Handler C E, Sowton E
Int J Cardiol. 1985 Oct;9(2):173-90. doi: 10.1016/0167-5273(85)90196-2.
Submaximal and maximal treadmill exercise tests were performed predischarge in 64 patients after acute myocardial infarction to assess the relative yield of residual ischaemic abnormalities. The reproducibility of individual abnormalities resulting from maximal stress tests performed predischarge and 6 weeks after infarction was also assessed in 55 of these patients. Compared with predischarge submaximal exercise testing, a maximal exercise test identified a significantly greater number of patients with residual myocardial ischaemia (26 vs. 15, P less than 0.05) and this was associated with a significantly longer average maximal exercise duration (P less than 0.001), and a higher rate-pressure product (P less than 0.001). Among the 55 patients who had maximal stress tests both predischarge and 6 weeks after infarction, there was a significant lack of reproducibility in the occurrence of exercise induced angina (P less than 0.01) and an abnormal blood pressure response (P less than 0.02). In contrast, exercise induced ST segment depression and elevation and ventricular arrhythmias were relatively reproducible. More patients had an ischaemic test result (ST depression or angina) at the later test compared to the predischarge test (33 vs. 25 patients) but this increase was not statistically significant. There were, however, significant increases at the later test in mean maximal exercise duration (P less than 0.001). mean maximal heart rate (P less than 0.001) and heart rate-systolic blood pressure double product (P less than 0.001). The majority of patients who had a cardiac event in the period between the two tests had a predischarge test abnormality. We conclude that a significantly greater number of patients with residual reversible myocardial ischaemia after infarction will be identified by symptom limited exercise testing compared with a submaximal predischarge test. Because ST depression and elevation appear reproducible, patients who develop these abnormalities during a predischarge test do not, for prognostic reasons, need retesting 6 weeks after infarction. Exercise induced angina pectoris and an abnormal blood pressure response, however, are highly variable and in these patients a repeat test may be useful.
对64例急性心肌梗死后的患者在出院前进行次极量和极量平板运动试验，以评估残余缺血异常的相对检出率。还对其中55例患者评估了出院前和心肌梗死后6周进行的极量运动试验所导致的个体异常的可重复性。与出院前的次极量运动试验相比，极量运动试验能显著检出更多有残余心肌缺血的患者（26例对15例，P<0.05），这与显著更长的平均极量运动持续时间（P<0.001）以及更高的心率血压乘积（P<0.001）相关。在出院前和心肌梗死后6周均进行极量运动试验的55例患者中，运动诱发心绞痛的发生情况（P<0.01）和异常血压反应（P<0.02）的可重复性明显不足。相比之下，运动诱发的ST段压低和抬高以及室性心律失常的可重复性相对较好。与出院前试验相比，更多患者在后期试验时有缺血试验结果（ST段压低或心绞痛）（33例对25例患者），但这种增加无统计学意义。然而，后期试验时平均极量运动持续时间（P<0.001）、平均最大心率（P<0.001）和心率-收缩压双倍乘积（P<0.001）有显著增加。在两次试验期间发生心脏事件的大多数患者出院前试验有异常。我们得出结论，与出院前的次极量试验相比，症状限制性运动试验能显著检出更多梗死后有残余可逆性心肌缺血的患者。由于ST段压低和抬高似乎具有可重复性，出于预后原因，在出院前试验中出现这些异常的患者在心肌梗死后6周无需再次检测。然而，运动诱发的心绞痛和异常血压反应变化很大，对这些患者进行重复试验可能有用。
