Chaliki H P, Miller T D, Christian T F, Bailey K R, Gibbons R J
Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic Rochester, Minnesota 55905, USA.
Mayo Clin Proc. 1997 Aug;72(8):711-8. doi: 10.1016/S0025-6196(11)63589-1.
To determine whether worsening exercise performance on serial exercise radionuclide angiography identifies patients at increased risk of future cardiac events.
One hundred nine medically treated patients with previous Q-wave myocardial infarction underwent two exercise radionuclide angiographic studies at least 6 months apart (median, 16 months) without an intervening clinical event. Worsening exercise performance between the two studies was defined by five criteria: (1) lower (5% or more) peak exercise ejection fraction; (2) worsening peak exercise wall motion score; (3) combination of criteria 1 and 2; (4) worsening serial delta (exercise - rest) ejection fraction; or (5) increasing exercise ST-segment depression of 1 mm or more. Patients were followed up for a median duration of 3.9 years after the second exercise study.
Five cardiac deaths and 10 nonfatal myocardial infarctions occurred during follow-up. A Cox proportional hazards analysis failed to show an association between any of the aforementioned variables and cardiac events. Of the 15 patients with cardiac events, 4 (27%) had a lower (5% or more) exercise ejection fraction and 2 (13%) had a worsening exercise wall motion score. Of the 94 patients without cardiac events, 37 (39%) had a lower (5% or more) exercise ejection fraction and 28 (30%) had a worsening serial exercise wall motion score (not a statistically significant difference).
Worsening exercise performance on serial exercise radionuclide angiography does not identify patients at increased risk of future cardiac events.
确定在系列运动放射性核素血管造影中运动表现恶化是否能识别出未来发生心脏事件风险增加的患者。
109例接受药物治疗的既往有Q波心肌梗死的患者，在至少间隔6个月（中位数为16个月）且无中间临床事件的情况下接受了两次运动放射性核素血管造影研究。两次研究之间运动表现恶化由五个标准定义：（1）运动高峰射血分数降低（5%或更多）；（2）运动高峰壁运动评分恶化；（3）标准1和2的组合；（4）系列运动-静息射血分数差值恶化；或（5）运动ST段压低增加1mm或更多。在第二次运动研究后，对患者进行了中位数为3.9年的随访。
随访期间发生了5例心源性死亡和10例非致命性心肌梗死。Cox比例风险分析未能显示上述任何变量与心脏事件之间存在关联。在15例发生心脏事件的患者中，4例（27%）运动射血分数降低（5%或更多），2例（13%）运动壁运动评分恶化。在94例未发生心脏事件的患者中，37例（39%）运动射血分数降低（5%或更多），28例（30%）系列运动壁运动评分恶化（无统计学显著差异）。
系列运动放射性核素血管造影中运动表现恶化不能识别出未来发生心脏事件风险增加的患者。
