运动诱发的呼吸困难与多普勒衍生舒张功能的功能能力之间的关系

Relationship between exercise induced dyspnea and functional capacity with doppler-derived diastolic function'.

作者信息

Nasim Sumera, Nadeem Najaf, Zahidie Aysha, Sharif Tabbasum

出版信息

BMC Res Notes. 2013 Apr 15;6:150. doi: 10.1186/1756-0500-6-150.

DOI:10.1186/1756-0500-6-150

PMID:23587172

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3636105/

Abstract

BACKGROUND

Dyspnea is the frequent cause of exercise intolerance and physical inactivity among patients referred for exercise tolerance test. Diastolic dysfunction has shown significant correlation with exercise capacity and exercise induced dyspnea. To find out the frequency of diastolic dysfunction (DD) and the relationships between impaired exercise capacity and exercise induced dyspnea with DD by Doppler-derived indices among patients referred for stress test in a tertiary care hospital of Karachi.

METHODS

For this study 135 consecutive patients who were referred for stress test at our non-invasive lab were screened for eligibility. Patients with valvular pathology, atrial fibrillation (AF) and coronary artery disease (CAD) were excluded. Stress test was performed on treadmill using Bruce protocol. Assessment of diastolic function as determined by trans-mitral flow velocity pattern was carried at baseline and at peak exercise. We evaluated impaired exercise capacity and exercise induced dyspnea using validated Borg Scale among study subjects.

RESULTS

Study subjects 88% were males, mean age was 46 ± 16 years, BMI 27 ± 5 kg/m2, prevalence of diabetes mellitus (DM) 15%, hypertension 28% and smoking 21%. Exercise induced DD occurred among 44.6%. Patients with exercise induced DD had lower exercise capacity (9.2 vs. 10.2 METS; p = 0.04) and higher Borg Scale (5.2 vs. 4.0; p < 0.001). DD at baseline was present in 25(26%) of patients so they were excluded from the study. Five patients develop ischemia during stress test so were also excluded. So final analysis was done on 105 patients. Among patients without DD at baseline, there was significant vicariate linear inverse correlation between post exercise E/A ratio and Borg scale (r = -0.23; p = 0.02) and exercise capacity was assessed by exercise duration and MET (r-0.825; p = 0.04). Multivariate regression analysis revealed post exercise E/A ratio as an independent determinant of severity of exercise induced dyspnea and impaired exercise tolerance.

CONCLUSION

DD is significantly associated with impaired functional capacity and dyspnea among patients referred for exercise tolerance test.

摘要

背景

呼吸困难是运动耐量测试转诊患者运动不耐受和身体活动不足的常见原因。舒张功能障碍已显示出与运动能力和运动诱发的呼吸困难有显著相关性。为了在卡拉奇一家三级护理医院中，通过多普勒衍生指标找出接受压力测试患者中舒张功能障碍（DD）的发生率，以及运动能力受损和运动诱发的呼吸困难与DD之间的关系。

方法

在本研究中，对连续135名转诊至我们无创实验室进行压力测试的患者进行资格筛查。排除有瓣膜病变、心房颤动（AF）和冠状动脉疾病（CAD）的患者。使用布鲁斯方案在跑步机上进行压力测试。在基线和运动峰值时通过二尖瓣血流速度模式评估舒张功能。我们在研究对象中使用经过验证的博格量表评估运动能力受损和运动诱发的呼吸困难。

结果

研究对象中88%为男性，平均年龄为46±16岁，体重指数27±5kg/m²，糖尿病（DM）患病率15%，高血压28%，吸烟率21%。运动诱发的DD发生率为44.6%。运动诱发DD的患者运动能力较低（9.2对10.2代谢当量；p = 0.04），博格量表评分较高（5.2对4.0；p < 0.001）。25名（26%）患者基线时存在DD，因此将他们排除在研究之外。5名患者在压力测试期间出现缺血，因此也被排除。所以最终对105名患者进行了分析。在基线时无DD的患者中，运动后E/A比值与博格量表之间存在显著的双变量线性负相关（r = -0.23；p = 0.02），运动能力通过运动持续时间和代谢当量评估（r = -0.825；p = 0.04）。多变量回归分析显示运动后E/A比值是运动诱发呼吸困难严重程度和运动耐量受损的独立决定因素。