Gebska Milena A, Williford Noah N, Schadler Angela J, Laxson Carolyn, Alvarez Paulino, Briasoulis Alexandros, Cadaret Linda M, Yumul-Non Ily Kristine T, Kerber Richard E, Weiss Robert M
Division of Cardiovascular Medicine, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City.
Department of Internal Medicine, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City.
Mayo Clin Proc Innov Qual Outcomes. 2020 Jan 8;4(1):65-75. doi: 10.1016/j.mayocpiqo.2019.09.003. eCollection 2020 Feb.
To test the hypothesis that exercise and dobutamine would provide levels of cardiac stress that are comparable to those achieved in a general stress test population, and to one another, in heart transplant recipients.
From February 10, 2015, to December 31, 2017, 81 patients underwent exercise stress (N=45) or dobutamine stress (N=36) echocardiography at a mean ± SD of 11±14 years (range, 1-29 years) after heart transplant. Hemodynamic and inotropic responses were compared between groups, and to a prior test, longitudinally. The primary outcome was peak heart rate (HR) × systolic blood pressure (SBP).
Peak exercise HR × SBP × 10 was a mean ± SD of 24.9±4.9 mm Hg/min for exercise stress vs 21.2±3.4 mm Hg/min during dobutamine stress (<.001). In 35 patients who underwent a dobutamine stress test followed later by another dobutamine stress test, peak HR × SBP changed by 4.2%±16% (=.05). In 25 patients who underwent a dobutamine stress test followed later by an exercise stress test, peak HR × SBP increased by 12%±23% (=.002 vs serial dobutamine stress tests). Peak exercise HR did not correlate with time since heart transplant, patient age, or graft age. Peak dobutamine HR correlated modestly with patient age ( =0.28). Inotropic responses were similar in both groups. Overall, patients preferred exercise stress testing to dobutamine stress tests. Dobutamine stress testing was more expensive than exercise stress tests.
Exercise induces a level of cardiac stress that is equal to or greater than dobutamine-induced stress, at lower cost, in heart transplant recipients who express preference for exercise stress testing.
验证以下假设：在心脏移植受者中，运动和多巴酚丁胺所产生的心脏应激水平与一般应激试验人群所达到的水平相当，且二者之间也具有可比性。
2015年2月10日至2017年12月31日，81例患者在心脏移植术后平均±标准差11±14年（范围1 - 29年）接受了运动应激（N = 45）或多巴酚丁胺应激（N = 36）超声心动图检查。对两组之间以及与先前的一项检查进行血流动力学和变力反应的纵向比较。主要结局指标为心率（HR）峰值×收缩压（SBP）。
运动应激时运动HR峰值×SBP×10的平均值±标准差为24.9±4.9 mmHg/min，而多巴酚丁胺应激时为21.2±3.4 mmHg/min（P <.001）。在35例随后又接受了另一次多巴酚丁胺应激试验的患者中，HR峰值×SBP变化了4.2%±16%（P =.05）。在25例随后接受了运动应激试验的多巴酚丁胺应激试验患者中，HR峰值×SBP增加了12%±23%（与连续多巴酚丁胺应激试验相比，P =.002）。运动HR峰值与心脏移植后的时间、患者年龄或移植物年龄均无相关性。多巴酚丁胺HR峰值与患者年龄呈中度相关（r = 0.28）。两组的变力反应相似。总体而言，患者更喜欢运动应激试验而非多巴酚丁胺应激试验。多巴酚丁胺应激试验比运动应激试验费用更高。
在表达了对运动应激试验偏好的心脏移植受者中，运动所诱导的心脏应激水平等于或高于多巴酚丁胺诱导的应激水平，且成本更低。
