Chronotropic incompetence and a higher frequency of myocardial ischemia in exercise echocardiography.
Chronotropic incompetence and a higher frequency of myocardial ischemia in exercise echocardiography.
复制标题
DOI：
10.1186/1476-7120-5-38
复制
发表时间：
2007-11-02
影响因子：
1.9
通讯作者：
Sousa, Antonio C S
中科院分区：
文献类型：
--
作者：
Oliveira, Joselina L M;Goes, Thiago J S;Santana, Thaiana A;Travassos, Thiago F;Teles, Livia D;Anjos-Andrade, Fernando D;Nascimento-Junior, Adao C;Alves, Erica O;Barreto, Martha A;Barreto-Filho, Jose A;D'Oliveira, Argemiro Jr;Sousa, Antonio C S
运动超声心动图（EE）是诊断冠状动脉疾病（CAD）的既定方法。 EE 期间的变时性功能不全 (CI) 可能是心肌缺血的标志。本研究的目的是评估 EE 期间 CI 在 CAD 诊断中的附加价值。 2000 年至 2006 年间，4042 名患者（1900 名男性，平均年龄为 56 ± 11 岁）接受了 EE 评估。根据运动测试期间达到的心率（HR），受试者被分为两组：G1组——490名未能达到最大年龄预测HR的85%的患者，G2组——3552名能够达到最大年龄预测HR的85%的患者。临床特征、左心室壁运动异常——室壁运动评分指数（WMSI）——和冠状动脉造影（CA）是两组之间比较的参数。 G1 组左心室壁运动异常比 G2 组更常见（54% vs 26%；P < 0.00001）。 G1 组的 WMSI 高于 G2 组，休息时（1.06 ± 0.17 对比 1.02 ± 0.09；P < 0.0001）和运动后（1.12 ± 0.23 对比 1.04 ± 0.21；P < 0.0001）。在G1组中，心肌缺血EE阳性的患者中有82%出现冠状动脉阻塞，而G2组中这一比例为71%（P = 0.03）。 CI 与 EE 期间心肌缺血的较高频率相关，这强化了 CI 是心肌缺血严重程度标志的概念。
Exercise echocardiography (EE) is an established method to diagnose coronary artery disease (CAD). Chronotropic incompetence (CI) during the EE may be a marker of myocardial ischemia. The purpose of this investigation was to evaluate the additive value of CI during EE in CAD diagnosis. Between 2000 and 2006, 4042 patients (1900 men with a mean age of 56 ± 11 years) were evaluated by EE. Based on the heart rate (HR) reached during the exercise test, the subjects were divided into two groups: G1 group – 490 patients who failed to achieve 85% of the maximal age-predicted HR, and G2 group – 3552 patients who were able to achieve 85% of the maximal age-predicted HR. Clinical characteristics, left ventricular wall motion abnormalities – wall motion score index (WMSI) – and coronary angiography (CA) were the parameters compared between the two groups. The left ventricular wall motion abnormalities were more frequent in G1 group than in G2 group (54% versus 26%; P < 0.00001). WMSI was higher in G1 group than in G2 group, both at rest (1.06 ± 0.17 versus 1.02 ± 0.09; P < 0.0001) and after exercise (1.12 ± 0.23 versus 1.04 ± 0.21; P < 0.0001). In G1 group, 82% of the patients with positive EE for myocardial ischemia presented obstructive coronary, compared to 71% (P = 0.03) in G2 group. CI is associated with a higher frequency of myocardial ischemia during EE, reinforcing the concept that CI is a marker of the severity of myocardial ischemia.