Fuchs A R C N, Meneghelo R S, Stefanini E, De Paola A V, Smanio P E P, Mastrocolla L E, Ferraz A S, Buglia S, Piegas L S, Carvalho A A C
Serviço de Reabilitação Cardiovascular, Instituto Dante Pazzanese de Cardiologia, São Paulo, SP, Brasil.
Braz J Med Biol Res. 2009 Mar;42(3):272-8. doi: 10.1590/s0100-879x2009000300008.
Myocardial ischemia may occur during an exercise session in cardiac rehabilitation programs. However, it has not been established whether it is elicited when exercise prescription is based on heart rate corresponding to the anaerobic threshold as measured by cardiopulmonary exercise testing. Our objective was to determine the incidence of myocardial ischemia in cardiac rehabilitation programs according to myocardial perfusion SPECT in exercise programs based on the anaerobic threshold. Thirty-nine patients (35 men and 4 women) diagnosed with coronary artery disease by coronary angiography and stress technetium-99m-sestamibi gated SPECT associated with a baseline cardiopulmonary exercise test were assessed. Ages ranged from 45 to 75 years. A second cardiopulmonary exercise test determined training intensity at the anaerobic threshold. Repeat gated-SPECT was obtained after a third cardiopulmonary exercise test at the prescribed workload and heart rate. Myocardial perfusion images were analyzed using a score system of 6.4 at rest, 13.9 at peak stress, and 10.7 during the prescribed exercise (P < 0.05). The presence of myocardial ischemia during exercise was defined as a difference > or = 2 between the summed stress score and summed rest score. Accordingly, 25 (64%) patients were classified as ischemic and 14 (36%) as nonischemic. MIBI-SPECT showed myocardial ischemia during exercise within the anaerobic threshold. The 64% prevalence of ischemia observed in the study should not be looked on as representative of the whole population of patients undergoing exercise programs. Changes in patient care and exercise programs were implemented as a result of our finding of ischemia during the prescribed exercise.
在心脏康复计划的运动过程中可能会发生心肌缺血。然而，当运动处方基于心肺运动测试所测得的对应无氧阈值的心率时，心肌缺血是否会被诱发尚未明确。我们的目的是根据基于无氧阈值的运动计划中心肌灌注单光子发射计算机断层扫描（SPECT）来确定心脏康复计划中心肌缺血的发生率。对39例（35例男性和4例女性）经冠状动脉造影诊断为冠状动脉疾病且伴有基线心肺运动测试的静息心肌灌注99m锝-甲氧基异丁基异腈门控SPECT的患者进行了评估。年龄范围为45至75岁。第二次心肺运动测试确定了无氧阈值时的训练强度。在规定的工作量和心率下进行第三次心肺运动测试后，再次进行门控SPECT检查。使用评分系统分析心肌灌注图像，静息时评分为6.4，峰值应激时为13.9，规定运动时为10.7（P<0.05）。运动期间心肌缺血的存在定义为应激总分与静息总分之间的差异≥2。据此，25例（64%）患者被分类为缺血性，14例（36%）为非缺血性。MIBI-SPECT显示在无氧阈值内运动期间存在心肌缺血。该研究中观察到的64%的缺血患病率不应被视为接受运动计划的所有患者的代表。由于我们发现在规定运动期间存在缺血，因此对患者护理和运动计划进行了调整。
