Percutaneous transluminal coronary angioplasty improves oxygen uptake kinetics during the onset of exercise in patients with coronary artery disease
Percutaneous transluminal coronary angioplasty improves oxygen uptake kinetics during the onset of exercise in patients with coronary artery disease
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DOI：
10.1378/chest.118.2.329
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发表时间：
2000-08-01
期刊：
影响因子：
9.6
通讯作者：
Hiroe, M
中科院分区：
文献类型：
--
作者：
Adachi, H;Koike, A;Hiroe, M
研究目的：虽然已知经皮腔内冠状动脉成形术（PTCA）对运动能力有有益的影响，但其对运动开始时心血管反应的影响尚未明确，本研究旨在确定PTCA对冠状动脉疾病患者恒定工作速率运动时摄氧量(（V) / dot(O2)）动力学的影响，以及对其最大工作能力指标的影响。方法：17例成功接受PTCA的冠状动脉疾病患者在PTCA术前和术后4个月分别进行了50w恒定工作速率运动试验6分钟和症状限制的增量运动试验。(V)除以点（O2）由呼吸气体逐呼吸分析计算。通过对(V) over dot（O2）响应拟合单一指数函数，确定了50 w运动开始时(V) over dot（O2）动力学的时间常数。结果：14例无冠状动脉再狭窄患者(V) over dot（O2）动力学时间常数由PTCA前的（平均+/- SD） 57.4 +/- 12.6显著缩短至PTCA后的48.2 +/- 9.5 s (p = 0.0035)，表明(V) over dot（O2）反应动力学得到改善。在这些受试者中，最大运动试验时获得的峰值(V)比点（O2）也分别从23.1 +/- 3.5增加到26.5 +/- 3.2 mL/min/kg (p = 0.0005)，而PTCA后再狭窄患者的这些指标没有改善（n = 3）。结论：心肺运动试验指标反映运动肌肉的氧流效率，可作为了解PTCA术后哪些患者不会发生冠状动脉再狭窄的客观、无创、经济的指导。
Study objectives: Although percutaneous transluminal coronary angioplasty (PTCA) is known to have beneficial effects on exercise capacity, its effects on the cardiovascular response during the onset of exercise have not been clarified, The present study was undertaken to determine the effects of PTCA on the kinetics of oxygen uptake ((V) over dot(O2)) during constant-work-rate exercise in patients with coronary artery disease, as well as on their indexes of maximal work capacity.Methods: Seventeen patients with coronary artery disease who received successful PTCAs performed a 50-W constant-work-rate exercise test for 6 min and a symptom-limited incremental exercise test both before and 4 months after the PTCA procedure. (V) over dot(O2) was calculated from breath-by-breath analysis of respired gases. The time constant of (V) over dot(O2) kinetics during the onset of 50-W exercise was determined by fitting a single exponential function to the (V) over dot(O2) response.Results: In 14 patients without coronary restenosis, the time constant of (V) over dot(O2) kinetics was significantly shortened from (mean +/- SD) 57.4 +/- 12.6 before PTCA to 48.2 +/- 9.5 s after PTCA (p = 0.0035), indicating improved kinetics of the (V) over dot(O2) response. In these subjects, the peak (V) over dot(O2), obtained during maximal exercise testing also increased from 23.1 +/- 3.5 to 26.5 +/- 3.2 mL/min/kg, respectively (p = 0.0005), However, there was no improvement in these indexes in the patients who had restenosis after undergoing PTCA (n = 3).Conclusion: Indexes of cardiopulmonary exercise testing, which reflect an efficiency of oxygen flow to the exercising muscle, can be used as an objective, noninvasive, and cost-effective guide for understanding which patients will not have coronary restenosis following PTCA.