等长运动对冠心病患者左室功能的影响

目的探讨等长运动对冠心病患者左室功能的影响。方法28例冠心病患者和按同性别、身高、体重、年龄相配对的正常人(对照组),等长运动前后分别用彩色多普勒超声心动图测试左室舒张和收缩功能指标。结果两组患者静息状态下左室舒张功能多数指标变化不明显,运动后各项舒张功能指标变化显著(P均〈0.05),而收缩功能指标静息下两组相差显著,运动后变化更明显(P均〈0.05)。结论等长运动超声心动图测试法是评价冠心病患者左室收缩和舒张功能的一种简便和可靠的指标。     

乏氏动作对冠心病患者等长收缩运动时中心血流动力学的影响

观察１０名冠心病人在冠状动脉腔内成型术前后，进行等长收缩运动和乏氏动作对中心血流动力学的影响。１０名对象均为男性，平均年龄５２岁，单支血管病变伴劳力性心递交 痛，左心基本正常。运动为极量握力运动。运动中无１例病人发生临床可判断的心肌缺血，所有病人均无症状，附加乏氏动作对中心血流动力学的反应类型无明显影响。肺毛压在附加乏氏动作时增加较明显，但右房压也同时成比例增高。右房压与肺毛压变化的相关系数为０．     

Left ventricular torsion and circumferential strain responses to exercise in patients with ischemic coronary artery disease

LV torsion during exercise in patients with coronary artery disease (CAD) is not well known. Circumferential strain (CS) and left ventricular (LV) torsion (Tor) have not been evaluated during ischemia in these patients. We aimed to assess the effect of ischemia during exercise echocardiography (ExE) on CS and Tor. We studied a group of 73 patients with true positive ExE results (Ischemic group: ischemia plus an abnormal coronary angiogram) and a matched control group of 66 patients with negative ExE and either normal coronary angiography or low post-test probability of CAD. Basal rotation (Rot) and apical rotation and basal and apical CS were studied by speckle tracking at rest and exercise. Apical CS and apical and basal Rot values were similar between groups at rest, except basal CS which was already worse in the ischemic group. At exercise, all rotational and CS parameters were impaired in the ischemic in comparison with the control group (basal CS: ?18?±?5 vs. ?25?±?7?%, p?<?0.001; apical CS: ?31?±?11 vs. ??43?±?9?%, p?<?0.001; time to basal CS: 52?±?6 vs. 48?±?7?%, p?=?0.001; time to apical CS: 55?±?7 vs. 49?±?6?%, p?<?0.001; basal rotation: ?0.7?±?6.5° vs. ?6.2?±?8.5°, p?<?0.001; LV twist 13.0?±?10.4° vs.19.7?±?11.5°, p?<?0.001; LV-Tor 1.9?±?1.6°/cm vs. 2.8?±?1.7?/cm, p?=?0.001) with the exception of apical rotation which was similar (12.3?±?7.4° vs. 13.4?±?7.7°, p?=?NS). Basal and apical CS and basal rotation impair during exercise-induced ischemia. LV-Tor decreases with ischemia due to worsening of basal rotation, whereas apical rotation does not impair, suggesting the existence of an apical compensatory mechanism.     

Blood pressure response to isometric exercise in patients with peripheral atherosclerotic disease

BACKGROUND: The purpose of this study was to compare the circulatory responses to isometric exercise in patients with peripheral atherosclerotic disease (PAD) with healthy controls. METHODS: Eleven patients with diagnosed PAD, a control group of eleven healthy young adults, and a control group of eleven healthy age-matched adults participated. Blood pressure, heart rate, stroke volume, cardiac output, blood velocity in the brachial artery, acral skin perfusion was continuously recorded and total peripheral resistance calculated before, during and after 2 min of 40% maximum voluntary contraction of the forearm. RESULTS: At rest we found a consistently higher level of mean arterial pressure (MAP) and systolic pressure (SP) in the elderly, both PAD patients and elderly controls, compared with the young controls. We found no significant difference in diastolic blood pressure. Two minutes isometric handgrip exercise induced a similar increase in MAP in all three groups (patients 32.6 (17.9) mm Hg [mean (SD)], young control group 25.3 (8.9) mm Hg, age-matched control group 36.1 (10.6) mm Hg). No significant differences were found in the other measured cardiovascular variables during isometric handgrip. Increased TPR is the main factor contributing to the increase in blood pressure in all three groups. CONCLUSION: Our study indicates that the pressor response continues to be well regulated with age, also when the cardiovascular system is altered by marked atherosclerosis. The consequence is that both PAD patients and elderly controls reach higher SP values during isometric exercise due to higher SP baseline values.     

左心室压力-应变环评估冠心病患者冠状动脉病变程度

目的 观察左心室压力-应变环（LV-PSL）评估冠心病患者冠状动脉病变程度的价值。方法 按照Gensini评分将154例冠心病患者分为轻度组（n=51）、中度组（n=53）和重度组（n=50）,以50名健康志愿者作为对照组。采用LV-PSL观察并比较各组左心室整体纵向应变（GLS）及心肌做功（MW）参数,包括整体有用功（GCW）、整体无用功（GWW）、整体做功指数（GWI）及整体做功效率（GWE）,分析其评估冠状动脉病变程度的效能。结果 组间GLS及MW参数差异均有统计学意义（P均<0.05）。轻度组GWW高于、而GWE低于对照组（P均<0.05）;中度组GWW高于轻度组和对照组（P均<0.05）,GLS、GWI、GCW及GWE均低于轻度组和对照组（P均<0.05）;重度组GWW高于,而GLS、GWI、GCW及GWE均低于其余3组（P均<0.05）。GWE评估冠状动脉中、重度病变的曲线下面积均大于GWI、GCW及GWW （Z=0.73、0.74、0.88,P均<0.001）;以94.50%为GWE最佳截断值,其特异度为87.00%,敏感度为83.00%。Gensini评分与GWW呈中度正相关（r=0.69,P<0.01）,与GWI、GCW呈低度负相关（r=－0.42、－0.43,P均<0.01）,而与GWE呈中度负相关（r=－0.79,P<0.01）。结论 LV-PSL对评估冠心病患者冠状动脉病变程度具有一定价值,以左心室GWE诊断效能最佳。     

运动负荷诱发冠心病患者心律失常相关因素分析

目的:探讨活动平板运动试验中室性心律失常的发生与冠心病严重程度和运动时生理指标变化的关系。方法:选取1998-07/2003-06在中山大学附属第一医院心内科进行活动平板运动试验并经冠状动脉造影确诊为冠心病患者211例,男132例,女79例。所选患者运动前均无室性心律失常,也不伴有心瓣膜病,传导阻滞等。运动中,根据室性心律失常的发生程度分为3级,并以此作为分组依据:心律失常Ⅰ级组(n=145):运动中无室性心律失常发生;心律失常Ⅱ级组(n=38):运动中偶发室性期前收缩;心律失常Ⅲ级组(n=28):运动中出现严重室性心律失常。分析运动时室性心律失常的发生与冠状动脉病变程度,心肌缺血范围的大小以及运动中各生理指标变化的关系。结果:心律失常Ⅲ级组3支病变发生率(28.57%)高于心律失常Ⅰ级组(12.59%)(χ2=4.56,P<0.05)。核素运动心肌显像显示运动中心律失常Ⅲ级组患者多发性缺损的出现率(81.25%)明显高于心律失常Ⅰ级组(43.10%)(χ2=7.30,P<0.01)。运动试验阳性患者ST段压低开始的时间和压低的程度,各组间比较差异均有显著性意义(F=5.69,P<0.01;F=4.08,P<0.05);其中心律失常Ⅲ级组患者的ST段压低最大值分别明显大于心律失常Ⅰ,Ⅱ级组(F=4.08,P<0.05);心律失常Ⅱ,Ⅲ级组患者的ST段压低1mm开始时间(185.26,146.42s)     

冠心病患者等长收缩训练的作用及机理

目的：验证等长收缩训练(IE)在冠心病康复中的疗效及机理。方法：40例冠心病患者分为IE组和动力性运动DE组。IE组每日进行IE体操和有氧训练，DE组每日进行有氧训练，每周均训练5次。两组治疗时间均为6周。测定训练前后心率、血压、体重、腰围、臀围，心电运动试验，空腹血糖、血脂和二维超声心动图，并用放免法测定前后内啡肽(强啡肽、β—内啡肽、亮氨酸脑啡肽)的变化。结果：①两组均引起体质改善，但IE组腰围下降、肌力增加、最大运动时间增加和TG下降更为明显。②IE组定量运动时心血管反应下降。③IE组脑啡队和β—内啡肽明显增加。结论：冠心病患者IE训练可以安全有效地改善体质，提高最大运动能力，降低定量运动心血管反应，其机理与L—EK和β—END增加有关。     

分级等长收缩运动对正常人和心肌梗塞患者二尖瓣血流的影响——脉冲超声多普勒的研究

采用二维超声和脉冲超声多普勒对13例心肌梗塞患者和10名正常人进行研究,发现在近极量持续性肱二头肌和股四头肌等长收缩运动时患者最大二尖瓣舒张早期充盈速率(PE)下降,舒张晚期充盈速率(PA)升高,E/A比率下降,舒张时间缩短,与正常人的反应相似,两组诸指标的绝对差异在运动时缩小。提示这一现象可能为一种生理性反应,而不能简单地用心肌缺血来解释。     

Trimetazidine effects on exercise tolerance and left ventricular diastolic function in patients with coronary heart disease

AIM: Trial of trimetasidine effects on exercise tolerance (ET) and left ventricular diastolic function (LVDF) in patients with coronary heart disease (CHD). MATERIALS AND METHODS: The study group included 40 CHD patients. Of them 10, 18 and 12 had myocardial infarction, unstable angina pectoris and stable angina, respectively. 38 CHD patients of the control group had these disorders, respectively, in 5, 15 and 18 cases. 2-3-month therapy with nitrates, beta-blockers (BB) and inhibitors of angiotensin-converting enzyme (ACE) was given to both groups with adjuvant trimetasidine (60 mg/d) given to patients of the study group. The effects were judged by the results of cycle exercise tests and echo-CG including the loading one. RESULTS: Adjuvant use of trimetasidine improved exercise tolerance, mean threshold capacity, LVDF. When added to BB treatment, trimetasidine reduced damage to LVDF under dipiridamol test. CONCLUSION: Trimetasidine addition to combined treatment of CHD raises exercise tolerance and improves LVDF.     

Left ventricular volumes during graded upright exercise in healthy untrained subjects

Summary. Left ventricular (LV) volume changes were studied by radionuclide cardiography at rest and during graded upright bicycle exercise in seven healthy untrained men aged 21–30 years. The exercise-induced changes in LV volumes were most pronounced during mild exercise: from rest to 25% submaximal exercise stroke volume increased by 26% and LV ejection fraction from 0·60 to 0·69 (both P<0·01), whereas further increments of the work load resulted in only small changes of these variables. LV end-diastolic volume increased initially by 10% (P<0·05) but returned to baseline values at higher work loads, whilst a rather constant decrease was recorded in LV end-systolic volume during increasing exercise loads. Changes in plasma catecholamine levels were most pronounced at the high work loads, indicating that these hormones are not directly contributing to the LV volume changes.     

个体化有氧运动对冠心病患者心率恢复及运动能力的影响

目的:探讨个体化有氧运动对心率恢复异常冠心病患者心率恢复情况及运动能力的影响,并分析两者间的相关性。方法:招募经冠状动脉造影确诊的冠心病患者行心肺运动试验(CPET),将75例心率恢复异常(试验终止1min时的心率恢复值(HRR1)≤12次/min)的患者纳入研究,并随机分为康复组(38例)和对照组(37例)。对照组进行常规药物治疗;康复组在对照组基础上加以强度为60%—85%目标心率的个体化有氧运动训练,每次40min,每周3次,共12周。所有患者研究结束后再次进行CPET评估心率恢复及运动能力情况。结果:训练前,两组患者HRR1、峰值功率(PP)、峰值摄氧量(VO2peak)、无氧阈(AT)均无显著差异(P>0.05);训练后,康复组的PP、VO2peak、AT与训练前相比,差异具有显著性(P<0.01,P<0.01,P<0.05),且优于对照组(P<0.05);在HRR1方面,康复组与训练前比较,差异具有显著性(P<0.05);但与对照组相比,差异并不显著(P>0.05),训练后,康复组有16例患者HRR1>12次/min,且PP、VO2peak与HRR1≤12次/min的患者相比,差异具有显著性(P<0.05);康复组HRR1的提高值(△HRR1)与运动能力提高水平(△VO2peak、△PP)呈显著相关性(r=0.347,P<0.05;r=0.419,P<0.01)。结论:虽然有氧运动在改善心率恢复方面并不像提高运动能力那样显著,但是有氧运动可以改善心率恢复并与运动能力的提高密切相关。     

Hemodynamic control of graded isometric exercise in patients with acute myocardial infarction with hypokinetic type of circulation and stage I heart failure

A hypokinetic pattern of circulation (HKC) was revealed in 53 (63.1%) out of 84 patients with acute myocardial infarction (AMI) free of congestive cardiac insufficiency at rest examined upon discharge from hospital. Resting ++rheography evidence for pumping and constrictive cardiac functions fails to recognize CCI in stage I. A hemodynamic criterion of CCI was inadequate loading which implies no increment or reduction in the level reached at graded foot isometric exercise, in a number of indices such as cardiac index, hemodynamic performance of the heart, stroke and integral indices. The incidence of CCI stage I demonstrated by AMI patients with HKC was 64.2% (30.2% in period A and 34.0% in period B). HKC incidence in AMI patients without CCI outnumbered that in normal subjects by 30.6%.     

ST changes in relation to heart rate during bicycle exercise in patients with coronary artery disease

Summary. Exercise test on cycle ergometer and coronary angiography were performed on 190 patients with chest pain. Volunteers with a normal thallium scintigraphy (n= 47) served as controls. The load started at 20 W and increased at a rate of 10 W min^-1until exhaustion or symptoms. Conventional 12-lead ECGs were recorded by means of computer before, during and after exercise. Minimum ST amplitude 60 ms after the STJ point (ST60) at end of work with a cut-off level of -1·10 mm had a sensitivity of 69% (52/75) and a specificity of 89% (37/42) when individuals with a normal resting ECG were considered. ST80 and sum of ST60 in left ventricular leads had slightly lower values of sensitivity and specificity. Changes in ST60 during exercise discriminated less well between the groups. Final heart rate during exercise (>148 min^-1) had a sensitivity of 88% (53/60) and a specificity of 89% (42/47). The change in heart rate during exercise (>66min^-1) had a sensitivity of 50/60 (only patients without (β-blockers were considered). The best discrimination was obtained by defining a test score (TS) according to the linear equation TS = 2·95-0·023 × HRE-0·301 × ST60 where a positive value indicates a positive test and a negative value a negative test. Sensitivity and specificity were 21/23 (91%) and 40/42 (95%), respectively. The test score was also calculated in those patients having significant coronary disease and an abnormal resting ECG (no bundle branch block, no β-blockers) and this yielded a sensitivity of 30/34.     

血浆内源性阿片肽对冠心病患者等长收缩运动心血管反应的调控

目的：探讨血浆内源性阿片肽（ＥＯＰｓ）对等长收缩运动（ＩＥ）心血管反应的调控机制及其与心肌缺血的关系。方法：冠心病人运动试验阴性组（ＥＳＮ组,１０名）和运动试验阳性组（ＥＳＰ组,１０名）,以及正常人（ＮＯＲ组,１０名）进行最大短暂等长收缩运动（ＢＩＥ）、最大持续等长收缩运动（ＳＩＥ）及分级卧位踏车运动（ＤＥ）,观察ＥＯＰｓ变化及心血管反应。结果：从总体上ＥＯＰｓ运动反应表现为ＳＩＥ＞ＢＩＥ＞ＤＥ;各阶段各组间ＥＯＰｓ反应的趋势相似。正常人心率、血压、两项乘积、射血分数（ＥＦ）、短轴缩短率（ＳＦ）和Ｅ／Ａ表现为ＤＥ＞ＳＩＥ＞ＢＩＥ。结论：冠心病人ＩＥ的血浆ＥＯＰｓ反应与正常人类似;ＩＥ的血浆ＥＯＰｓ释放与心肌缺血无直接关联;ＩＥ,尤其是ＳＩＥ时中枢命令较强,血浆ＥＯＰｓ释放较多,可能有助于降低交感神经兴奋性,减少冠心病人的运动风险。     

个体化运动康复治疗对未行血运重建的冠心病患者的影响

目的:观察6min步行试验指导的个体化运动康复治疗对未行血运重建的冠心病患者心功能、生活质量及近期预后的影响。方法:选择在我院心内科住院治疗,且经冠脉造影证实至少一支或多支冠状动脉血管狭窄≥75%,但未接受血运重建的冠心病患者200例为研究对象。分为常规药物治疗(A组)和常规药物治疗+运动康复治疗(B组)各100例。2组患者均给予常规冠心病药物治疗,且在出院后每周来医院接受健康教育,B组患者在此基础上加用个性化运动康复治疗方案。结果:治疗8周后,B组患者心力衰竭、再发心肌梗死率及死亡发生率均明显低于A组(P0.05)。治疗后,2组静息室壁运动积分及生活质量评分均较出院时明显下降(P0.05),且B组较A组下降更明显(P0.05);2组左室射血分数及6min步行距离均较出院时明显提高(均P0.05),且B组较A组提高更明显(P0.05)。结论:6min步行试验指导的个体化运动康复治疗可明显改善未行血运重建的冠心病患者心功能、生活质量及近期预后。     

等长运动对原发性高血压患者左室功能的影响

目的:探讨等长运动负荷对原发性高血压患者左心功能的影响,寻找可靠的早期检出和评估手段。 方法:45例原发性高血压患者(按高血压危险分层条件为A组和B组患者)(高血压组)按相同年龄、性别、身高和体质量与正常人(对照组)进行1:1配对。治疗前1周高血压组进行等长运动负荷试验,对照组测试在体检期间进行。 结果:左室舒张功能指标比较中,运动前高血压组的左室舒张晚期峰值(A波)(55.85±16.31)mm/s和E/A(0.91±0.04)明显高于对照组[(49.33±14.72)mm/s和0.83±0.07],左室舒张早期峰值(E波)(68.27±10.73)mm/s明显低于对照组(70.29±18.63)mm/s(t=2.047～2.131,P均<0.05)。等长运动后两组对象的全部左室舒张功能指标均较运动前有显著改善(t=1.939～2.531,P均<0.05),同时高血压组的E波、左房射血前期均明显低于对照组,而A,E/A、左房射血时间和左室等容舒张时间均明显高于对照组(t=2.084～2.283,P均<0.05)。左室收缩功能指标比较中,运动后两组对象的全部收缩功能指标均较运动前有显著变化,高血压组的左室舒张末内径明显高于对照组,而左室短轴缩短率、周径纤维缩短速度和左室射血分数明显低于对照组(t=2.027～2.379,P均<0.05)。 结论:等长运动负荷实验是早期检出原发性高血压患者心功能异常的可靠方法。     

植物神经功能与冠心病患者室性心律失常的相关性研究

目的：探讨植物神经功能与冠状动脉粥样硬化性心脏病（简称冠心病）患者室性心律失常的关系。方法：对我院126例进行了动态心电图检查及心率变异性（heartrate variability,HRV）分析的冠心病患者的室性心律失常和HRV指标进行回顾性分析。并应用Logistic回归筛选冠心病患者室性心律失常的HRV预测指标。结果：HRV各项时域指标和频域指标中的LF、VLF、HF均有随着室性心律失常程度的加重而降低的趋势．时域指标中的SDNN、SDANN、ASDNN、PNN50b与室性心律失常程度呈弱负相关（P〈0．01或P〈0．05）。Logistic回归结果表明SDANN为冠心病患者室性心律失常的保护因素。结论：HRV与冠心病患者室性心律失常程度呈弱负相关。SDANN为冠心病患者室性心律失常的保护因素。早期对植物神经功能紊乱进行干预治疗,可能有利于减少冠心病患者室性心律失常的发生