心肺运动试验在二尖瓣和主动脉瓣反流中的作用：它可以预测术后结果。

The role of cardiopulmonary exercise test in mitral and aortic regurgitation: it can predict post-operative results.

作者信息

Kim Hyun Joong, Park Seung Woo, Cho Byung Ryul, Hong Sun Hee, Park Pyo Won, Hong Kyung Pyo

机构信息

Division of Cardiovascular Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Kangnam-ku, Seoul 135-170, Korea.

出版信息

Korean J Intern Med. 2003 Mar;18(1):35-9. doi: 10.3904/kjim.2003.18.1.35.

DOI:10.3904/kjim.2003.18.1.35

PMID:12760266

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4531601/

Abstract

BACKGROUND

We evaluated the efficacy of the cardiopulmonary exercise test as an objective indicator of functional status and as a pre-operative prognostic indicator in patients with mitral regurgitation (MR) and aortic regurgitation (AR).

METHODS

Cardiopulmonary exercise tests and echocardiography were performed in 47 patients (MR: 30, AR: 15, MR + AR: 2) before surgery and repeated one year after surgery. We compared the New York Heart Association (NYHA) functional class, peak oxygen consumption rate (VO2peak), exercise duration, left ventricular dimension and ejection fraction, before and after surgery.

RESULTS

Initial VO2peak and exercise duration were significantly different according to NYHA class. A year later, NYHA functional class improved from 2.1 +/- 0.1 to 1.4 +/- 0.1 (p < 0.001). The VO2peak was significantly increased (21.7 +/- 1.0 to 23.7 +/- 1.0 mL/kg per min, p = 0.008) and exercise duration also increased (521.7 +/- 35.9 to 623.3 +/- 35.7 seconds, p < 0.001). When patients were analysed according to their post-operative NYHA functional class, those with class I showed significantly different pre-operative VO2peak (class I: 23.7 +/- 1.1, II: 18.3 +/- 1.5 mL/kg per min, p = 0.005) and exercise durations (class I: 587.5 +/- 43.2, II: 415.6 +/- 55.7 seconds, p = 0.02). Patients with higher pre-operative VO2peak (19.0 mL/kg per min) more frequently became NYHA functional class I than those with a lower pre-operative VO2peak (76.7% vs. 35.3%, p = 0.02). But baseline left ventricular dimension and ejection fraction by echocardiography were not different between post-operative class I and II group.

CONCLUSION

VO2peak and exercise duration are excellent parameters to evaluate the subjective functional class and to predict the post-operative functional class of patients with MR and/or AR. Patients with a pre-operative VO2peak of 19.0 mL/kg per min or more will have a better functional status one year after surgery.

摘要

背景

我们评估了心肺运动试验作为二尖瓣反流（MR）和主动脉瓣反流（AR）患者功能状态的客观指标以及术前预后指标的有效性。

方法

对47例患者（MR：30例，AR：15例，MR + AR：2例）在手术前进行了心肺运动试验和超声心动图检查，并在术后一年重复进行。我们比较了手术前后纽约心脏协会（NYHA）的心功能分级、峰值耗氧率（VO2peak）、运动持续时间、左心室尺寸和射血分数。

结果

初始VO2peak和运动持续时间根据NYHA分级有显著差异。一年后，NYHA心功能分级从2.1±0.1改善至1.4±0.1（p < 0.001）。VO2peak显著增加（从21.7±1.0增至23.7±1.0 mL/kg每分钟，p = 0.008），运动持续时间也增加（从521.7±35.9增至623.3±35.7秒，p < 0.001）。当根据患者术后NYHA心功能分级进行分析时，I级患者术前VO2peak有显著差异（I级：23.7±1.1，II级：18.3±1.5 mL/kg每分钟，p = 0.005），运动持续时间也有差异（I级：587.5±43.2，II级：415.6±55.7秒，p = 0.02）。术前VO2peak较高（19.0 mL/kg每分钟）的患者比术前VO2peak较低的患者更频繁地成为NYHA I级心功能（76.7%对35.3%，p = 0.02）。但超声心动图检查的基线左心室尺寸和射血分数在术后I级和II级组之间没有差异。