Jürs Anders, Pedersen Lene Rørholm, Olsen Rasmus Huan, Snoer Martin, Chabanova Elizaveta, Haugaard Steen Bendix, Prescott Eva
Department of Cardiology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark.
Department of Radiology, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark.
BMC Cardiovasc Disord. 2015 Nov 27;15:159. doi: 10.1186/s12872-015-0151-9.
Coronary artery disease (CAD) has a negative impact on exercise capacity. The aim of this study was to determine how coronary microvascular function, glucose metabolism and body composition contribute to exercise capacity in overweight patients with CAD and without diabetes.
Sixty-five non-diabetic, overweight patients with stable CAD, BMI 28-40 kg/m(2) and left ventricular ejection fraction (LVEF) above 35 % were recruited. A 3-hour oral glucose tolerance test was used to evaluate glucose metabolism. Peak aerobic exercise capacity (VO2peak) was assessed by a cardiopulmonary exercise test. Body composition was determined by whole body dual-energy X-ray absorptiometry scan and magnetic resonance imaging. Coronary flow reserve (CFR) assessed by transthoracic Doppler echocardiography was used as a measure of microvascular function.
Median BMI was 31.3 and 72 % had impaired glucose tolerance or impaired fasting glucose. VO2peak adjusted for fat free mass was correlated with CFR (r = 0.41, p = 0.0007), LVEF (r = 0.33, p = 0.008) and left ventricular end-diastolic volume (EDV) (r = 0.32, p = 0.01) while it was only weakly linked to measures of glucose metabolism and body composition. CFR, EDV and LVEF remained independent predictors of VO2peak in multivariable regression analysis.
The study established CFR, EDV and LVEF as independent predictors of VO2peak in overweight CAD patients with no or only mild functional symptoms and a LVEF > 35 %. Glucose metabolism and body composition had minor impact on VO2peak. The findings suggest that central hemodynamic factors are important in limiting exercise capacity in overweight non-diabetic CAD patients.
冠状动脉疾病（CAD）对运动能力有负面影响。本研究的目的是确定冠状动脉微血管功能、葡萄糖代谢和身体组成如何影响超重且无糖尿病的CAD患者的运动能力。
招募了65名非糖尿病、超重的稳定CAD患者，BMI为28 - 40kg/m²，左心室射血分数（LVEF）高于35%。采用3小时口服葡萄糖耐量试验评估葡萄糖代谢。通过心肺运动试验评估峰值有氧运动能力（VO2peak）。通过全身双能X线吸收法扫描和磁共振成像确定身体组成。经胸多普勒超声心动图评估的冠状动脉血流储备（CFR）用作微血管功能的指标。
BMI中位数为31.3，72%的患者糖耐量受损或空腹血糖受损。调整无脂肪体重后的VO2peak与CFR（r = 0.41，p = 0.0007）、LVEF（r = 0.33，p = 0.008）和左心室舒张末期容积（EDV）（r = 0.32，p = 0.01）相关，而与葡萄糖代谢和身体组成指标的关联较弱。在多变量回归分析中，CFR、EDV和LVEF仍然是VO2peak的独立预测因素。
该研究确定CFR、EDV和LVEF是超重且无或仅有轻度功能症状、LVEF > 35%的CAD患者VO2peak的独立预测因素。葡萄糖代谢和身体组成对VO2peak影响较小。研究结果表明，中心血流动力学因素在限制超重非糖尿病CAD患者的运动能力方面很重要。
