微血管性心绞痛患者运动试验期间的心率恢复和血压反应
Heart rate recovery and blood pressure response during exercise testing in patients with microvascular angina.
作者信息
Kim Bong-Joon, Jo Eun-Ah, Im Sung-Il, Kim Hyun-Su, Heo Jung Ho, Cho Kyoung-Im
机构信息
1Division of Cardiology, Department of Internal Medicine, Kosin University College of Medicine, 34, Amnam-dong, Seo-gu, Busan, 602-702 Korea.
2Convergence Medicine & Exercise Science Research Institute, Kosin University College of Medicine, 34, Amnam-dong, Seo-gu, Busan, 602-702 Korea.
出版信息
Clin Hypertens. 2019 Mar 1;25:4. doi: 10.1186/s40885-019-0108-x. eCollection 2019.
BACKGROUND
Angina pectoris with a normal coronary angiogram, termed microvascular angina (MVA), is an important clinical entity; however, its causes remain unclear. Autonomic dysfunction is one of the possible causes. Therefore, this study aimed to investigate parasympathetic dysfunction assessed by heart rate recovery (HRR) and increased sympathetic activity assessed by exaggerated blood pressure (BP) response (EBPR) to exercise in MVA.
METHODS
The study participants were consecutive patients with anginal chest pain who underwent both coronary angiography with an ergonovine provocation test and a treadmill exercise test between January 2008 and February 2015. Patients with significant coronary artery disease (coronary artery stenosis ≥50%) or significant coronary artery spasm (≥90%) were excluded. Based on the treadmill exercise test, patients were categorized into the microvascular angina (MVA) group (patients with uniform ST depression ≥1 mm) and the control group. HRR was defined as peak heart rate minus heart rate after a 1 min recovery; blunted HRR was defined as ≤12 beats/min. EBPR was defined as a peak exercise systolic BP ≥210 mmHg in men and ≥ 190 mmHg in women. These parameters were compared between patients with MVA and the controls.
RESULTS
Among the 970 enrolled patients (mean age 53.1 years; female 59.0%), 191 (20.0%) were diagnosed with MVA. In baseline characteristics, the MVA group had older participants, female predominance, and a higher prevalence of hypertension. The MVA group showed significantly lower HRR 1 min (24.9 ± 15.9 vs. 31.3 ± 22.7, < 0.001) compared with the control group. Moreover, the proportion of EBPR was significantly higher in the MVA group than in the control group (21.5% vs. 11.6%, p < 0.001). Multivariable logistic regression analysis showed that age (odds ratio (OR), 1.045; 95% confidence interval (CI), 1.026-1.064; p < 0.001), HRR 1 min (OR, 0.990; 95% CI, 0.982-0.999; = 0.022), and EBPR (OR, 1.657; 95% CI, 1.074-2.554; p = 0.022) were independently associated with MVA.
CONCLUSION
HRR and EBPR were associated with MVA, which suggests a link between MVA and autonomic dysregulation.
背景
冠状动脉造影正常的心绞痛，即微血管性心绞痛（MVA），是一种重要的临床病症；然而，其病因仍不明确。自主神经功能障碍是可能的病因之一。因此，本研究旨在探讨通过心率恢复（HRR）评估的副交感神经功能障碍以及通过运动时血压过度反应（EBPR）评估的交感神经活动增强在MVA中的情况。
方法
研究参与者为2008年1月至2015年2月期间连续入选的心绞痛患者，这些患者均接受了麦角新碱激发试验的冠状动脉造影和跑步机运动试验。排除患有严重冠状动脉疾病（冠状动脉狭窄≥50%）或严重冠状动脉痉挛（≥90%）的患者。根据跑步机运动试验，将患者分为微血管性心绞痛（MVA）组（ST段压低均匀≥1毫米的患者）和对照组。HRR定义为峰值心率减去恢复1分钟后的心率；HRR减弱定义为≤12次/分钟。EBPR定义为男性运动时收缩压峰值≥210毫米汞柱，女性≥190毫米汞柱。比较MVA患者和对照组的这些参数。
结果
在970名入选患者中（平均年龄53.1岁；女性占59.0%），191名（20.0%）被诊断为MVA。在基线特征方面，MVA组患者年龄较大，女性居多，高血压患病率较高。与对照组相比，MVA组1分钟时的HRR显著更低（24.9±15.9对31.3±22.7，<0.001）。此外，MVA组中EBPR的比例显著高于对照组（21.5%对11.6%，p<0.001）。多变量逻辑回归分析显示，年龄（比值比（OR），1.045；95%置信区间（CI），1.026 - 1.064；p<0.001）、1分钟时的HRR（OR，0.990；95%CI，0.982 - 0.999；p = 0.022）和EBPR（OR，1.657；95%CI，1.074 - 2.554；p = 0.022）与MVA独立相关。
结论
HRR和EBPR与MVA相关，这表明MVA与自主神经调节异常之间存在联系。
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