Iovescu D, Cottin Y, Berteau O, Mouallem J, Ressencourt O, Cande F, Casillas J M, Louis P, Wolf J E
Centre de cardiologie clinique et interventionnelle, Dijon.
Arch Mal Coeur Vaiss. 1998 Jul;91(7):855-61.
The development of stress echocardiography on an ergometric table has increased the number of stress tests in the decubitus position, whereas most of the information currently available concerns stress tests in the sitting position or on the treadmill. In order to study the influence of this position of stress testing, the authors compared the results obtained in a series of 15 patients without cardiac disease (Group I) and another series of 15 coronary patients (Group II) undergoing the two types of stress testing, in the vertical position on a bicycle ergometer and in the lateral decubitus position on the ergometric table. Effort tolerance on the bicycle ergometer was significantly greater in terms of work load (202 +/- 35 vs 180 +/- 36 watts (p < 0.001) in the controls, and 120 +/- 32 vs 106 +/- 22 watts (p < 0.05) in the coronary group), of duration of effort (19 +/- 3 vs 16 +/- 3 minutes (p < 0.001) in the controls and 10 +/- 3 vs 8 +/- 2 minutes (p < 0.05) in the coronary patients), of heart rate (190 +/- 10 vs 172 +/- 21 beats/min (p < 0.005) in controls and 118 +/- 19 vs 111 +/- 14 beats/min (p < 0.05) in the coronary patients). On the other hand, blood pressure and O2 saturation tended to be greater during exercise in the decubitus position: SBP 200 +/- 23 vs 196 +/- 27 mmHg (NS) in the controls and 158 +/- 21 vs 166 +/- 23 mmHg (NS) in the coronary patients; DBP 97 +/- 10 vs 102 +/- 27 mmHg (NS) in the controls and 85 +/- 6 vs 90 +/- 10 mmHg (NS) in the coronary patients; O2 sat 96.8 +/- 1 vs 97.6 +/- 0.8% (p < 0.05) in the coronary patients. The anaerobic threshold and peak VO2 were much higher during exercise in the sitting position: oxygen consumption at the threshold 14.8 +/- 3.8 vs 12.6 +/- 2.3 ml.kg-1.min-1 (p < 0.01), peak VO2 22.2 +/- 5.9 vs 18.8 +/- 4.7 ml.kg-1.min-1 (p < 0.01) in the coronary patients. The results of this study show that the cardiovascular stimulation obtained in the decubitus position is not identical to that obtained by traditional exercise stress testing, particularly in coronary patients.
在测力计台上进行的负荷超声心动图检查的发展增加了卧位应激试验的数量，而目前大多数可用信息涉及坐位或跑步机上的应激试验。为了研究这种应激试验体位的影响，作者比较了两组患者的结果，一组是15名无心脏病患者（第一组），另一组是15名冠心病患者（第二组），他们分别进行了两种类型的应激试验，即坐在自行车测力计上的垂直位和躺在测力计台上的侧卧位。就工作量而言，自行车测力计上的运动耐力明显更高（对照组中为202±35瓦对180±36瓦（p<0.001），冠心病组中为120±32瓦对106±22瓦（p<0.05）），运动持续时间（对照组中为19±3分钟对16±3分钟（p<0.001），冠心病患者中为10±3分钟对8±2分钟（p<0.05）），心率（对照组中为190±10次/分钟对172±21次/分钟（p<0.005），冠心病患者中为118±19次/分钟对111±14次/分钟（p<0.05））。另一方面，卧位运动时血压和氧饱和度往往更高：对照组中收缩压为200±23毫米汞柱对196±27毫米汞柱（无显著性差异），冠心病患者中为158±21毫米汞柱对166±23毫米汞柱（无显著性差异）；对照组中舒张压为97±10毫米汞柱对102±27毫米汞柱（无显著性差异），冠心病患者中为85±6毫米汞柱对90±10毫米汞柱（无显著性差异）；冠心病患者中氧饱和度为96.8±1%对97.6±0.8%（p<0.05）。坐位运动时无氧阈值和峰值摄氧量要高得多：冠心病患者中阈值时的氧耗量为14.8±3.8毫升·千克⁻¹·分钟⁻¹对12.6±2.3毫升·千克⁻¹·分钟⁻¹（p<0.01），峰值摄氧量为22.2±5.9毫升·千克⁻¹·分钟⁻¹对18.8±4.7毫升·千克⁻¹·分钟⁻¹（p<0.01）。这项研究的结果表明，卧位获得的心血管刺激与传统运动应激试验获得的刺激不同，尤其是在冠心病患者中。
