1 First Cardiology Clinic, Hippokration Hospital, School of Medicine, University of Athens, Greece.
2 Emory University School of Medicine, Department of Medicine, Division of Cardiology, USA.
Eur J Prev Cardiol. 2017 Oct;24(15):1627-1636. doi: 10.1177/2047487317726069. Epub 2017 Aug 9.
Aims Haemodynamic parameters during and after exercise test seem to have a role in predicting cardiovascular events. We sought to evaluate the potential different responses in exercise capacity, heart rate and blood pressure levels in relation to major cardiovascular disease risk factors, among individuals undergoing exercise tolerance testing. Methods and results Consecutive individuals ( N = 12,327), aged 55 ± 11.8 years, underwent exercise tolerance testing, using the Bruce protocol. Obese participants showed higher values of peak systolic and diastolic blood pressure ( p < 0.01), with no heart rate differences. Diabetic patients presented increased systolic blood pressure across the test ( p = 0.02) and decreased tolerance to exercise ( p = 0.05), but without differences in diastolic blood pressure or heart rate. Hypertensives showed exaggerated blood pressure, chronotropic response and decreased capacity to exercise ( p < 0.001 for all). Smokers had increased baseline systolic blood pressure, peak diastolic blood pressure and recovery heart rate and decreased tolerance to exercise ( p < 0.001 for all). For all high-risk subgroups, exercise testing was more often positive. Age-stratified analysis revealed different patterns: all four risk factors significantly decreased peak metabolic equivalent in subjects <50 years old ( p < 0.05 for all), while in participants between 50 and 69 years old, diabetes mellitus ( p = 0.03), hypertension ( p = 0.04) and smoking ( p = 0.01) predicted achieved metabolic equivalent. For patients of ≥ 70 years old, obesity ( p = 0.006) and hypertension ( p = 0.02) decreased peak metabolic equivalent and systolic blood pressure recovery. In subjects without pre-existing cardiovascular disease and negative exercise tolerance testing (7064 subjects, mean age: 52.4 ± 12.1 years, 62.9% males), age, obesity, hypertension and female gender inversely and independently predicted peak metabolic equivalent. Conclusions High-risk individuals showed different haemodynamic responses when undergoing exercise tolerance testing, reflecting independent pathophysiological pathways.
目的
运动试验期间和之后的血流动力学参数似乎在预测心血管事件方面具有作用。我们旨在评估在进行运动耐量测试的个体中，与主要心血管疾病危险因素相关的运动能力、心率和血压水平的潜在不同反应。
方法和结果
连续的个体（N=12327），年龄 55±11.8 岁，使用布鲁斯方案进行运动耐量测试。肥胖参与者的收缩压和舒张压峰值较高（p<0.01），但心率无差异。糖尿病患者在整个测试过程中收缩压升高（p=0.02），运动耐量降低（p=0.05），但舒张压或心率无差异。高血压患者的血压、变时反应和运动能力明显升高（p<0.001 均）。吸烟者静息收缩压、峰值舒张压和恢复心率升高，运动耐量降低（p<0.001 均）。所有高危亚组中，运动试验阳性的情况更为常见。年龄分层分析显示出不同的模式：所有四个危险因素在<50 岁的受试者中显著降低了峰值代谢当量（p<0.05 均），而在 50-69 岁的参与者中，糖尿病（p=0.03）、高血压（p=0.04）和吸烟（p=0.01）预测了达到的代谢当量。对于≥70 岁的患者，肥胖（p=0.006）和高血压（p=0.02）降低了峰值代谢当量和收缩压恢复。在无预先存在的心血管疾病和运动耐量测试阴性的患者中（7064 例，平均年龄：52.4±12.1 岁，62.9%为男性），年龄、肥胖、高血压和女性性别与峰值代谢当量呈负相关且独立相关。
结论
高危个体在进行运动耐量测试时表现出不同的血流动力学反应，反映了独立的病理生理途径。
