运动对慢性心衰患者心肺功能的影响

目的：评价医疗体育运动对慢性心衰心肺功能的影响。方法：采用分级踏车试验检测79例慢性心衰患的心肺功能，对比观察运动指导对慢性心衰患心肺功能及血流动力学的影响。结果：运动组较传统疗养组VO2max,VO2max/kg,VO2max/HR,HRmax及VEmax平均值增高，除HRmax外，差异有显性（P＜0．05）；每搏量，心率，平均血压显改善（P＜0．05）。无氧阈时运动组心肺功能指标上升（P＜0．05）。结论：运动能改善慢性心衰患的运动贮量，减轻疲劳和呼吸困难，对预后有重要意义。     

综合康复医疗对慢性心衰患者心肺功能的影响

目的:评价综合康复医疗对慢性心衰患者心肺功能的影响。方法:采用逐级负荷踏车试验检测79例慢性心衰患者的心肺功能,对比观察综合康复医疗组(观察组)与传统疗养组(对照组)治疗前、后心率、血压、心肌耗氧量及6 min步行距离的变化。结果:观察组较对照组6 min步行试验后心率、血压增加值减少,步行距离延长,心肌耗氧量降低(P<0.05).VO2max,VO2max/kg,VO2max/HR,VEmax均值均高于对照组(P<0.05)。结论:综合康复医疗对改善慢性心衰患者心肺功能,提高生存率有益。     

急性心肌梗塞运动试验的临床价值

目的：研究急性心肌梗塞（AMI）患者平板运动试验的评定心功能、指导康复作用。方法：16例AMI病人（平均56．5岁）在发病4周后按照Bruce方案进行症状限止平板运动试验。结果：VO2max3～12（平均7．3±3．8）METs；HRmax106～186（平均152．7±29．7）次／分；运动试验阳性12例．其中ST段下移、VO2max＜4METs者6例（50％）；ST段抬高、VO2max＜4METs者5例（31．2％）；没有1例发生意外。结论：AMI病人的运动试验对评定心功能、指导康复有较大临床意义；只要掌握适应证、禁忌证，运动中严密监护．AMI病人运动试验是安全的。     

健康成人最大运动负荷下的摄氧量和心率的测定

我们测定了94例健康国人在递增运动至症状自限的运动下的摄氧量（VO2）、心率（HR）和HR－VO2的关系。方法：94例健康成人（男性48例，女性46例）踏功率自行车进行运动测试，每分钟递增功率直至受试者最大耐受量，同步记录VO2和HR。结果：VO2max与年龄（AGE）和体表面积（BSA）有关，预计方程为：女性VO2max（ml／min）＝917．75×BSA－8．99×AGE＋176．20（SEE＝171．7，r2＝0.36）；男性VO2max（ml／min）＝660．61×BSA－18．92×AGE＋1510．23（SEE＝271．5，r2＝0．49）。HRmax＝174－0．562×年龄。HR－VO2的关系为：HR（女性）＝70．32＋0．058×VO2（ml／min）±12；HR（男性）＝75．01＋0.037×VO2（ml／min）±12。结论：VO2max受性别、年龄和体表面积的影响，但HR－VO2的关系变异较小。     

重组人脑钠肽对急性心肌梗死冠脉未通患者左室重塑和心功能的影响

目的研究重组人脑钠肽（rhBNP）对急性心肌梗死（AMI）冠脉未通患者左室重塑和心功能的影响。方法将103例AMI冠脉未通患者随机分为常规治疗组23例、地高辛组40例、rhBNP治疗组40例,并于AMI后1周、12周、24周分别进行超声心动图分析,测定左室心肌重量,左室收缩功能、舒张功能,了解rhBNP对AMI后左室重塑的阻抑作用。结果①AMI后24周时rhBNP组与常规治疗组和地高辛组比较,室间隔厚度、左室后壁厚度、左室舒张末内径和左室心肌重量指数均明显降低。地高辛组与常规治疗组各项指标比较差异无统计学意义。②AMI后1周时,地高辛组和rhBNP组左室收缩末期容积较常规治疗组降低（P〈0．01）,左室射血分数较常规治疗组升高（P〈0．05）,两组间差异无统计学意义（P〉0．05）。治疗后12周、24周时,rhBNP组左室舒张末期容积和收缩末期容积较同时间点常规治疗组和地高辛组均显著降低（P〈0．05）,而左室射血分数、E／A则显著升高（P〈0．05）。结论rhBNP能明显减轻心肌梗死后心肌肥厚和左室重塑,阻抑左室重塑过程,改善左室功能。     

欣怡胶囊对兔急性心肌梗死再灌注后心肌无复流程度的影响

目的：观察欣怡胶囊对兔急性心肌梗死（AMI）再灌注后心肌无复流的影响。方法将80只兔分为5组,模型组,阳性药组（替罗非班60μg/kg）,欣怡胶囊高、中、低剂量组（4.0 g生药/kg、2.0 g生药/kg、1.0 g生药/kg）,每组16只,另取14只作为假手术组,灌胃给药5 d后分别建立 AMI缺血再灌注模型,结扎兔冠状动脉左回旋支近段3 h,再灌注1 h,记录 AMI术前和 AMI再灌注后心电图,比较 J点抬高情况;AMI再灌注后左心室插管连接 POWERLAB生物信号采集处理系统,记录血流动力学相关指标;采用Evan’s蓝和硫磺素 S对心脏进行活体染色,记录心肌无复流程度。结果欣怡胶囊高、中和低剂量组心肌无复流程度均比模型组显著降低,分别降低了38.1%、24.5%和19.7%（P〈0.05或P〈0.01）,AMI再灌注后心电图中 J点比模型组明显降低,左心室内压（LVSP）、心率（HR）、左心室压力最大上升速率（＋dp/dtmax）、左心室内压最大下降速率（-dp/dtmax）明显升高,左心室舒张末期内压（LVEDP）明显降低,差异有统计学意义（P〈0.05或P〈0.01）。结论欣怡胶囊灌胃给药能一定程度预防和改善兔 AMI再灌注后导致的心肌无复流现象。     

老年急性心肌梗死后冠状动脉微循环障碍患者的临床特点及远期预后的研究

目的 分析急性心肌梗死（AMI）后冠状动脉微循环障碍（CMD）的年龄≥75岁患者的临床特点及预后。方法选择2016年6月～2021年9月北京大学人民医院心血管内科收治并于住院期间完成心肌声学造影的AMI患者197例,纳入合并CMD患者115例（58.4%）为研究对象,根据AMI发病时年龄分为≥75岁组20例和对照组（年龄<75岁）95例。收集2组基线资料,测量左心室舒张末期内径（LVEDD）、LVEF、整体长轴应变（GLS）、室壁运动评分（WMSI）、节段性室壁运动异常（RWMA）以及心肌灌注指数（MPI）。随访8(3,13)个月,观察2组患者主要不良心血管事件（MACE）。结果 与对照组比较,≥75岁组女性（50.0%vs 18.9%,P=0.003）、非ST段抬高型心肌梗死（NSTEMI）比例明显升高（40.0%vs 15.8%,P=0.014）,2组入院时Killip分级比较,有统计学差异（P=0.016）。2组LVEDD、LVEF、GLS、RWMA、WMSI及MPI比较,差异无统计学意义（P>0.05）。校正性别、Killip分级及NSTEMI后,≥75岁组患者再住...     

99mTc-MIBI心肌灌注显像预测急性心肌梗死患者延迟PCI疗效的临床意义

目的评价^99mTc-MIBI心肌灌注显像在急性心肌梗死（AMI）患者延迟经皮冠状动脉介入治疗（PCI）策略中的意义。方法 55例未行急诊PCI的AMI患者,以术前静息及硝酸甘油介入^99mTc-MIBI心肌灌注显像结果分为有存活心肌组和无存活心肌组,观察两组PCI前后1周静息心肌灌注缺损计分变化及PCI前、PCI后12个月后超声心动图改变。结果有存活心肌组和无存活心肌组静息心肌灌注显像缺损积分PCI前分别为（11.66±0.43）、（12.41±0.64）分,PCI后分别为（7.02±0.56）、（10.09±0.45）分,两组PCI前后心肌血流灌注均有改善（P均<0.05）,有存活心肌组心肌血流灌注改善更显著（P<0.01）。超声心动图检测显示PCI前两组左室射血分数（LVEF）及左室舒张末期内径（LVEDD）比较有统计学差异（P<0.05或<0.01）,PCI后12个月有存活心肌组LVEF、LVEDD改善优于无存活心肌组（P<0.05或<0.01）。结论静息及硝酸甘油介入^99mTc-MIBI心肌灌注显像可作为判断AMI患者延迟PCI疗效的可靠方法。     

38例急性心肌梗死患者早期应用吗啡效果观察

目的探讨吗啡对早期急性心肌梗死（AMI）患者的心肌保护作用及机制。方法将60例AMI患者随机分为观察组38例和对照组22例。两组均予基础治疗,观察组入院后立即注射吗啡3mg,5～10min后再次注射3mg,于治疗前及治疗后6、12、24h测定两组肌钙蛋白（cTnT）水平。比较两组心律失常发生情况。结果观察组cTnT水平及心律失常发生率均明显低于较对照组（P均〈0.05）。结论吗啡能降低早期AMI患者心律失常的发生率,对心肌有保护作用,其机制为激动阿片类受体、降低血浆cTnT水平。     

弹力带抗阻练习结合呼吸训练对冠心病患者经皮冠状动脉介入术后心肺功能及运动耐力的效果分析

目的探讨弹力带抗阻练习结合呼吸训练对提高经皮冠状动脉介入(PCI)术后患者心肺功能及运动耐力的影响。方法选择2016年7月至2016年8月解放军总医院心血管内科常规复诊的PCI术后患者77例,所有患者均接受弹力带抗阻训练,将患者分为弹力带抗阻练习结合呼吸训练组(呼吸训练组)41例和常规弹力带抗阻训练组(对照组)36例,进行为期16周的规律康复训练,每周3次,隔日1次。比较2组训练前后心肺运动相关指标变化。采用SPSS 16.0统计软件对数据进行分析,根据数据类型,组间比较采用t检验或卡方检验。结果呼吸训练组患者锻炼后与锻炼前比较,最大运动负荷(Metsmax)、最大摄氧量(VO2max)、最大公斤摄氧(VO2/kgmax)显著升高(P0.01),Borg劳累度评估量表(Borg)评分显著降低(P0.01),最大氧脉搏(VO2max/HR)明显升高(P0.05);对照组患者锻炼后最大心率(HRmax)及无氧阈心率(HRAT)明显低于锻炼前,差异有统计学意义;2组比较,呼吸训练组患者锻炼后Metsmax[(6.03±1.63)vs(5.20±1.21)METs]、VO2/kgmax[(21.08±5.72)vs(18.12±4.29)ml/(kg·min)]及无氧阈公斤摄氧(VO2/kgAT)[(16.10±4.80)vs(14.49±4.46)ml/(kg·min)]显著高于对照组,差异有统计学意义(P0.05)。呼吸训练组锻炼后与锻炼前比较,二氧化碳通气当量(VE/VCO2)显著降低,第1秒用力呼气末容积(FEV1)及最大通气量(MVV)显著升高,差异均有统计学意义(P0.01);对照组锻炼后VE/VCO2较锻炼前显著降低,差异有统计学意义(P0.05);2组比较,呼吸训练组锻炼后FEV1[(5.42±1.72)vs(2.42±0.85)L]及MVV[(111.24±9.50)vs(95.80±6.23)L]显著升高,差异有统计学意义(P0.01)。结论与常规弹力带抗阻练习比较,弹力带抗阻练习结合呼吸训练更能有效提高PCI术后患者运动耐力并改善心肺功能。     

Value of exercise electrocardiography to predict additional jeopardized myocardial regions remote from site of previous myocardial infarction

In order to evaluate the efficacy of exercise electrocardiography (ECG) to identify jeopardized myocardial regions remote from the site of previous infarction, exercise ECG, left ventriculography, and coronary arteriography were performed in 90 patients with previous transmural myocardial infarction (MI). Of the 90 patients, angiographic studies revealed jeopardized myocardial regions in 47 patients. Exercise ECG correctly identified 32 of these 47 patients for a sensitivity value of 68%. There were 43 patients without any additional jeopardized myocardial regions. Exercise ECG correctly identifed only 24 of these 43 patients for a specificity value of 56%. The sensitivity and specificity values were similar in patients with prior anterior and inferior wall MI. It is concluded that relatively low sensitivity and specificity values preclude the ability of exercise ECG to accurately identify patients with jeopardized myocardial regions distant from the site of previous MI. Moreover, when such patients were correctly detected, exercise ECG was rather poor in localizing these additional jeopardized myocardial areas.     

急性心肌梗塞患者出院前的运动心电图试验

急性心肌梗塞（ＡＭＩ）患者出院前作运动心电图试验有临床实际意义。我科自１９９４年６月至１９９６年４月，给５１例病情稳定的ＡＭＩ患者作此检查，男４１例（６３．４±６．４岁）。女１０例（７０．６±６．２岁）试验距发病３０．６±１４．７天（５～５２天），其中有６例广泛性梗塞。结果：（１）多数患者能达到与其年龄相应的运动量；（２）室性心律失常发生率较高（２５％）；（３）患者发生心绞痛、气急、疲劳及血压下降者亦较多（各约１９％）；（４）２６例患者作了冠脉造影（ＣＡＧ），显示运动心电图试验阳性者多为多支冠脉病变；敏感性为８４．６％，特异性达９２．３％。作者认为，只要掌握适应证及试验时间，作好监护急救准备，试验方法适宜，心肌梗塞患者出院前作运动试验基本是安全的。     

Exercise-provoked ST-segment depression and prognosis in patients recovering from acute myocardial infarction. Significance and pitfalls

Abstract. The importance of maximal versus submaximal exercise testing and the significance of heart failure on the prognostic value of exercise-provoked ST-segment depression ≥ 0.1 mV was studied in 143 patients recovering from acute myocardial infarction. Patients were exercise tested prior to discharge and follow up lasted for up to 18 months (mean 17 months). End-point was first major event (i.e. first non-fatal reinfarction or death). A symptom-limited exercise test was superior to a heart-rate-limited test in detecting ST-segment depressions (27% vs. 20%; P < 0.5), and patients with ST-segment depression at lower heart rates did not have an increased risk of subsequent events compared with patients with ST-segment depression at higher heart rates (14% vs. 27%; NS). Heart failure surpassed ST-segment depression as a risk predictor (34% vs. 18%). Based on a meta-analysis including 13 studies (1987 patients) exercise-provoked ST-segment depression possessed an increased risk of subsequent major events (P < 0.0001; risk ratio = 1.90: 95% confidence limits 1.43.2.51). Thus, ST-segment depression provoked by a symptom-limited test selects patients with an increased risk of subsequent major events. In patients with a history of heart failure exercise-provoked ST-segment depression is of limited value.     

Women with high exercise tolerance and the role of myocardial perfusion imaging

BACKGROUND: Myocardial perfusion imaging (MPI) provides incremental diagnostic and prognostic information, even in patients with high exercise tolerance. HYPOTHESIS: Myocardial perfusion imaging provides significant diagnostic value, specifically in women with high exercise tolerance. METHODS: Our study population consisted of all women who underwent exercise MPI in our Department from January 1992 to June 1996 and reached at least Stage IV in the Bruce protocol. Patients were divided into those with known and those with possible coronary artery disease (CAD). All patients were followed for 3 years from the performance of MPI. RESULTS: Of 4,803 women who underwent myocardial perfusion imaging, 3,183 had exercise stressing, and of those, 311 reached at least Stage IV in the Bruce protocol. Of these 311 MPI scans, only 23 (7.4%) were abnormal (reversible, fixed, or mixed) and the remaining 288 (92.6%) were normal. Of the 82 patients with known CAD, 13 (15.8%) had an abnormal MPI, while only 10 (4.4%) of the 229 patients with possible CAD. No myocardial infarction or cardiac death occurred within 3 years; one patient with normal MPI needed revascularization. CONCLUSION: In women with high exercise tolerance, especially in those without already known CAD, the yield of MPI is very low. Women with high exercise tolerance have an excellent prognosis.     

Cardiocirculatory adjustments to exercise following myocardial infarction in rats

Summary The sequential changes of the cardiocirculatory response to exercise over time in rats with myocardial infarction and failure were studied. Hemodynamics and regional blood flow (RBF, radioactive microspheres) were determined at rest and during exercise either at 1, 10 or 42 days after infarction (MI, infarct size 41.4±2.6% of LV) or sham procedures (SH). Whereas the response to exercise was attenuated one day after surgery in MI and SH, cardiocirculatory recovery was present in SH at 10 days and LV systolic and end-diastolic pressures separated SH and MI groups. Renal vasoconstriction during exercise occurred 10 days after MI and BF to working muscle during exercise was significantly lower in MI as compared to SH. At 42 days after MI manifest heart failure was present and despite significant blood flow redistribution (p<0.05 MI vs SH in renal and cutaneous beds) impaired skeletal muscle flow was observed along with increased vascular resistance in working muscle during exercise. We conclude that the cardiocirculatory response to exercise following large MI follows a distinctive time-dependent pattern, which differs from that observed at rest. Besides exaggerated sympathetically mediated vasoconstriction during exercise, impaired vasodilatation in skeletal muscle at exercise emerged.Helmut Drexler was recipient of a fellowship grant from the Deutsche Forschungsgemeinschaft (DFG)Edward J. Toggart was supported by the National Heart, Lung and Blood Institute Public Health Service grant No. HL 06239-02     

Thrombolysis significantly reduces transient myocardial ischaemia following first acute myocardial infarction.

In order to investigate whether thrombolysis affects residual myocardial ischaemia, we prospectively performed a predischarge maximal exercise test and early out-of-hospital ambulatory ST segment monitoring in 123 consecutive men surviving a first acute myocardial infarction (AMI). Seventy-four patients fulfilled our criteria for thrombolysis, but only the last 35 patients included received thrombolytic therapy. As thrombolysis was not available in our Department at the start of the study, the first 39 patients included were conservatively treated (controls). No significant differences in baseline clinical characteristics were found between the two groups. In-hospital atrial fibrillation and digoxin therapy was more prevalent in controls (P less than 0.05). During exercise, thrombolysed patients reached a higher maximal work capacity compared with controls: 160 +/- 41 vs 139 +/- 34 W (P less than 0.02). Thrombolysis resulted in a non-significant reduction in exercise-induced ST segment depression: prevalence 43% vs 62% in controls. However, during ambulatory monitoring the duration of transient myocardial ischaemia was significantly reduced in thrombolysed patients: 322 min vs 1144 min in controls (P less than 0.05). Thrombolysed patients reached a higher heart rate during transient ischaemic episodes: 114 +/- 17 vs 93 +/- 11 b.min-1 in controls (P less than 0.001). In conclusion, thrombolytic therapy administered for a first AMI significantly reduces the burden of transient myocardial ischaemia. This may explain the improvement in myocardial function during physical activities, which was also observed in this study.     

Clinical studies on diabetic myocardial disease using exercise testing with myocardial scintigraphy and endomyocardial biopsy

Nine diabetics without significant coronary stenosis participated in an exercise testing protocol with thallium-201 myocardial scintigraphy. Endomyocardial biopsy of right ventricle was also obtained. There were 4 patients with abnormal perfusion (positive group) and 5 patients with normal perfusion (negative group). All cases of the positive group were familial diabetics and there was only one case of dietary treatment, whereas in the negative group, there were only 2 cases of familial diabetics and 3 cases receiving dietary treatment. No statistical differences between the positive and negative groups were observed for the data of exercise performance and hemodynamic parameters in cardiac catheterization at rest. However, the mean ejection fraction in the positive group (62 ± 13%) was significantly lower than in the negative group (77±4%). In both groups, the mean diameter of myocardial cells and the mean percent fibrosis of biopsy specimens showed significant increases compared with the control group. The mean percent fibrosis in the positive group (24.1±8.5%) compared with that in the negative group (16.5±5.9%) showed a tendency to increase. It is suggested that the abnormal perfusion of thallium-201 in the positive group indicates subclinically a pathological change of microcirculation caused by diabetes mellitus.     

The correlation between myocardial resilience after high-intensity exercise and markers of myocardial injury in swimmers

To investigate how high-intensity exercise influences an athlete''s myocardial resilience and the correlation between myocardial resilience and markers of myocardial ischemic injury.Fifteen swimmers participated in high-intensity exercises. Cardiac ultrasound was performed before and after exercise on each subject. Left ventricular general strain, systolic general strain rate, and the differences (▴general strain and ▴ general strain rate, respectively), before and after exercise were analyzed. Blood was collected at the morning of the exercise day and 6 hours after exercise to measure cardiac enzyme indicators.The correlation between myocardial resilience and markers of myocardial injury were evaluated. Most cardiac enzymes concentrations increased after exercise (P < .05). Cardiac troponin I, creatine kinase MB, and cardiac troponin T were all correlated with the degree of ▴ peak strain (differential value of posterior wall basal segment before and after exercise) and ▴ peak strain rate (differential value before and after exercise) (P < .05).After high-intensity exercise, the concentrations of creatine kinase MB and cardiac troponin T in the blood are positively correlated with two-dimensional ultrasound deformation indices, proving the fact that the seindices can be used as a diagnostic basis for myocardial injury, and are more sensitive than general strain. The two-dimensional strain echocardiogram is non-invasive and easily accepted by the patient. It can make up for the shortage of myocardial enzymes in the injury areas, including weak timeliness and the inability to locate injury.     

Transient ischaemia after acute myocardial infarction: relationship to exercise ischaemia

To study the implications of transient myocardial ischaemia following acute myocardial infarction we compared ambulatory ST segment monitoring with exercise treadmill testing in 170 patients (mean age 58 years) at 4-8 weeks after admission. Ambulatory monitoring detected transient ischaemia (265 episodes; 249 (94%) silent) in 53/170 patients (31%) which was less frequent than ischaemia during exercise testing (90 patients; 53%) (P less than 0.0001). However, patients displaying transient ambulatory ischaemia (i) achieved less total exercise (248.7 +/- 17.2 vs 318.7 +/- 14.1 s; means +/- SEM) (P less than 0.006), (ii) developed exercise ST deviation earlier (172.4 +/- 14.3 vs 244.8 +/- 16.2 s) (P less than 0.0004) and (iii) had more widespread exercise ischaemia (3.8 +/- 0.3 vs 2.5 +/- 0.2 ECG leads) (P less than 0.005). Positive ambulatory ST segment monitoring was infrequently found (12/80 patients; 15%) in the presence of a negative exercise test but did identify the majority of patients (9/11 patients; 82%) with easily provoked exercise ischaemia and hence strongly positive exercise tests. These data suggest a limited role for routine 24 h ambulatory monitoring after myocardial infarction for the diagnosis of ongoing ischaemia but raise the possibility of an important place for this test in prognosis and risk stratification.