Casella G, Pavesi P C, Sangiorgio P, Rubboli A, Bracchetti D
Cardiology Section, Ospedale Maggiore, Bologna, Italy.
Int J Cardiol. 1993 Jul 15;40(3):229-35. doi: 10.1016/0167-5273(93)90005-2.
Controversy exists about the clinical and prognostic significance of exercise-induced ventricular arrhythmias late after myocardial infarction. The aim of the study was to identify the main clinical and prognostic features of exercise-induced ventricular arrhythmias in out-patients with healed Q-wave myocardial infarction.
The study population was 777 consecutive patients who underwent a symptom-limited (Bruce protocol) treadmill test from May 1988 to January 1991 after myocardial infarction (at least 1 year). Clinical and exercise data were prospectively entered in a computerized database and retrospectively two different groups were selected: (1) 228 patients with exercise-induced ventricular arrhythmias; (2) 549 patients without. Incidence and morphology of exercise-induced ventricular arrhythmias, various exercise parameters and a follow-up were evaluated.
Patients with exercise-induced ventricular arrhythmias were older (P < 0.001), had higher blood pressure (P < 0.03) and peak exercise rate pressure product (P < 0.00) than the others. No difference was found in the incidence of exercise-ischaemia: either symptomatic or not. When simple (< or = 2 Lown) versus complex (> or = 3 Lown) exercise-induced ventricular arrhythmias were considered, the latter were more frequent in patients with anterior myocardial infarction, shorter exercise duration (P < 0.001) and lower exercise rate pressure product, lower ejection fraction and lower incidence of exercise-induced ischaemia. In the follow-up (mean 24 +/- 13 month) there were 24 deaths: five (2.2%) in patients with exercise-induced ventricular arrhythmias and 19 (3.4%) in patients without. Cardiac event rate was similar in both groups.
We conclude that in out-patients with healed myocardial infarction exercise-induced ventricular arrhythmias are quite frequent, but they are not associated with exercise-induced ischaemia, either symptomatic or not. Exercise-induced ventricular arrhythmias seem to be related to age or peak workload. Moreover patients with these arrhythmias have no adjunctive negative risk on prognosis.
心肌梗死后晚期运动诱发的室性心律失常的临床及预后意义存在争议。本研究的目的是确定Q波型心肌梗死愈合后的门诊患者运动诱发室性心律失常的主要临床和预后特征。
研究人群为1988年5月至1991年1月间连续777例心肌梗死后（至少1年）接受症状限制性（Bruce方案）平板运动试验的患者。临床和运动数据前瞻性地录入计算机数据库，并回顾性地选择了两个不同的组：（1）228例运动诱发室性心律失常的患者；（2）549例无运动诱发室性心律失常的患者。评估运动诱发室性心律失常的发生率和形态、各种运动参数及随访情况。
运动诱发室性心律失常的患者比其他患者年龄更大（P<0.001）、血压更高（P<0.03）、运动高峰心率血压乘积更高（P<0.00）。运动性缺血的发生率在有或无症状方面均未发现差异。当考虑简单（≤2级Lown分级）与复杂（≥3级Lown分级）运动诱发的室性心律失常时，后者在前壁心肌梗死患者中更常见，运动持续时间更短（P<0.001）、运动心率血压乘积更低、射血分数更低以及运动诱发缺血的发生率更低。在随访（平均24±13个月）期间有24例死亡：运动诱发室性心律失常患者中有5例（2.2%），无运动诱发室性心律失常患者中有19例（3.4%）。两组的心脏事件发生率相似。
我们得出结论，在心肌梗死愈合的门诊患者中，运动诱发的室性心律失常相当常见，但它们与有或无症状的运动性缺血均无关。运动诱发的室性心律失常似乎与年龄或运动高峰负荷有关。此外，有这些心律失常的患者在预后方面没有额外的不良风险。
