冠心病患者心肺运动试验安全性方面跑步机与自行车测力计运动的比较
Comparison Between Treadmill and Bicycle Ergometer Exercises in Terms of Safety of Cardiopulmonary Exercise Testing in Patients With Coronary Heart Disease.
作者信息
Ren Chuan, Zhu Jingxian, Shen Tao, Song Yanxin, Tao Liyuan, Xu Shunlin, Zhao Wei, Gao Wei
机构信息
Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital, National Health Commission, Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Key Laboratory of Molecular Cardiovascular Science of Ministry of Education, Beijing Key Laboratory of Cardiovascular Receptors Research, Beijing, China.
Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine, Peking University, Beijing, China.
出版信息
Front Cardiovasc Med. 2022 Jun 20;9:864637. doi: 10.3389/fcvm.2022.864637. eCollection 2022.
BACKGROUND
Cardiopulmonary exercise testing (CPET) is used widely in the diagnosis, exercise therapy, and prognosis evaluation of patients with coronary heart disease (CHD). The current guideline for CPET does not provide any specific recommendations for cardiovascular (CV) safety on exercise stimulation mode, including bicycle ergometer, treadmill, and total body workout equipment.
OBJECTIVE
The aim of this study was to explore the effects of different exercise stimulation modes on the occurrence of safety events during CPET in patients with CHD.
METHODS
A total of 10,538 CPETs, including 5,674 performed using treadmill exercise and 4,864 performed using bicycle ergometer exercise at Peking University Third Hospital, were analyzed retrospectively. The incidences of CV events and serious adverse events during CPET were compared between the two exercise groups.
RESULTS
Cardiovascular events in enrolled patients occurred during 355 CPETs (3.4%), including 2 cases of adverse events (0.019%), both in the treadmill group. The incidences of overall events [235 (4.1%) vs. 120 (2.5%), < 0.001], premature ventricular contractions (PVCs) [121 (2.1%) vs. 63 (1.3%), = 0.001], angina pectoris [45 (0.8%) vs. 5 (0.1%), < 0.001], and ventricular tachycardia (VT) [32 (0.6%) vs. 14 (0.3%), = 0.032] were significantly higher in the treadmill group compared with the bicycle ergometer group. No significant difference was observed in the incidence of bradyarrhythmia and atrial arrhythmia between the two groups. Logistic regression analysis showed that the occurrence of overall CV events ( < 0.001), PVCs ( = 0.007), angina pectoris ( < 0.001), and VT ( = 0.008) was independently associated with the stimulation method of treadmill exercise. In male subjects, the occurrence of overall CV events, PVCs, angina pectoris, and VT were independently associated with treadmill exercise, while only the overall CV events and angina pectoris were independently associated with treadmill exercise in female subjects.
CONCLUSION
In comparison with treadmill exercise, bicycle ergometer exercise appears to be a safer exercise stimulation mode for CPET in patients with CHD.
背景
心肺运动试验（CPET）广泛应用于冠心病（CHD）患者的诊断、运动治疗及预后评估。目前的CPET指南未就运动刺激模式（包括自行车测力计、跑步机和全身锻炼设备）的心血管（CV）安全性提供任何具体建议。
目的
本研究旨在探讨不同运动刺激模式对冠心病患者CPET期间安全事件发生情况的影响。
方法
回顾性分析北京大学第三医院共10538例CPET，其中5674例采用跑步机运动，4864例采用自行车测力计运动。比较两组运动期间CV事件和严重不良事件的发生率。
结果
入选患者中355例CPET期间发生心血管事件（3.4%），包括2例不良事件（0.019%），均发生在跑步机组。跑步机组总体事件发生率[235例（4.1%）对120例（2.5%），P<0.001]、室性早搏（PVCs）发生率[121例（2.1%）对63例（1.3%），P=0.001]、心绞痛发生率[45例（0.8%）对5例（0.1%），P<0.001]和室性心动过速（VT）发生率[32例（0.6%）对14例（0.3%），P=0.032]均显著高于自行车测力计组。两组缓慢性心律失常和房性心律失常发生率无显著差异。Logistic回归分析显示，总体CV事件（P<0.001）、PVCs（P=0.007）、心绞痛（P<0.001）和VT（P=0.008）的发生与跑步机运动刺激方式独立相关。在男性受试者中，总体CV事件、PVCs、心绞痛和VT的发生与跑步机运动独立相关，而在女性受试者中，仅总体CV事件和心绞痛与跑步机运动独立相关。
结论
与跑步机运动相比，自行车测力计运动似乎是冠心病患者CPET更安全的运动刺激模式。
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