Cardiopulmonary exercise testing and efficacy of percutaneous coronary intervention: a substudy of the ORBITA trial.
Cardiopulmonary exercise testing and efficacy of percutaneous coronary intervention: a substudy of the ORBITA trial.
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经皮冠状动脉干预的心肺运动测试和功效：Orbita试验的典型。
DOI：
10.1093/eurheartj/ehac260
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发表时间：
2022-09-01
影响因子：
39.3
通讯作者：
Al-Lamee, Rasha
中科院分区：
文献类型：
--
作者：
Ganesananthan, Sashiananthan;Rajkumar, Christopher A.;Foley, Michael;Thompson, David;Nowbar, Alexandra N.;Seligman, Henry;Petraco, Ricardo;Sen, Sayan;Nijjer, Sukhjinder;Thom, Simon A.;Wensel, Roland;Davies, John;Francis, Darrel;Shun-Shin, Matthew;Howard, James;Al-Lamee, Rasha
关键词：
在心肺运动试验(CPET)中测量的氧脉冲形态和气体交换分析与心肌缺血有关。这项分析的目的是研究慢性冠状动脉综合征患者CPET参数、心肌缺血和心绞痛症状之间的关系，并确定这些参数预测经皮冠状动脉介入治疗(PCI)的安慰剂控制反应的能力。在Orbita试验中，严重单支冠状动脉疾病(CAD)患者被随机分为1：1组接受经皮冠状动脉介入治疗或安慰剂治疗。受试者接受了随机前的平板CPET、多巴酚丁胺负荷超声心动图(DSE)和症状评估。在为期6周的盲法随访期结束时，重复这些评估。共有195名有CPET数据的患者被随机分组(102名经皮冠状动脉介入治疗，93名安慰剂)。与非CPET组相比，CPET期间出现氧脉搏平台者DSE评分[+0.82个节段，95%可信区间(CI)：0.40~1.25，P = 0.0068]和低血流储备分数(−=0.07；95%CI：−=0.12~−0.02，P = 0.011)明显升高。在氧脉搏斜率较低(更异常)的情况下，经皮冠状动脉介入治疗的安慰剂控制效果在DSE评分[氧脉搏平台存在(P交互作用 = 0.026)和氧脉冲梯度(P交互作用 = 0.023)]和西雅图心绞痛物理限制评分[氧脉冲平台存在(P交互作用 = 0.037)]方面有更大的改善。峰值VO2、VE/VCO2斜率、峰值氧脉搏和氧摄取效率斜率受损与较高的症状负担显著相关，但与缺血的严重程度或预测冠状动脉介入治疗的反应无关。虽然选择的CPET参数与心绞痛症状的严重程度和生活质量有关，但只有氧脉搏平台检测心肌缺血的严重程度，并预测单支冠状动脉病变患者接受经皮冠状动脉介入治疗的安慰剂控制疗效。只有氧脉搏平台与缺血的标志物有关，并预测慢性冠脉综合征患者经皮冠状动脉介入治疗的安慰剂对照疗效。
Oxygen-pulse morphology and gas exchange analysis measured during cardiopulmonary exercise testing (CPET) has been associated with myocardial ischaemia. The aim of this analysis was to examine the relationship between CPET parameters, myocardial ischaemia and anginal symptoms in patients with chronic coronary syndrome and to determine the ability of these parameters to predict the placebo-controlled response to percutaneous coronary intervention (PCI). Patients with severe single-vessel coronary artery disease (CAD) were randomized 1:1 to PCI or placebo in the ORBITA trial. Subjects underwent pre-randomization treadmill CPET, dobutamine stress echocardiography (DSE) and symptom assessment. These assessments were repeated at the end of a 6-week blinded follow-up period. A total of 195 patients with CPET data were randomized (102 PCI, 93 placebo). Patients in whom an oxygen-pulse plateau was observed during CPET had higher (more ischaemic) DSE score [+0.82 segments; 95% confidence interval (CI): 0.40 to 1.25, P = 0.0068] and lower fractional flow reserve (−0.07; 95% CI: −0.12 to −0.02, P = 0.011) compared with those without. At lower (more abnormal) oxygen-pulse slopes, there was a larger improvement of the placebo-controlled effect of PCI on DSE score [oxygen-pulse plateau presence (Pinteraction = 0.026) and oxygen-pulse gradient (Pinteraction = 0.023)] and Seattle angina physical-limitation score [oxygen-pulse plateau presence (Pinteraction = 0.037)]. Impaired peak VO2, VE/VCO2 slope, peak oxygen-pulse, and oxygen uptake efficacy slope was significantly associated with higher symptom burden but did not relate to severity of ischaemia or predict response to PCI. Although selected CPET parameters relate to severity of angina symptoms and quality of life, only an oxygen-pulse plateau detects the severity of myocardial ischaemia and predicts the placebo-controlled efficacy of PCI in patients with single-vessel CAD. Only an oxygen pulse plateau relates to markers of ischaemia and predicts the placebo-controlled efficacy of percutaneous coronary intervention in patients with chronic coronary syndrome.
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影响因子：
168.9
作者：
Al-Lamee, Rasha;Thompson, David;Francis, Darrel P.
通讯作者：
Francis, Darrel P.
影响因子：
37.8
作者：
Arena, Ross;Myers, Jonathan;Guazzi, Marco
通讯作者：
Guazzi, Marco
影响因子：
37.8
作者：
Guazzi, Marco;Arena, Ross;Lavie, Carl J.
通讯作者：
Lavie, Carl J.
影响因子：
4.8
作者：
Ajisaka, R;Watanabe, S;Sugishita, Y
通讯作者：
Sugishita, Y
影响因子：
9.6
作者：
Adachi, H;Koike, A;Hiroe, M
通讯作者：
Hiroe, M