Hakki A H, Munley B M, Hadjimiltiades S, Meissner M D, Iskandrian A S
Am J Cardiol. 1986 Jan 1;57(1):71-5. doi: 10.1016/0002-9149(86)90954-9.
This study assessed the determinants of exercise-induced abnormal systolic blood pressure (BP) response in 127 patients with documented coronary artery disease (CAD) who underwent exercise thallium-201 scintigraphy. Three types of systolic BP response to exercise were identified: an increase by more than 20 mm Hg (group I, n = 74); an increase by 20 mm Hg or less (group II, n = 36); and a decrease of at least 10 mm Hg (group III, n = 17). The 3 groups were not significantly different in age, gender or medications. The number of segments with perfusion defects was significantly higher in groups II and III than group I (group III, 2.9 +/- 1.5; group II, 2.9 +/- 2.1; and group I, 1.8 +/- 1.4, p = 0.009). Prior myocardial infarction, abnormal left ventricular ejection fraction, and multivessel CAD were more common in group III than in groups I and II. Stepwise discriminant analysis of 15 relevant clinical, angiographic and exercise scintigraphic descriptors showed that the number of thallium perfusion defects, abnormal LV ejection fraction at rest and multivessel CAD to be important predictors of hypotensive BP response. Multivariate analysis, however, showed that the number of thallium perfusion defects was the only important predictor of the hypotensive response. Thus, it is the functional significance of CAD assessed by the extent of thallium perfusion abnormalities rather than the extent of CAD or left ventricular dysfunction at rest that determines the systolic BP response to exercise.
本研究评估了127例经记录确诊为冠心病（CAD）并接受运动铊-201心肌灌注显像的患者运动诱发异常收缩压（BP）反应的决定因素。确定了三种运动时收缩压反应类型：升高超过20 mmHg（I组，n = 74）；升高20 mmHg或更低（II组，n = 36）；以及降低至少10 mmHg（III组，n = 17）。三组在年龄、性别或用药方面无显著差异。II组和III组灌注缺损节段数显著高于I组（III组，2.9±1.5；II组，2.9±2.1；I组，1.8±1.4，p = 0.009）。III组既往心肌梗死、左心室射血分数异常和多支血管CAD比I组和II组更常见。对15项相关临床、血管造影和运动心肌灌注显像描述指标进行逐步判别分析显示，铊灌注缺损数、静息时左心室射血分数异常和多支血管CAD是低血压BP反应的重要预测因素。然而，多变量分析显示，铊灌注缺损数是低血压反应的唯一重要预测因素。因此，决定运动时收缩压反应的是通过铊灌注异常程度评估的CAD功能意义，而非CAD程度或静息时左心室功能障碍。
