Exercise electrocardiogram, blood pressure, and working capacity in young patients with valvular or discrete subvalvular aortic stenosis.
Exercise electrocardiogram, blood pressure, and working capacity in young patients with valvular or discrete subvalvular aortic stenosis.
复制标题
年轻瓣膜性或离散性瓣膜下主动脉狭窄患者的运动心电图、血压和工作能力。
DOI：
10.1016/0002-9149(82)91232-2
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发表时间：
1982
期刊：
影响因子：
--
通讯作者：
Spilkin,SP
中科院分区：
文献类型：
--
作者：
James,FW;Schwartz,DC;Kaplan,S;Spilkin,SP
对65例患有主动脉瓣或离散性主动脉瓣下狭窄的儿童和年轻人（平均年龄12岁）进行直立循环运动试验，记录心电图变化、血压和做功能力（总功）。所有患者均行心导管检查，但无手术治疗。对照组包括164名正常受试者（平均年龄15岁）。在患者中，运动试验和心导管插入术之间的间隔时间为1个月或更短的占66%，2至12个月的占28%，12至24个月的占6%。根据静息时左心室-主动脉峰值收缩压差将患者分为I组（梯度小于30 mm Hg），II（30至49毫米汞柱），III（50至69毫米汞柱），和IV运动诱发的S-T压低的平均频率和幅度患者组均大于对照组（P< 0.005），并随梗阻程度加重而增加。与对照组相比，左心室-主动脉收缩压差大于或等于30 mm Hg的患者的平均总功和运动收缩压峰值显著降低（p< 0.03）。19例静息左心室-主动脉收缩压差≥ 70 mm Hg的患者（第IV组）的运动特征包括S-T压低≥ 2 mm，总功和收缩压显著降低。在46例静息左心室-主动脉收缩压差小于70 mm Hg的患者中，11例（24%）出现了至少2个或更多运动特征。这项研究表明，运动试验揭示了严重异常的患者，否则被归类为有轻微或中度梗阻，一个正确的运动研究可以在最小的风险，病人。
Electrocardiographic changes, blood pressure, and working capacity (total work) were recorded during an upright cycle exercise test in 65 children and young adults (mean age 12 years) with valvular or discrete subvalvular aortic stenosis. All patients had cardiac catheterization, but none had surgical treatment. Controls consisted of 164 normal subjects (mean age 15 years). In the patients, the intervals between the exercise test and cardiac catheterization were 1 month or less in 66%, 2 to 12 months in 28%, and 12 to 24 months in 6%. The patients were classified by resting left ventricular to aortic peak systolic pressure gradient into Groups I (gradient less than 30 mm Hg), II (30 to 49 mm Hg), III (50 to 69 mm Hg), and IV (70 mm Hg or greater).The mean frequency and magnitude of exerciseinduced S-T depression were greater in the patients than in the control subjects (p< 0.005) and increased with increasing obstruction in the patients. Mean total work and peak exercise systolic pressure were significantly decreased in the patients with a left ventricular to aortic systolic gradient of 30 mm Hg or greater as compared with the control subjects (p< 0.03). An exercise profile consisting of S-T depression of 2 mm or more, and markedly decreased total work and systolic blood pressure were characteristic of the 19 patients (Group IV) with a resting left ventricular to aortic systolic gradient of 70 mm Hg or greater. At least 2 or more components of this exercise profile occurred in 11 (24%) of the 46 patients with a resting left ventricular to aortic systolic gradient less than 70 mm Hg. This study demonstrates that exercise testing reveals serious abnormalities in patients otherwise classified as having trivial or moderate obstruction, and that a properly performed exercise study can be done at minimal risk to the patient.