Exercise-induced myocardial ischaemia detected by cardiopulmonary exercise testing
Exercise-induced myocardial ischaemia detected by cardiopulmonary exercise testing
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DOI：
10.1016/s0195-668x(03)00210-0
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发表时间：
2003-07-01
影响因子：
39.3
通讯作者：
D'Eusanio, G
中科院分区：
文献类型：
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作者：
Belardinelli, R;Lacalaprice, F;D'Eusanio, G
背景 本研究的目的是确定心肺运动试验 (CPET) 的参数，以检测运动诱发的心肌缺血 (EIMI)，并确定其在识别冠状动脉疾病 (CAD) 患者方面的诊断准确性。 方法和结果 我们前瞻性研究了 202 名连续患有 CAD 的患者（173 名男性，29 名女性，平均年龄 55.7 +/- 10.8 岁）。所有患者均接受增量运动压力测试 (ECG-St)，并进行每次呼吸气体交换分析，然后进行 2 天压力/休息门控 SPECT 心肌闪烁扫描 (GSMS)，作为缺血检测的金标准。 ROC 分析选择双变量模型 - O-2 脉冲平坦持续时间（从心肌缺血开始到运动峰值计算）和 DeltaVO(2)/Deltawork 速率斜率 - 通过 CPET 预测 EIMI。 GSMS 确定了 140 名患有可逆性心肌缺陷的患者，总差异评分 (SDS) 为 9.7 +/- 2.8，并排除了 62 名患者的 EIMI (SDS 1.3 +/- 1.6)。与 CPET（分别为 87% 和 74%）相比，ECG-St 诊断 EIMI 的敏感性 (46%) 和特异性 (66%) 较低。 结论 气体交换分析的加入提高了标准心电图压力测试在识别 EIMI 方面的诊断准确性。基于O 2 脉冲平坦持续时间和DeltaVO(2)/Deltawork速率斜率的二变量模型具有识别EIMI的最高预测能力。 (C) 2003 年由 Elsevier Ltd 代表欧洲心脏病学会出版。
Background The objective of the study was to identify the parameter(s) of cardiopulmonary exercise testing (CPET) that can detect exercise-induced myocardial ischaemia (EIMI), and to determine its diagnostic accuracy for identifying patients with coronary artery disease (CAD).Methods and resuIts We prospectively studied 202 consecutive patients (173 men, 29 women, mean age 55.7 +/- 10.8 years) with documented CAD. All patients underwent an incremental exercise stress testing (ECG-St) with breath - by- breath gas exchange analysis, followed by a 2-day stress/rest gated SPECT myocardial scintigraphy (GSMS) as the gold standard for ischaemia detection. ROC analysis selected a two-variabte model-O-2 pulse flattening duration, calculated from the onset of myocardial ischaemia to peak exercise, and DeltaVO(2)/Deltawork rate slope-to predict EIMI by CPET. GSMS identified 140 patients with reversible myocardial defects, with a Summed Difference Score (SDS) of 9.7 +/- 2.8, and excluded EIMI in 62 (SDS 1.3 +/- 1.6). ECG-St had tow sensitivity (46%) and specificity (66%) to diagnose EIMI as compared with CPET (87% and 74%, respectively).Conclusions The addition of gas exchange analysis improves the diagnostic accuracy of standard ECG stress testing in identifying EIMI. A two-variable model based on 02 pulse flattening duration and DeltaVO(2)/Deltawork rate slope had the highest predictive ability to identify EIMI. (C) 2003 Published by Elsevier Ltd on behalf of The European Society of Cardiology.