呼吸应激反应：一种通过短暂呼吸运动时的指脉搏波分析来检测显著冠状动脉疾病的新型诊断方法。
Respiratory stress response: a novel diagnostic method for detection of significant coronary artery disease from finger pulse wave analysis during brief respiratory exercise.
机构信息
Cardiology Department, Barzilai Medical Center, Ashkelon, Israel.
出版信息
Am J Med Sci. 2010 May;339(5):440-7. doi: 10.1097/MAJ.0b013e3181d6566a.
INTRODUCTION
Respiratory maneuvers can uncover manifestations of myocardial ischemia. Some pulse wave characteristics are associated with significant coronary artery disease (S-CAD). An innovative test using the respiratory stress response (RSR) has been developed for the detection of S-CAD based on spectral analysis of finger pulse wave oscillations measured using photoplethysmography (PPG) during deep, paced breathing at a rate of 6 breaths per minute (0.1 Hz) for 70 seconds. We evaluated this test (RSR) as an indicator of S-CAD.
METHODS
The study consisted of 2 stages--feasibility and validation--assessing RSR in patients referred for coronary angiography. RSR was calculated by proprietary software analysis of the relative spectral power of the respiratory peak area at 0.1 Hz. The coronary angiograms were analyzed visually (stage I) and by quantitative coronary angiography (stage II) by 1 cardiologist blinded to the RSR results. S-CAD was defined as luminal stenosis >70% of at least 1 coronary artery or LM stenosis >50%.
RESULTS
A total of 193 consecutive patients (stage I: 98 and stage II: 95) with a mean age of 63.2 +/- 11.9 years, 70% men, 112 (58%) with S-CAD, were included. S-CAD patients had significantly lower RSR compared with patients without S-CAD, P < 0.001. RSR yielded a sensitivity of 83% (95% confidence interval = 75-90) and specificity of 70% (95% confidence interval = 59-80) for indicating S-CAD. Multivariate logistic regression analysis, adjusted for risk factors, showed that RSR is a strong independent indicator of S-CAD [OR = 18.9 (7.2-49.5), P < 0.001].
CONCLUSION
Reduced RSR is an accurate noninvasive indicator of S-CAD.
简介
呼吸动作可以揭示心肌缺血的表现。一些脉搏波特征与严重冠状动脉疾病（S-CAD）有关。一种新的测试方法使用呼吸应激反应（RSR），通过对使用光体积描记法（PPG）测量的手指脉搏波振荡在每分钟 6 次（0.1 Hz）的深度、有节奏呼吸期间的光谱分析，来检测 S-CAD。这种测试方法（RSR）是基于在 70 秒内进行 6 次呼吸/分钟（0.1 Hz）的深度、有节奏呼吸，使用脉搏血氧仪（PPG）进行测量。我们评估了这种测试（RSR）作为 S-CAD 的指标。
方法
该研究包括 2 个阶段——可行性和验证性评估，评估了冠状动脉造影患者的 RSR。RSR 通过专有的软件分析在 0.1 Hz 处的呼吸峰面积的相对光谱功率来计算。冠状动脉造影通过 1 位对 RSR 结果不知情的心脏病专家进行视觉分析（第 I 阶段）和定量冠状动脉造影分析（第 II 阶段）。S-CAD 定义为至少 1 支冠状动脉管腔狭窄>70%或 LM 狭窄>50%。
结果
共纳入 193 例连续患者（第 I 阶段：98 例，第 II 阶段：95 例），平均年龄 63.2±11.9 岁，70%为男性，112 例（58%）患有 S-CAD。与无 S-CAD 的患者相比，S-CAD 患者的 RSR 显著降低，P<0.001。RSR 对 S-CAD 的敏感度为 83%（95%置信区间为 75-90），特异度为 70%（95%置信区间为 59-80）。多变量逻辑回归分析显示，调整危险因素后，RSR 是 S-CAD 的一个强有力的独立指标[OR=18.9（7.2-49.5），P<0.001]。
结论
RSR 降低是 S-CAD 的准确无创指标。
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