Heterogeneity among cardiac ischemic and anginal responses to exercise, mental stress, and daily life.
Heterogeneity among cardiac ischemic and anginal responses to exercise, mental stress, and daily life.
复制标题
心脏缺血和心绞痛对运动、精神压力和日常生活的反应之间存在异质性。
DOI：
10.1016/s0002-9149(98)00228-8
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发表时间：
1998
期刊：
影响因子：
--
通讯作者：
Kaufmann,PG
中科院分区：
文献类型：
--
作者：
Sheps,DS;McMahon,RP;Pepine,CJ;Stone,PH;Goldberg,AD;Taylor,H;Cohen,JD;Becker,LC;Chaitman,B;Knatterud,GL;Kaufmann,PG
本研究的目的是比较和对比一组特征明确的196例冠状动脉疾病患者的缺血指标，这些患者有血管造影记录或经证实有心肌梗死史，并有运动试验阳性结果。心肌缺血是冠状动脉疾病患者对日常应激的常见反应。心肌缺血的心理生理干预研究为研究缺血的神经内分泌和心理表现提供了一个独特的机会。运动性缺血患者停药后行运动核素脑室造影、心电图监测和2种实验室精神应激源（Speech和Stroop）。此外，在日常活动中记录48小时动态心电图。过去3个月内有心绞痛史的患者在自行车或跑步机测试中报告心绞痛的频率远高于没有心绞痛史的患者（77% vs 26%）。在言语任务中射血分数异常的患者中，有48%的患者在Stroop测试中有异常反应，而在射血分数正常的患者中，有17%的患者有异常反应（p <0.01）。76%的患者对自行车运动有异常的EF反应。比较同种实验室应激源和不同应激类型下的3个缺血指标（st段下降、壁运动异常和EF反应）。运动时3项指标的存在仅存在中度相关性，精神应激时3项缺血性指标的存在仅存在弱相关性或不显著相关性。相同的缺血标记物的出现在两种精神应激任务之间存在中度相关，但在运动过程中相同的缺血标记物的出现与精神应激之间几乎没有关联。使用心电图、动态心电图或放射性核素标准对应激期间缺血的心理和运动应激测试的反应存在明显的异质性。这种异质性可能与引起的生理反应的大小或类型的差异以及用于识别缺血的不同测试的敏感性和特异性的差异有关。
The objectives of this study were to compare and contrast indicators of ischemia in a well-characterized group of 196 patients with coronary artery disease, documented angiographically or by verified history of myocardial infarction, and a positive exercise test result. Myocardial ischemia occurs frequently in response to everyday stressors in patients with coronary artery disease. The Psychophysiological Interventions in Myocardial Ischemia study provides a unique opportunity to study neuroendocrine and psychological manifestations of ischemia. Patients with exercise-induced ischemia underwent exercise radionuclide ventriculography and electrocardiographic monitoring and 2 laboratory mental stressors (Speech and Stroop) after being withdrawn from cardiac medications. In addition, 48-hour ambulatory electrocardiograms were recorded during routine daily activities. Patients with a history of angina within the past 3 months reported angina during the bicycle or treadmill test with a much higher frequency than patients without such an anginal history (77% vs 26%). Ejection fraction (EF) responses to the Stroop test were abnormal in 48% of patients with an abnormal EF response to the Speech task, versus 17% in patients with a normal EF response (p <0.01). Seventy-six percent of patients had an abnormal EF response to bicycle exercise. Three indicators of ischemia (ST-segment depression, wall motion abnormality, and EF response) were compared during the same laboratory stressor and across different types of stress tests. Presence of the 3 indicators was only moderately associated during exercise, and only weak or nonsignificant associations occurred among the presence of the 3 ischemic markers during mental stress. Occurrence of the same ischemic markers was moderately associated between the 2 mental stress tasks, but few associations were found between the occurrence of the same ischemic marker during exercise and mental stress. There is a marked heterogeneity of responses to psychological and exercise stress testing using electrocardiography, ambulatory electrocardiography, or radionuclide criteria for ischemia during stress. The heterogeneity may be related to differences in the magnitude or types of physiologic responses provoked and to differences in the sensitivity and specificity of the different tests used to identify ischemia.