Montreal Behavioural Medicine Centre, Research Centre, Montreal Heart Institute, 5000 Belanger, Montreal, Quebec, Canada.
J Cardiopulm Rehabil Prev. 2011 Jan-Feb;31(1):60-6. doi: 10.1097/HCR.0b013e3181ebf2c0.
To evaluate the sensitivity of electrocardiogram (ECG) versus single photon emission computed tomography (SPECT) assessments of ischemia in patients with anxiety disorders (AD) and the extent to which patients exhibit poorer exercise performance, compared with patients without AD.
Patients referred for nuclear exercise stress testing (N = 2271) underwent a structured psychiatric interview (PRIME-MD) to assess for AD. Exercise performance parameters were assessed during ECG treadmill testing, after which patients underwent SPECT imaging.
Analyses revealed that patients with AD exhibited lower peak exercise systolic blood pressure and rate pressure product than patients without AD. When major depressive disorder was included as an additional covariate, the previous results became trends. Results also indicated a lower rate of electrically positive ecg tests and a higher rate of false-negative diagnoses of myocardial ischemia according to ecg among patients with AD. Including major depressive disorder as a covariate rendered the effects of ad nonsignificant. There was no evidence of reduced exercise performance in patients with AD.
Findings suggest that AD may be associated with mild impairments in cardiovascular exercise reactivity and may also alter the detection of myocardial ischemia using ecg assessments in patients referred for exercise stress testing. However, the influence of AD appears to be moderated by comorbid depression. Results suggest that exercise test performance and detection of ischemia may be influenced by mood and/or anxiety disorders and that greater efforts should be made to include routine mood and/or anxiety disorder screening as part of exercise stress testing protocols.
评估心电图（ECG）与单光子发射计算机断层扫描（SPECT）评估焦虑障碍（AD）患者缺血的敏感性，以及与无 AD 患者相比，患者的运动表现较差的程度。
接受核运动应激测试（N = 2271）的患者接受了结构化精神病学访谈（PRIME-MD）以评估 AD。在 ECG 跑步机测试期间评估运动表现参数，之后患者进行 SPECT 成像。
分析显示，AD 患者的峰值运动收缩压和心率血压乘积低于无 AD 患者。当将重度抑郁症作为附加协变量时，先前的结果成为趋势。结果还表明，AD 患者的心电图测试阳性率较低，根据心电图诊断心肌缺血的假阴性率较高。将重度抑郁症作为协变量包括在内，AD 的影响变得不显著。AD 患者的运动表现没有下降的证据。
研究结果表明，AD 可能与心血管运动反应能力的轻度受损有关，并且可能会改变心电图评估在运动应激测试中对心肌缺血的检测。然而，AD 的影响似乎受到共病性抑郁的调节。结果表明，运动试验表现和缺血检测可能受到情绪和/或焦虑障碍的影响，应该更加努力地将常规情绪和/或焦虑障碍筛查作为运动应激测试方案的一部分。
