[心肺运动试验在扩张型心肌病所致慢性左心衰竭患者心功能评估中的价值]

[Value of cardiopulmonary exercise test in cardiac function evaluation of patients with chronic left heart failure caused by dilated cardiomyopathy].

作者信息

Zhang Wei, Huang Jie, Xu Haiyan, Zhang Shu, Liu Zhihong, Liao Zhongkai, Ma Xiuping, Liu Qing

机构信息

Department of Cardiology, Fuwai Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing 100037, China.

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出版信息

Zhonghua Yi Xue Za Zhi. 2014 Apr 15;94(14):1076-9.

PMID:24851891

Abstract

OBJECTIVE

To assess the value of cardiopulmonary exercise test in the evaluation of cardiac function in patients with chronic left heart failure caused by dilated cardiomyopathy.

METHODS

Fifty-three inpatients aged 18 year and over with chronic left heart failure caused by dilated cardiomyopathy at Fuwai Hospital from October 2010 to October 2011 were selected and divided into 2 groups according to the New York Heart Association (NYHA) heart function classification. One group had 20 cases for class II and another 33 cases for class III-IV. All of them received cardiopulmonary exercise tests. Synchronous measurement and record of gas exchange indices were taken during every breath, and so were heart rate, blood pressure, electrocardiogram and blood oxygen saturation. At the same time, other routine tests were also performed. After exercise test, anaerobic threshold and peak oxygen consumption indices were calculated and statistically analyzed. They also received subsequent follow-ups of 1 day, 1 week, 1 month, 6 months and 1 year, including activities, clinical manifestations and cardiac adverse events.

RESULTS

At baseline, the differences in gender, age, body mass index, concurrent diseases, left ventricular end-diastolic diameter, left ventricular ejection fraction and serum creatinine had no statistical significance (P > 0.05). Compared with cardiac function class II group, the class III-IV group had higher left atrial diameter, level of amino terminal pro-B-type natriuretic peptide (NT-proBNP), incidence of atrial fibrillation ((51.4 ± 7.5) vs (43.6 ± 7.7) mm, (2 607 ± 1 782) vs (1 312 ± 901) µg/L, 42.4% (14/33) vs 5.0% (1/20)) and lower glomerular filtration rate, peak oxygen consumption, levels of anaerobic threshold ((72 ± 20) vs (97 ± 23) ml/min, (13.7 ± 2.6) vs (20.5 ± 3.6) ml·min(-1)·kg(-1), (10.7 ± 1.5) vs (13.3 ± 2.1) ml·min(-1)·kg(-1)) (all P < 0.01). And NT-proBNP and cardiac function classification showed a positive correlation (OR = 1.002, P = 0.003) while peak oxygen consumption, anaerobic threshold and cardiac function classification were negatively correlated (OR = 0.736, 0.608; P = 0.011, 0.001).

CONCLUSIONS

Cardiopulmonary exercise test objectively reflects the cardiopulmonary reserve of heart failure patients with dilated cardiomyopathy. And the parameters of anaerobic threshold and peak oxygen consumption may reflect the patient's motor ability quantitatively and accurately.

摘要

目的

评估心肺运动试验在评价扩张型心肌病所致慢性左心衰竭患者心功能方面的价值。

方法

选取2010年10月至2011年10月在阜外医院住院的53例年龄18岁及以上、由扩张型心肌病引起慢性左心衰竭的患者，根据纽约心脏协会（NYHA）心功能分级分为两组。其中Ⅱ级组20例，Ⅲ - Ⅳ级组33例。所有患者均接受心肺运动试验。在每次呼吸时同步测量并记录气体交换指标，同时测量心率、血压、心电图和血氧饱和度。同时还进行其他常规检查。运动试验后，计算无氧阈和峰值摄氧量指标并进行统计学分析。对患者进行1天、1周、1个月、6个月和1年的随访，内容包括活动情况、临床表现及心脏不良事件。

结果

基线时，两组在性别、年龄、体重指数、合并疾病、左心室舒张末期内径、左心室射血分数和血清肌酐方面的差异无统计学意义（P > 0.05）。与心功能Ⅱ级组相比，Ⅲ - Ⅳ级组左心房内径、氨基末端B型利钠肽原（NT - proBNP）水平、心房颤动发生率更高（（51.4 ± 7.5）对（43.6 ± 7.7）mm，（2 607 ± 1 782）对（1 312 ± 901）μg/L，42.4%（14/33）对5.0%（1/20）），而肾小球滤过率、峰值摄氧量、无氧阈水平更低（（72 ± 20）对（97 ± 23）ml/min，（13.7 ± 2.6）对（20.5 ± 3.6）ml·min⁻¹·kg⁻¹，（10.7 ± 1.5）对（13.3 ± 2.1）ml·min⁻¹·kg⁻¹）（均P < 0.01）。NT - proBNP与心功能分级呈正相关（OR = 1.002，P = 0.003），而峰值摄氧量、无氧阈与心功能分级呈负相关（OR = 0.736，0.608；P = 0.011，0.001）。