慢性血栓栓塞性肺动脉高压患者6分钟步行试验期间的心率和血氧饱和度变化模式

Heart Rate and Oxygen Saturation Change Patterns During 6-min Walk Test in Subjects With Chronic Thromboembolic Pulmonary Hypertension.

作者信息

Inagaki Takeshi, Terada Jiro, Yahaba Misuzu, Kawata Naoko, Jujo Takayuki, Nagashima Kengo, Sakao Seiichiro, Tanabe Nobuhiro, Tatsumi Koichiro

机构信息

Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan.

Division of Rehabilitation, Chiba University Hospital, Chiba, Japan.

出版信息

Respir Care. 2018 May;63(5):573-583. doi: 10.4187/respcare.05788. Epub 2017 Dec 26.

DOI:10.4187/respcare.05788

PMID:29279364

Abstract

BACKGROUND

The 6-min walk test (6MWT) is commonly performed to assess functional status in patients with chronic thromboembolic pulmonary hypertension. However, changes in heart rate and oxygen saturation (S ) patterns during 6MWT in patients with chronic thromboembolic pulmonary hypertension remain unclear.

METHODS

Thirty-one subjects with chronic thromboembolic pulmonary hypertension were retrospectively evaluated to examine the relationships between the change in heart rate (Δheart rate), heart rate acceleration time, slope of heart rate acceleration, heart rate recovery during the first minute after 6MWT (HRR1), change in S (ΔS ), S reduction time, and S recovery time during 6MWT, and the severity of pulmonary hemodynamics assessed by right heart catheterization and echocardiography.

RESULTS

Subjects with severe chronic thromboembolic pulmonary hypertension had significantly longer heart rate acceleration time (144.9 ± 63.9 s vs 96.0 ± 42.5 s, = .033), lower Δheart rate (47.4 ± 16.9 vs 61.8 ± 13.6 beats, = .02), and lower HRR1 (13.3 ± 9.0 beats vs 27.1 ± 9.2 beats, < .001) compared to subjects with mild chronic thromboembolic pulmonary hypertension. Subjects with severe chronic thromboembolic pulmonary hypertension also had significantly longer S reduction time (178.3 ± 70.3 s vs 134.3 ± 58.4 s, = .03) and S recovery time (107.6 ± 35.3 s vs 69.8 ± 32.7 s, = .004) than did subjects with mild chronic thromboembolic pulmonary hypertension. Multivariate linear regression analysis showed only mean pulmonary arterial pressure independently was associated with heart rate acceleration time and slope of heart rate acceleration.

CONCLUSIONS

Heart rate and S change patterns during 6MWT are predominantly associated with pulmonary hemodynamics in subjects with chronic thromboembolic pulmonary hypertension. Evaluating heart rate and S change patterns during 6MWT may serve as a safe and convenient way to follow the change in pulmonary hemodynamics.

摘要

背景

6分钟步行试验（6MWT）常用于评估慢性血栓栓塞性肺动脉高压患者的功能状态。然而，慢性血栓栓塞性肺动脉高压患者在6MWT期间心率和血氧饱和度（S）模式的变化仍不清楚。

方法

对31例慢性血栓栓塞性肺动脉高压患者进行回顾性评估，以研究心率变化（Δ心率）、心率加速时间、心率加速斜率、6MWT后第一分钟内心率恢复情况（HRR1）、S变化（ΔS）、S降低时间和6MWT期间S恢复时间与通过右心导管检查和超声心动图评估的肺血流动力学严重程度之间的关系。

结果

与轻度慢性血栓栓塞性肺动脉高压患者相比，重度慢性血栓栓塞性肺动脉高压患者的心率加速时间显著更长（144.9±63.9秒对96.0±42.5秒，P = 0.033），Δ心率更低（47.4±16.9对61.8±13.6次/分钟，P = 0.02），HRR1更低（13.3±9.0次/分钟对27.1±9.2次/分钟，P < 0.001）。重度慢性血栓栓塞性肺动脉高压患者的S降低时间（178.3±70.3秒对134.3±58.4秒，P = 0.03）和S恢复时间（107.6±35.3秒对69.8±32.7秒，P = 0.004）也显著长于轻度慢性血栓栓塞性肺动脉高压患者。多因素线性回归分析显示，仅平均肺动脉压独立与心率加速时间和心率加速斜率相关。