Leroy F, Lablanche J M, Bauters C, McFadden E P, Bertrand M E
Service de Cardiologie B et Hémodynamique, Hôpital Cardiologique, Lille, France.
Am J Cardiol. 1992 Jul 15;70(2):152-5. doi: 10.1016/0002-9149(92)91267-8.
To investigate the prognostic value of exercise-induced changes in R-wave amplitude and their relation to other exercise and angiographic variables, 303 consecutive patients who underwent maximal exercise testing and coronary angiography within 2 months of a first acute myocardial infarction were studied. R-wave amplitude at peak exercise increased or was unchanged in 159 patients (57.4%) and decreased in 118 (42.6%). Increased R-wave amplitude was significantly related to underlying 3-vessel disease (p = 0.0001), the extent of ST-segment depression on exercise (p = 0.0001), and the time to 1 mm ST depression (p less than 0.05). Follow-up information was available in 285 patients (86.4%) at a mean of 4 +/- 1.8 years. Death from cardiac causes occurred in 25 patients (9%); 18 (6.5%) developed recurrent myocardial infarction, and 32 (11.6%) developed angina. Variables with a predictive value for cardiac death were maximal exercise heart rate (p = 0.0005), occurrence of exercise-related supraventricular arrythmia (p = 0.02), and number of diseased vessels (p = 0.02). R-wave changes had no predictive value. No variable had a predictive value for recurrent infarction. Maximal exercise heart rate (p = 0.02) and increased R-wave amplitude (p = 0.0001) were significantly related to the occurrence of angina at follow up. Exercise-related R-wave increases were associated with the presence of angina at follow-up, but had no predictive value for cardiac death or recurrent infarction; their association with subsequent angina appears to reflect an association with more severe underlying coronary disease.
为研究运动诱发的R波振幅变化的预后价值及其与其他运动和血管造影变量的关系，我们对303例在首次急性心肌梗死后2个月内接受最大运动试验和冠状动脉造影的连续患者进行了研究。运动高峰时R波振幅增加或不变的患者有159例（57.4%），降低的有118例（42.6%）。R波振幅增加与潜在的三支血管病变显著相关（p = 0.0001）、运动时ST段压低程度（p = 0.0001）以及出现1mm ST段压低的时间（p < 0.05）。285例患者（86.4%）获得了随访信息，平均随访时间为4±1.8年。25例患者（9%）死于心脏原因；18例（6.5%）发生复发性心肌梗死，32例（11.6%）发生心绞痛。对心脏死亡有预测价值的变量为最大运动心率（p = 0.0005）、运动相关室上性心律失常的发生（p = 0.02）以及病变血管数量（p = 0.02）。R波变化无预测价值。没有变量对复发性梗死有预测价值。最大运动心率（p = 0.02）和R波振幅增加（p = 0.0001）与随访时心绞痛的发生显著相关。运动相关的R波增加与随访时心绞痛的存在相关，但对心脏死亡或复发性梗死无预测价值；它们与随后心绞痛的关联似乎反映了与更严重的潜在冠状动脉疾病的关联。
