心电图平板运动试验阳性患者运动后收缩压恢复延迟与冠状动脉病变程度相关性研究

目的:探讨心电图平板运动试验阳性的患者,运动后收缩压恢复延迟与冠状动脉病变程度的相关性研究。方法:经症状限制性运动试验检查,并于30d内行冠状动脉造影患者。运动后收缩压恢复延迟定义为:运动后3min收缩压与运动后1min收缩压比值≥1.0,(即:收缩压恢复比值rSBPR3min/1min≥1.0)。冠状动脉病变程度的量化指标:应用杜克预后评分方法(分值范围0~100),将积分≥42确定为重度冠状动脉病变。入选164例年龄36~78岁,平均(57±8)岁,男性82%,重度冠状动脉病变患者73例(44%)。结果:收缩压恢复比值与冠状动脉病变严重程度杜克预后评分呈明显正相关(r=0.84,P<0.001)。二分类变量Logisitic回归分析,在调节运动SBP变化和临床情况等因素,收缩压恢复比值(rSBPR)仍能反映冠状动脉疾病严重程度OR=2.43(95%CI1.31~4.50)P=0.005。冠状动脉造影阳性组rSBPR较冠状动脉造影阴性组明显增高(P<0.05),但与是否合并高血压病无关(P>0.05)。结论:运动后收缩压恢复延迟与冠状动脉病变严重程度明显相关。

Delayed recovery of postexecise systolic blood pressure association with extent of coronary artery deseasa

Objective：To investigate the characteristics of delayed decline in systolic blood pressure （SBP） after positive electrocardiogram treadmill exercise test （ETT） in related to the extent of angiographic coronary artery disease（CAD）. Method： Among adults who underwent symptom-limited ETT positive andwho underwent coronary angiographic （CAG） within 30 days. A delayed decline in SBP during recovery was defined as a ratio of SBP at 3 min of recovery divided by that at 1 rain of recovery exceeded or equale 1.0 （i. e.,rSBPR 3 min/1 min≥1.0）. Angiographic severity of CAD was a assessed using the Duke CAD Prognostic Severity Index（ on a scale of 0-100）, with a score≥42 considered to be indicative of severe CAD. Result： There were 164 subjects eligible for analyses （age 57±8 years, 82% male）, Severe angiographic coronary disease was noted 73 （44%）. The increase value of rSBPR had a positive correlation with the extent of Duke CAD Prognostic Severity Index [ r = 0.84, P 〈 0.001]. In binary logistic regression analyses adjusting for SBP change during exercise and the potential confounders, a delayed decline in SBP during recovery remained predictive of severe angiographic coronary disease [ OR = 2.43, 95 % CI 1.31- 4.50, P=0.005 ]. The rSBPR in patients with group CAG positive exceeded that of the angiographic negative subjects （ P 〈 0.05）, and independently of the presence of hypertension （ P 〉 0.05 ）. Conclusion： A delayed decline in SBP during recovery is associated with a greater likelihood of severe angiographic coronary disease.