MacLellan-Tobert S G, Driscoll D J, Mottram C D, Mahoney D W, Wollan P C, Danielson G K
Department of Pediatrics, Covenant Medical Center, Waterloo, Iowa, USA.
J Am Coll Cardiol. 1997 Jun;29(7):1615-22. doi: 10.1016/s0735-1097(97)82541-7.
The purpose of this study was to identify the determinants of exercise tolerance in patients with Ebstein's anomaly.
Patients with Ebstein's anomaly of the tricuspid valve may have exercise limitation that improves after surgical repair.
One hundred seventeen patients performed cycle ergometry for a total of 124 tests (preoperative test in 76 patients, postoperative test in 23, test but no operation in 18, preoperative and postoperative test in 7). Multiple linear regression analysis was used to identify predictors of maximal oxygen uptake, oxygen saturation and heart rate at peak exercise.
Age at the time of exercise ranged from 6 to 60 years (median 15). An atrial septal defect was present in 67 patients (88%) preoperatively. Compared with the preoperative group, the postoperative group had significantly higher maximal oxygen uptake (mean [+/- SD] 20.5 +/- 7.4 vs. 25.3 +/- 7.0 ml/kg body weight per min, p = 0.006). Postoperative rest and exercise blood oxygen saturation was higher than that measured preoperatively (p = 0.0001). Six of seven patients tested before and after the operation showed improved exercise tolerance. Preoperatively, major predictors of maximal oxygen uptake were oxygen saturation at rest (p = 0.01) and age (p = 0.0001). Preoperatively, the major predictor of oxygen saturation at peak exercise was rest oxygen saturation (p = 0.0001), and major predictors of peak exercise heart rate were rest heart rate (p = 0.01) and rest oxygen saturation (p = 0.01). In the postoperative group, predictors of maximal oxygen uptake included age at exercise testing, male gender and heart size.
Definitive operation for Ebstein's anomaly results in improved exercise tolerance. Before the operation, rest oxygen saturation is the major predictor of exercise tolerance, oxygen saturation at peak exercise and peak heart rate. Postoperatively, age, gender and heart size influenced maximal oxygen uptake.
本研究旨在确定埃布斯坦畸形患者运动耐量的决定因素。
三尖瓣埃布斯坦畸形患者可能存在运动受限情况，手术修复后会有所改善。
117例患者进行了总计124次运动负荷试验（76例患者术前试验，23例患者术后试验，18例患者仅试验未手术，7例患者术前及术后试验）。采用多元线性回归分析确定运动峰值时最大摄氧量、血氧饱和度及心率的预测因素。
运动时年龄范围为6至60岁（中位数15岁）。术前67例患者（88%）存在房间隔缺损。与术前组相比，术后组最大摄氧量显著更高（平均[±标准差] 20.5±7.4 vs. 25.3±7.0 ml/kg体重每分钟，p = 0.006）。术后静息和运动时的血氧饱和度高于术前测量值（p = 0.0001）。7例手术前后均接受试验的患者中有6例运动耐量得到改善。术前，最大摄氧量的主要预测因素是静息血氧饱和度（p = 0.01）和年龄（p = 0.0001）。术前，运动峰值时血氧饱和度的主要预测因素是静息血氧饱和度（p = 0.0001），运动峰值心率的主要预测因素是静息心率（p = 0.01）和静息血氧饱和度（p = 0.01）。在术后组中，最大摄氧量的预测因素包括运动试验时的年龄、男性性别和心脏大小。
埃布斯坦畸形的确定性手术可改善运动耐量。术前，静息血氧饱和度是运动耐量、运动峰值时血氧饱和度和峰值心率的主要预测因素。术后，年龄、性别和心脏大小影响最大摄氧量。
