Palma Alexandra, Pereira Charlotte, Probert Heather, Shannon Harriet
Specialist Physiotherapist, Cardiac Rehabilitation Team University College London Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 3EH.
Lecturer, Postgraduate Cardiorespiratory Physiotherapy Education, and Clinical Specialist Lead - Transplantation, Harefield Hospital University College London Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 3EH.
Br J Cardiol. 2021 Mar 9;28(1):13. doi: 10.5837/bjc.2021.013. eCollection 2021.
The incremental shuttle walk test (ISWT) is a valid, reliable submaximal exercise test used in the assessment of patients prior to cardiac rehabilitation (CR). Simultaneous electrocardiogram (ECG) measurements would provide important information on the safety of the test, and adequacy of subsequent cardiac risk stratification. Risk stratification is recommended to assess patients' suitability for cardiac rehabilitation. For example, ST-segment depression >2 mm from baseline during testing would place a person in a high-risk category. However, such ECG measurements are rarely undertaken in clinical practice. The aim of the study was to investigate the incidence of ECG changes during an ISWT, and report on the possible impact of these findings on subsequent cardiac risk stratification. A retrospective case note review was undertaken for the year 2017. Baseline clinical characteristics from eligible patients were gathered including those with ischaemic heart disease, heart failure, transplant and valve replacement, along with ECG measurements during the ISWT. The impact of ECG findings on cardiac risk stratification was calculated, based on risk stratification developed by the American Association of Cardiovascular and Pulmonary Rehabilitation. The safety of the ISWT was measured by the absence of major ECG changes. Data were gathered for 295 patients. Minor ECG changes were identified during the ISWT in 189 patients (64.1%), with no major changes. The presence of silent myocardial ischaemia (ST-segment depression) had an impact on cardiac risk stratification in 27 patients. There was a statistically significant positive association between ST-segment depression with cardiac risk stratification (p<0.001). In conclusion, the ISWT is safe in terms of ECG changes. The impact of ECG findings on cardiac risk stratification is significant and worthy of further consideration.
递增往返步行试验（ISWT）是一种有效、可靠的次极量运动试验，用于心脏康复（CR）前对患者进行评估。同步心电图（ECG）测量可为试验安全性及后续心脏风险分层的充分性提供重要信息。建议进行风险分层以评估患者是否适合心脏康复。例如，测试期间ST段压低超过基线2 mm会将患者归入高风险类别。然而，这种ECG测量在临床实践中很少进行。本研究的目的是调查递增往返步行试验期间ECG变化的发生率，并报告这些发现对后续心脏风险分层可能产生的影响。对2017年的病例记录进行了回顾性研究。收集了符合条件患者的基线临床特征，包括患有缺血性心脏病、心力衰竭、移植和瓣膜置换的患者，以及递增往返步行试验期间的ECG测量结果。根据美国心血管和肺康复协会制定的风险分层，计算了ECG结果对心脏风险分层的影响。递增往返步行试验的安全性通过无重大ECG变化来衡量。收集了295例患者的数据。在递增往返步行试验期间，189例患者（64.1%）出现轻微ECG变化，无重大变化。无症状心肌缺血（ST段压低）的存在对27例患者的心脏风险分层产生了影响。ST段压低与心脏风险分层之间存在统计学上显著的正相关（p<0.001）。总之，就ECG变化而言，递增往返步行试验是安全的。ECG结果对心脏风险分层的影响显著，值得进一步考虑。
