Clinical study on the diagnostic value of cardiopulmonary exercise test for coronary atherosclerotic heart disease

doi:10.12047/j.cjap.0090.2021.108

Abstract

Abstract: Objective: To evaluate the value of cardiopulmonary exercise testing in diagnosing coronary atherosclerotic heart disease（CHD). Methods: A total of 156 patients with suspected CHD（The patient's condition is relatively stable, aged 18 to 80 years）were performed for cardiopulmonary exercise testing, ECG exercise test and coronary angiography. Based on the results of coronary angiography, the sensitivity, specificity and diagnostic value of relevant indicators of cardiopulmonary exercise testing (CPET) parameters (Peak VO₂%pred、Peak O₂ pulse%pred、ΔVO₂/ΔWR) in diagnosing CHD were analyzed by statistical methods based on the results of coronary angiography. Results: Useing the best cut-off point of Peak VO₂ ≤69%pred for detecting CHD, the sensitivity was 55.1%, the specificity was 77.0%, and the AUC was 0.698. The sensitivity, specificity and AUC of peak O₂pulse%pred were 50.7%, 72.4% and 0.58 respectively. ΔVO₂/ΔWR sensitivity in diagnosing CHD was 44.9%, specificity was 87.4%, AUC was 0.647. The sensitivity of peak O₂ pulse%pred and ΔVO₂/ΔWR were much higher than the ECG exercise test, the difference was statistically significant (P<0.01). Conclusion: The sensitivity of some indexes of CPET in diagnosing CHD was better than ECG exercise test, the specificity and diagnostic value of the optimal cut-off point are high. CPET has predictive value for the diagnosis of CHD, it can diagnose CHD early and accurately.

Key words: cardiopulmonary exercise testing, coronary atherosclerotic heart disease, peak oxygen uptake, peak oxygen pulse, oxygen uptake work efficiency, exercise ECG

CLC Number:

R541

ZHU Shan-yu, WANG Xi, SUN Xing-guo. Clinical study on the diagnostic value of cardiopulmonary exercise test for coronary atherosclerotic heart disease[J]. CJAP, 2021, 37(1): 72-78.

References

[1] 胡盛寿,高润霖,刘力生,等. 《中国心血管病报告2018》概要[J]. 中国循环杂志, 2019, 34(3): 209-220.
[2] 孙兴国. 生命整体调控新理论体系与心肺运动试验[J].医学与哲学(人文社会医学版), 2013, 34(3): 22-27.
[3] Guazzi M, Arena R, Halle M, et al. 2016 focused update: Clinical recommendations for cardiopulmonary exercise testing data assessment in specific patient populations[J]. Circulation, 2012, 33(23): 2261-2274.
[4] Belardinelli R, Lacalaprice F, Tiano L, et al. Cardiopulmonary exercise testing is more accurate than ECG-stress testing in diagnosing myocardial ischemia in subjects with chest pain[J]. Int J Cardiol, 2014, 174(2): 337-342.
[5] Sun XG, Hansen JE, Beshai JF, et al. Oscillatory breathing and exercise gas exchange abnormalities prognosticate early mortality and morbidity in heart failure[J]. J Am Coll Cardiol, 2010, 55: 1814-1823.
[6] Chaudhry S, Arena R, Wasserman K, et al. Exercise-induced myocardial ischemia detected by cardiopulmonary exercise testing[J]. Am J Cardiol, 2009, 103(5): 615-619.
[7] 李四维, 徐浩, 陈可冀.心肺运动试验在心脏康复评估中的应用[J]. 中国循环杂志, 2017, 32(4): 331-333.
[8] 孙兴国. 为强化心肺代谢等整体功能的心肺运动试验新9图图解[J]. 中国应用生理学杂志, 2015, 31(4): 369-373.
[9] 郑宏超,丁跃有,孙兴国,等.经皮冠状动脉腔内血管成形术改变稳定性冠心病患者整体功能的临床研究[J].中国应用生理学杂志, 2015, 31(4): 378-381.
[10] 孙兴国. 心肺运动试验的规范化操作要求和难点-数据分析图示与判读原则[J]. 中国应用生理学杂志, 2015, 31(4): 361-365.
[11] Society TAT.ATS/ACCP statement on cardio-pulmonary exercise testing[J]. Am J Respir Crit Care Med, 2003, 167(2): 211-277.
[12] Wasserman K, Hansen JE, Sue DY, et al. Principles of exercise testing and interpretation-Including pathophysiology and clinical applications[M]. 5th ed, Philadelphia: LIPPINCOTT WILLIAMS & WILKINS, 2012.
[13] 费家玥. 心肺运动试验在冠心病诊断中的价值分析[D]. 郑州大学, 2018.
[14] 王岚, 郭丹杰, 牛亚芊芊, 等. CPET评价冠状动脉粥样硬化性心脏病患者的临床意义[J]. 中国现代医学杂志, 2018, 26: 88-91.
[15] 孙兴国, 谭晓越, 唐熠达, 等. 冠心病患者心肺运动功能检查特征性改变及其临床意义初步分析[J]. 中国实用内科杂志, 2013, S1: 31-32.
[16] Aklncl ozyürek B, Savas Bozbas S, Aydlnalp A, et al. Value of cardiopulmonary exercise testing in the diagnosis of coronary artery disease.[J]. Tuberkuloz ve toraks, 2019, 67(2): 102-107.
[17] 中国康复医学会心血管病专业委员会, 中国老年学学会心脑血管病专业委员会. 慢性稳定性心力衰竭运动康复中国专家共识[J]. 中华心血管病杂志, 2014, 42(9): 714-720.
[18] Kaminsky LA, Imboden MT, Arena R, et al. Reference standards for cardiorespiratory fitness measured with cardiopulmonary exercise testing using cycle ergometry: Data from the fitness registry and the importance of exercise national database (FRIEND) registry[J]. Mayo Clin Proc, 2017, 92(2): 228-233.
[19] 宁亮, 孙兴国. 心肺运动试验在医学领域的临床应用[J]. 中国全科医学, 2013, 16(39): 3898-3902.
[20] Mazaheri R, Shakerian F, Vasheghani-Farahani A, et al. The usefulness of cardiopulmonary exercise testing in assessment of patients with suspected coronary artery disease[J]. Postgrad Med J, 2016, 92(1088): 328-332.
[21] Chaudhry S, Arena R, Bhatt DL, et al. A practical clinical approach to utilize cardiopulmonary exercise testing in the evaluation and management of coronary artery disease: a primer for cardiologists[J]. Curr Opin Cardiol, 2018, 33(2): 168-177.
[22] Guazzi M.Clinician's guide to cardiopulmonary exercise testing in adults: a scientific statement from the American Heart Association[J]. Circulation, 2010, 122(2): 191-225.
[23] 郭志勇, 滕志涛, 蔡爱宁, 等. 心肺运动功能检查在冠心病诊断中的临床价值[J]. 中国医学工程, 2013, 21(4): 21-22.
[24] Beaver WL, Wasserman K, Whipp BJ.A new method for detecting the anaerobic threshold by gas exchange[J]. J Appl Physiol, 1986, 60(6): 2020-2027.
[25] Sun XG, Hansen JE, Stringer WW.Oxygen uptake efficiency plateau: physiology and reference values[J]. Eur J Appl Physiol, 2012, 112(3): 919-928.
[26] Sun Y, Li W, Yin L, et al. Diagnostic accuracy of treadmill exercise tests among Chinese women with coronary artery diseases: A systematic review and meta-analysis[J]. Int J Cardiol, 2016: S0167527316335896.
[27] Knol RJJ, Kan H, Wondergem M, et al. Exercise electrocardiogram neither predicts nor excludes coronary artery disease in women with low to intermediate risk[J]. J Womens Health (Larchmt), 2018, 27(4): 476-484.