[运动诱发无症状性心肌缺血的多中心研究：4389例确诊为缺血性心脏病患者的临床、既往史及运动耐力参数]
[Multicenter study on exercise-induced silent myocardial ischemia: clinical, anamnestic and ergometric parameters in 4389 patients with proven ischemic cardiopathy].
作者信息
Ignone G, Vona M, Scardi S
机构信息
Divisione di Cardiologia, Fondazione Clinica del Lavoro, IRCCS, Veruno NO.
出版信息
G Ital Cardiol. 1994 Apr;24(4):349-59.
AIM OF THE STUDY
In order to evaluate the incidence and clinical significance of myocardial ischemia during exercise testing (ExT) in patients (pts) with proven ischemic heart disease (Stable Effort Angina = SEA, Myocardial Infarction = MI, PTCA or CABG) 73 ergometric laboratories participated in a multicenter prospective study (SMISS) coordinated by the Italian Working Group on Cardiac Rehabilitation. Here we report the clinical and ergometric parameters.
METHODS
Over a period of six months 4,389 consecutive pts were enrolled in the study after performing a maximal limited ExT (25 watts x 3') after drug withdrawal. All pts are followed at 6 and 12 months, at which time electrocardiogram, physical examination and clinical history were reassessed. A preliminary quality control of ECGraphic signal of ischemia was performed. Between the core center and the ergometric laboratories there was an 88% agreement (positive/negative ECG). 617 (14%) pts with angina (Group A), 2621 (59.7%) MI pts (Group B), 313 (7.2%) PTCA pts (Group C1), 838 (19.1%) patients with previous coronary bypass (Group C2) were studied.
RESULTS
Interruption criteria were: maximal heart rate (11.7%), fatigue (66.6%), angina (10.9%), dispnea (2.3%), ST depression (13.9%), complex VPBs (2.2%), abnormal blood pressure (3.3%). In all pts the maximal work load was 100.3 +/- 31 W (lower in SEA pts). HR was 141 +/- 20/min at maximal work load (lower in SEA pts). The incidence of complex VPBs was 7.9% (higher in Mi and CABG pts). The results of ExT were: normal in 62% of all pts (21% in SEA pts), angina alone in 3.3% (7.6% in SEA pts and 1.8% in MI pts), symptomatic ischemia in 12.7% (40% in SEA pts, 9.3% in MI pts and 5.7% in CABG pts), silent ischemia in 22% (31.8% in SEA pts, 21.6 in MI pts and 16.6% in CABG pts). All differences were significant (p < 0.01).
CONCLUSIONS
In a low risk group of coronary patients the incidence of myocardial ischemia during ExT was 38%. Ischemia was silent in 58% of the patients.
研究目的
为评估确诊患有缺血性心脏病（稳定劳力型心绞痛 = SEA、心肌梗死 = MI、经皮冠状动脉腔内血管成形术或冠状动脉旁路移植术）的患者在运动试验（ExT）期间心肌缺血的发生率及临床意义，73个测力计实验室参与了由意大利心脏康复工作组协调的一项多中心前瞻性研究（SMISS）。在此，我们报告临床和测力计参数。
方法
在6个月的时间里，4389例连续患者在停药后进行最大限量ExT（25瓦×3分钟）后被纳入研究。所有患者在6个月和12个月时接受随访，此时重新评估心电图、体格检查和临床病史。对缺血性心电图信号进行了初步质量控制。核心中心与测力计实验室之间在心电图结果（阳性/阴性）上的一致性为88%。对617例（14%）心绞痛患者（A组）、2621例（59.7%）心肌梗死患者（B组）、313例（7.2%）经皮冠状动脉腔内血管成形术患者（C1组）、838例（19.1%）既往有冠状动脉搭桥术患者（C2组）进行了研究。
结果
终止标准为：最大心率（11.7%）、疲劳（66.6%）、心绞痛（10.9%）、呼吸困难（2.3%）、ST段压低（13.9%）、复杂性室性早搏（2.2%）、血压异常（3.3%）。所有患者的最大工作量为100.3±31瓦（SEA患者较低）。最大工作量时心率为141±20次/分钟（SEA患者较低）。复杂性室性早搏的发生率为7.9%（心肌梗死和冠状动脉搭桥术患者较高）。运动试验结果为：所有患者中62%正常（SEA患者中为21%），单纯心绞痛3.3%（SEA患者中为7.6%，心肌梗死患者中为1.8%），有症状性缺血12.7%（SEA患者中为40%，心肌梗死患者中为9.3%，冠状动脉搭桥术患者中为5.7%），无症状性缺血22%（SEA患者中为31.8%，心肌梗死患者中为21.6%，冠状动脉搭桥术患者中为16.6%）。所有差异均具有统计学意义（p < 0.01）。
结论
在低风险冠状动脉患者组中，运动试验期间心肌缺血的发生率为38%。58%的患者缺血为无症状性。
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