-PCI group,these parameters were1.59±0.33 L/min,1.02±0.20 L/min,12.37±2.72 mL/time,39.20±5.60,26.93 ±2.88,29.30±2.82,132.00±31.70 W,and 6.21 ±1.05 min,respectively,and compared with the pre-PCI group,the post-PCI group had significant increases in peak oxygen uptake,anaerobic threshold,peak oxygen pulse,peak load power,and increasing power movement time(P<0.05),while there were no significant differences in oxygen uptake efficiency plateau,slope of ventilatory equivalent for carbon dioxide,and minimum ventilatory equivalent for carbon dioxide between the pre-PCI group and the post-PCI group(P>0.05). The core CPET parameters were highly correlated with LVEF(absolute r value=0.579-0.908,all P<0.05). Conclusion:The core CPET parameters can be used for noninvasive quantitative monitoring of changes in cardiopulmonary function after PCI and has a good clinical value.
Objective:To investigate the clinical value of symptom-limited cardiopulmonary exercise testing(CPET) in the quantitative evaluation of cardiopulmonary function before and after percutaneous coronary intervention(PCI). Methods:A total of 12 healthy individuals and 12 patients who were diagnosed with coronary heart disease by coronary angiography and planned to undergo PCI were enrolled,and CPET was performed for the quantitative evaluation of cardiopulmonary function before and after PCI. The CPET parameters were interpreted by standardized analysis. Left ventricular ejection fraction(LVEF) was measured at the same time. The changes in CPET parameters after PCI and their correlation with LVEF were analyzed. Results:There was a significant change in LVEF after PCI(42.83%±5.92% vs. 45.08%±4.76%,P<0.05). As for the core CPET parameters,compared with the normal control group, the pre-PCI group had significantly lower peak oxygen uptake(1.41±0.46 L/min vs. 1.99±0.19 L/min,P<0.05),anaerobic threshold(0.87±0.23 L/min vs. 1.22±0.19 L/min,P<0.05),peak oxygen pulse(11.43±3.29 mL/time vs. 14.18±2.59 mL/time,P<0.05),oxygen uptake efficiency plateau(40.13±5.18 vs. 47.10±4.44,P<0.05),peak load power(112.00±51.10 W vs. 162.00±17.60 W,P <0.05),and increasing power movement time(5.28±1.81 min vs. 6.47±0.80 min,P<0.05) and significantly higher slope of ventilatory equivalent for carbon dioxide(27.85±4.81 vs. 23.01±2.63,P<0.05) and minimum ventilatory equivalent for carbon dioxide(29.55±3.90 vs. 25.06±2.43,P<0.05);in the post-PCI group,these parameters were1.59±0.33 L/min,1.02±0.20 L/min,12.37±2.72 mL/time,39.20±5.60,26.93 ±2.88,29.30±2.82,132.00±31.70 W,and 6.21 ±1.05 min,respectively,and compared with the pre-PCI group,the post-PCI group had significant increases in peak oxygen uptake,anaerobic threshold,peak oxygen pulse,peak load power,and increasing power movement time(P<0.05),while there were no significant differences in oxygen uptake efficiency plateau,slope of ventilatory equivalent for carbon dioxide,and minimum ventilatory equivalent for carbon dioxide between the pre-PCI group and the post-PCI group(P>0.05). The core CPET parameters were highly correlated with LVEF(absolute r value=0.579-0.908,all P<0.05). Conclusion:The core CPET parameters can be used for noninvasive quantitative monitoring of changes in cardiopulmonary function after PCI and has a good clinical value.
引文
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[3]孙兴国.整体整合生理学医学新理论体系:人体功能一体化自主调控[J].中国循环杂志,2013,28(2):88-92.
[4]孙兴国.心肺运动试验在临床心血管病学中的应用价值和前景[J].中华心血管病杂志,2014,42(4):347-351.
[5]谭晓越,孙兴国.从心肺运动的应用价值看医学整体整合的需求[J].医学与哲学,2013,34(3):28-31.
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[9]孙兴国,胡大一.心肺运动试验的实验室和设备要求及其临床实施难点的质量控制[J].中华心血管病杂志,2014,42(10):817-821.
[10] Huszczuk A,Whipp BJ,Wasserman K. A respiratory gas exchange simulator for routine calibration in metabolic studies[J]. Eur Respir J,1990,3(4):465-468.
[11] Wasserman K,Sun XG,Hansen JE. Effect of biventricular pacing on the exercise pathophysiology of heart failure[J]. Chest,2007,132(1):250-261.
[12]孙兴国.更为强化心肺代谢等整体功能的心肺运动试验新9图图解[J].中国应用生理学杂志,2015,31(4):369-373.
[13]孙兴国.心肺运动试验的规范化操作要求和难点——数据分析图示与判读原则[J].中国应用生理学杂志,2015,31(4):361-365.
[14] Beaver WL,Wasserman K,Whipp BJ. A new method for detecting anaerobic threshold by gas exchange[J]. J Appl Physiol,1986,60(6):2020-2027.
[15] Sun XG,Hansen JE,Beshai JF,et al. Oscillatory breathing and exercise gas exchange abnormalities prognosticate early mortality and morbidity in heart failure[J]. J Am Coll Cardiol,2010,55(17):1814-1823.
[16] Sun XG,Hansen JE,Garatachea N,et al. Ventilatory efficiency during exercise in healthy subjects[J]. Am J Respir Crit Care Med,2002,166(11):1443-1448.
[17] Sun XG,Hansen JE,Stringer WW. Oxygen uptake efficiency plateau:physiology and reference values[J]. Eur J Appl Physiol,2012,112(3):919-928.
[18] Sun XG,Hansen JE,Stringer WW. Oxygen uptake efficiency plateau best predicts early death in heart failure[J]. Chest,2012,141(5):1284-1294.
[19] Older P,Hall A,Hader R. Cardiopulmonary exercise testing as a screening test for perioperative management of major surgery in the elderly[J]. Chest,1999,116(2):355-362.
[20] Guazzi M,Arena R,Halle M,et al. 2016 focused update:clinical recommendations for cardiopulmonary exercise testing data assessment in specific patient populations[J]. Circulation,2016,133(24):e694-711.
[21] Ribeiro JP,Stein R,Chiappa GR. Beyond peak oxygen uptake:new prognostic markers from gas exchange exercise tests in chronic heart failure[J]. J Cardiopulm Rehabil,2006,26(2):63-71.
[22] Oudiz RJ,Midde R,Hovenesyan A,et al. Usefulness of right-toleft shunting and poor exercise gas exchange for predicting prognosis in patients with pulmonary arterial hypertension[J]. Am J Cardiol,2010,105(8):1186-1191.
[23] Ndrepepa G,Mehilli J,Martinoff S,et al. Evolution of left ventricular ejection fraction and its relationship to infarct size after acute myocardial infarction[J]. J Am Coll Cardiol,2007,50(2):149-156.
[24] Kruk M,Buller CE,Tchenq JE,et al. Impact of left ventricular ejection fraction on clinical outcomes over five years after infarct-related coronary artery recanalization(from the Occluded Artery Trial[OAT])[J].Am J Cardiol,2010,105(1):10-16.
[25] McDonagh TA,Cunningham AD,Morrison CE,et al. Left ventricular dysfunction,natriuretic peptides,and mortality in an urban population[J]. Heart,2001,86(1):21-26.
[26] Potter E,Marwick TH. Assessment of left ventricular function by echocardiography:the case for routinely adding global longitudinal strain to ejection fraction[J]. JACC Cardiovasc Imaging,2018,11(2 Pt1):260-274.
[2] Bristow MR,Kao DP,Breathett KK,et al. Structural and functional phenotyping of the failing heart:is the left ventricular ejection fraction obsolete?[J]. JACC Heart Fail,2017,5(11):772-781.
[3]孙兴国.整体整合生理学医学新理论体系:人体功能一体化自主调控[J].中国循环杂志,2013,28(2):88-92.
[4]孙兴国.心肺运动试验在临床心血管病学中的应用价值和前景[J].中华心血管病杂志,2014,42(4):347-351.
[5]谭晓越,孙兴国.从心肺运动的应用价值看医学整体整合的需求[J].医学与哲学,2013,34(3):28-31.
[6] Hightower CE,Riedel BJ,Feiq BW,et al. A pilot study evaluating predictors of postoperative outcomes after major abdominal surgery:physiological capacity compared with the ASA physical status classification system[J]. Br J Anaesth,2010,104(4):465-471.
[7] Sun XG,Hansen JE,Oudiz RJ,et al. Exercise pathophysiology in patients with primary pulmonary hypertension[J]. Circulation,2001,104(4):429-435.
[8] Sun XG,Hansen JE,Oudiz RJ,et al. Gas exchange detection of exercise-induced right-to-left shunt in patients with primary pulmonary hypertension[J]. Circulation,2002,105(1):54-60.
[9]孙兴国,胡大一.心肺运动试验的实验室和设备要求及其临床实施难点的质量控制[J].中华心血管病杂志,2014,42(10):817-821.
[10] Huszczuk A,Whipp BJ,Wasserman K. A respiratory gas exchange simulator for routine calibration in metabolic studies[J]. Eur Respir J,1990,3(4):465-468.
[11] Wasserman K,Sun XG,Hansen JE. Effect of biventricular pacing on the exercise pathophysiology of heart failure[J]. Chest,2007,132(1):250-261.
[12]孙兴国.更为强化心肺代谢等整体功能的心肺运动试验新9图图解[J].中国应用生理学杂志,2015,31(4):369-373.
[13]孙兴国.心肺运动试验的规范化操作要求和难点——数据分析图示与判读原则[J].中国应用生理学杂志,2015,31(4):361-365.
[14] Beaver WL,Wasserman K,Whipp BJ. A new method for detecting anaerobic threshold by gas exchange[J]. J Appl Physiol,1986,60(6):2020-2027.
[15] Sun XG,Hansen JE,Beshai JF,et al. Oscillatory breathing and exercise gas exchange abnormalities prognosticate early mortality and morbidity in heart failure[J]. J Am Coll Cardiol,2010,55(17):1814-1823.
[16] Sun XG,Hansen JE,Garatachea N,et al. Ventilatory efficiency during exercise in healthy subjects[J]. Am J Respir Crit Care Med,2002,166(11):1443-1448.
[17] Sun XG,Hansen JE,Stringer WW. Oxygen uptake efficiency plateau:physiology and reference values[J]. Eur J Appl Physiol,2012,112(3):919-928.
[18] Sun XG,Hansen JE,Stringer WW. Oxygen uptake efficiency plateau best predicts early death in heart failure[J]. Chest,2012,141(5):1284-1294.
[19] Older P,Hall A,Hader R. Cardiopulmonary exercise testing as a screening test for perioperative management of major surgery in the elderly[J]. Chest,1999,116(2):355-362.
[20] Guazzi M,Arena R,Halle M,et al. 2016 focused update:clinical recommendations for cardiopulmonary exercise testing data assessment in specific patient populations[J]. Circulation,2016,133(24):e694-711.
[21] Ribeiro JP,Stein R,Chiappa GR. Beyond peak oxygen uptake:new prognostic markers from gas exchange exercise tests in chronic heart failure[J]. J Cardiopulm Rehabil,2006,26(2):63-71.
[22] Oudiz RJ,Midde R,Hovenesyan A,et al. Usefulness of right-toleft shunting and poor exercise gas exchange for predicting prognosis in patients with pulmonary arterial hypertension[J]. Am J Cardiol,2010,105(8):1186-1191.
[23] Ndrepepa G,Mehilli J,Martinoff S,et al. Evolution of left ventricular ejection fraction and its relationship to infarct size after acute myocardial infarction[J]. J Am Coll Cardiol,2007,50(2):149-156.
[24] Kruk M,Buller CE,Tchenq JE,et al. Impact of left ventricular ejection fraction on clinical outcomes over five years after infarct-related coronary artery recanalization(from the Occluded Artery Trial[OAT])[J].Am J Cardiol,2010,105(1):10-16.
[25] McDonagh TA,Cunningham AD,Morrison CE,et al. Left ventricular dysfunction,natriuretic peptides,and mortality in an urban population[J]. Heart,2001,86(1):21-26.
[26] Potter E,Marwick TH. Assessment of left ventricular function by echocardiography:the case for routinely adding global longitudinal strain to ejection fraction[J]. JACC Cardiovasc Imaging,2018,11(2 Pt1):260-274.