Instituto de Cardiologia do Distrito Federal, Brasília, DF, Brazil.
Arq Bras Cardiol. 2011 Feb;96(2):107-13. doi: 10.1590/s0066-782x2011005000004. Epub 2011 Jan 14.
Increased pulmonary capillary pressure (PCP) is one of the mechanisms of exercise intolerance. Assessment of the diastolic function by echocardiography (ECHO) enables estimation of PCP.
To identify variables that determine the exercise capacity in patients undergoing routine exercise test (ET), conventional ECHO, and tissue Doppler imaging (TD).
A total of 640 patients undergoing ET, ECHO, and TD were retrospectively studied. Patients with ejection fraction < 55% were excluded. Mitral annulus velocities by conventional Doppler imaging were obtained in early diastole (E) and late diastole (A), and TD of the mitral annulus measured early diastole (e') and late diastole (a') velocities. E/e'> 10 was considered an estimate of increased PCP. Maximal exercise capacity was analyzed by the number of metabolic equivalents (MET). The patients were divided into two groups for analysis: MET<7 (n=48) and MET>7 (n=572). Morise score showed a population at low risk (60%) for coronary artery disease (CAD).
The number of patients with E/e' > 10 was significantly higher in the MET < 7 group in relation to the MET > 7 group (41.7% vs 9.4%, p=0.001), and so was the presence of any degree of diastolic dysfunction (76.6% vs 34.1% p=0.001). Using logistic regression analysis, age, female gender and A velocity (late diastole) were the independent variables related to a low exercise capacity (MET < 7).
Diastolic dysfunction as determined by ECHO, female gender, and age are associated with a lower exercise capacity in a population at low risk for CAD.
肺毛细血管压力（PCP）升高是运动不耐受的机制之一。超声心动图（ECHO）评估舒张功能可估计 PCP。
确定常规运动试验（ET）、常规 ECHO 和组织多普勒成像（TD）中哪些变量可决定患者的运动能力。
回顾性研究了 640 例接受 ET、ECHO 和 TD 的患者。排除射血分数<55%的患者。常规多普勒成像获得二尖瓣环速度在舒张早期（E）和舒张晚期（A），TD 测量二尖瓣环在舒张早期（e'）和舒张晚期（a'）速度。E/e' > 10 被认为是 PCP 升高的估计值。最大运动能力通过代谢当量（MET）的数量进行分析。患者分为两组进行分析：MET<7（n=48）和 MET>7（n=572）。Morise 评分显示人群患冠心病（CAD）的风险低（60%）。
MET<7 组的 E/e' > 10 患者数量明显高于 MET>7 组（41.7% vs 9.4%，p=0.001），任何程度的舒张功能障碍（76.6% vs 34.1%，p=0.001）也明显更多。使用逻辑回归分析，年龄、女性和 A 速度（晚期）是与低运动能力（MET<7）相关的独立变量。
ECHO 确定的舒张功能障碍、女性和年龄与 CAD 低风险人群的低运动能力相关。
