Trojnarska Olga, Gwizdała Adrian, Oko-Sarnowska Zofia, Szyszka Andrzej
Akademia Medyczna w Poznaniu, Klinika Kardiologii
Pol Merkur Lekarski. 2006 Mar;20(117):293-5.
There are few data available on applying the cardiopulmonary exercise test for evaluation of cardiac exercise capacity in adult patients with congenital heart diseases. The aim of the study was to perform this test in adults with Ebstein anomaly and patients with patent ASD II (atrial septal defect) and determination of potential relationships between these parameters and echocardiographically assessed hemodynamic indices.
Twenty patients with Ebstein anomaly mean aged 40.3 +/- 12.3 years were studied. Control group consisted of 19 individuals at mean age of 39.9 years. Echocardiography was performed for the evaluation of severity of the disease. Additionally, 36 patients with ASD II were included, mean age 44.7 +/- 8.2 years. The control group consisted of 25 individuals at mean age of 45.6 years. Maximum exercise treadmill test was carried out and resting and exercise spirometry.
Ebstein anomaly. Maximum oxygen uptake, minute ventilation, maximum heart rate and blood pressure at peak exercise were significantly lower in study patients than in control group. VE/VCO2 was increased. No differences were observed between groups with respect to spirometric parameters. Oxygen uptake decreased along with the severity of the disease. ASD II. Maximum oxygen uptake, minute ventilation, maximum heart rate and blood pressure at peak exercise and spirometric parameters were significantly lower in study patients than in control group. Significant negative correlations were shown for VO2 (maximum oxygen uptake) and Qp:Qs (pulmonary to systemic flow ratio) (p = 0.004), maximum heart rate - HRmax and HRmax% and RV (end-diastolic right ventricular diameter) (p = 0.02 i p = 0.01), RV and systolic pressure at peak exercise (p = 0.03), obstruction marker FEV1 and RV (p = 0.04) and between RVSP (right ventricular end-systolic pressure) (p = 0.01). Negative correlation was observed between RQ (respiratory quotient) and RVSP (p = 0.004), and positive correlation between HRmax and VO2 (p = 0.005).
The exercise capacity of adults with Ebstein anomaly and those with patent ASD II is significantly reduced. It decreases along with the echocardiographic severity of the disease in Ebstein anomaly patients and it seems to result from the right ventricular volume overload in patients with patent ASD II.
关于应用心肺运动试验评估先天性心脏病成年患者心脏运动能力的数据较少。本研究的目的是对患有埃布斯坦畸形的成年人和继发孔型房间隔缺损（ASD II）患者进行该试验，并确定这些参数与超声心动图评估的血流动力学指标之间的潜在关系。
研究了20例平均年龄为40.3±12.3岁的埃布斯坦畸形患者。对照组由19名平均年龄为39.9岁的个体组成。进行超声心动图检查以评估疾病的严重程度。此外，纳入了36例ASD II患者，平均年龄44.7±8.2岁。对照组由25名平均年龄为45.6岁的个体组成。进行了最大运动平板试验以及静息和运动时的肺功能测定。
埃布斯坦畸形。研究患者在运动峰值时的最大摄氧量、分钟通气量、最大心率和血压均显著低于对照组。VE/VCO2升高。两组在肺功能参数方面未观察到差异。摄氧量随疾病严重程度而降低。ASD II。研究患者在运动峰值时的最大摄氧量、分钟通气量、最大心率和血压以及肺功能参数均显著低于对照组。VO2（最大摄氧量）与Qp:Qs（肺循环与体循环血流量之比）之间显示出显著的负相关（p = 0.004），最大心率 - HRmax和HRmax%与右心室舒张末期内径（RV）之间显示出显著的负相关（p = 0.02和p = 0.01），RV与运动峰值时的收缩压之间显示出显著的负相关（p = 0.03），阻塞指标FEV1与RV之间显示出显著的负相关（p = 0.04），以及右心室收缩末期压力（RVSP）之间显示出显著的负相关（p = 0.01）。呼吸商（RQ）与RVSP之间观察到负相关（p = 0.004），HRmax与VO2之间观察到正相关（p = 0.005）。
患有埃布斯坦畸形的成年人和患有ASD II的成年人的运动能力显著降低。在埃布斯坦畸形患者中，运动能力随疾病的超声心动图严重程度而降低，而在患有ASD II的患者中，运动能力似乎是由右心室容量超负荷导致的。
