Changes in myocardial perfusion due to physical exercise in patients with stable coronary artery disease
Changes in myocardial perfusion due to physical exercise in patients with stable coronary artery disease
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DOI：
10.1007/s00259-005-1768-1
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发表时间：
2005-07-01
影响因子：
9.1
通讯作者：
Kluge, R
中科院分区：
文献类型：
--
作者：
Kendziorra, K;Walther, C;Kluge, R
目的：经皮冠状动脉腔内成形术（Percutaneous transluminal coronary angioplasty，PTCA）是治疗冠心病（coronary artery disease，CAD）的主要方法之一，可改善心肌灌注和运动能力。然而，研究也表明，定期运动训练对心肌灌注和最大运动能力有积极影响。本研究的目的是评估运动训练1年后的心肌负荷灌注的变化与冠心病患者的PTCA的效果相比。方法：在66例男性患者中，血管造影证实的一个靶血管的冠状动脉狭窄，心肌灌注造影进行基线和12个月后随机分为体育锻炼组或PTCA组。结果：12个月后，PTCA组和训练组缺血节段靶区心肌计数率均明显改善，而对照组无明显改善（PTCA组：从76.8 ± 4.9%到86.6 ± 10.9%，p=0.03;训练组：从74.0 ± 7.3%到83.7 ± 10.8%，p < 0.01）。在靶区之外，只有训练组显示出显著改善（从77.7 +/- 4.4%到91.7 +/-4.8%，p < 0.01）。结论：我们的数据表明，训练组在12个月后的应激心肌灌注有显著改善。不仅在主要狭窄的靶区域，而且在其他缺血心肌区域，缺血也减少。相比之下，经皮腔内冠状动脉成形术后，压力灌注仅在靶区的初始缺血部分得到改善。
Purpose: Percutaneous transluminal coronary angioplasty (PTCA) is one of the main therapy options for patients with coronary artery disease (CAD), resulting in an improvement in myocardial perfusion and exercise capacity. Nevertheless, studies have also demonstrated a positive effect of regular exercise training on myocardial perfusion and maximum exercise capacity. The aim of this study was to evaluate changes in myocardial stress perfusion after 1 year of exercise training in comparison with the effects of PTCA in patients with CAD.Methods: In 66 male patients with angiographically confirmed significant coronary artery stenosis in one target vessel, myocardial perfusion scintigraphy was performed at baseline and 12 months after randomisation into either a physical exercise group or a PTCA group. Circumferential count rate profiles in 16 wall segments were classified according to their relative count rate and localisation within or outside the area supplied by the stenosed vessel.Results: Ischaemic segments showed a significant improvement in myocardial count rate within the target area after 12 months in both the PTCA and the training group (PTCA group: from 76.8 +/- 4.9% to 86.6 +/- 10.9%, p=0.03; training group: from 74.0 +/- 7.3% to 83.7 +/- 10.8%, p < 0.01). Outside the target area only the training group showed a significant improvement (from 77.7 +/- 4.4% to 91.7 +/- 4.8%, p < 0.01).Conclusion: Our data indicate a significant improvement in stress myocardial perfusion in the training group after 12 months. The ischaemia is reduced not only in the target region of the leading stenosis but also in other ischaemic myocardial areas. In contrast, after PTCA stress perfusion improves only in the initially ischaemic parts of the target area.