Features and clinical significance of cardiopulmonary exercise testing in elderly patients with coronary heart disease / 中华老年医学杂志

ABSTRACT

Objective To examine the features and clinical significance of cardiopulmonary exercise testing(CPET)in elderly patients with coronary heart disease.Methods A retrospective study was conducted at the Fifth Affiliated Hospital of Zhengzhou University from September 2015 to August 2017.Fifty-nine elderly inpatients who had undergone coronary angiography and CPET were enrolled.The mean age was 61.5 years,and there were 48 males and 11 females.Based on the results of coronary angiography,patients were divided into a coronary heart disease(CAD)group(n =40)and a non-CAD group (n =19).Meanwhile,according to the degree of coronary stenosis assessed by angiography,the CAD group was further divided into two subgroups (Group Acoronary stenosis,50 ％ -70％,n =25;Group Bcoronary stenosis,＞ 70％,n =15).All results of CPET were compared between the groups.Results Patients in the CAD group were significantly associated with a lower anaerobic threshold(855.8±207.0)ml/min vs.(976.5±231.8)ml/min,a lower peak VO2 (1 371.5±388.8)ml/min vs.(1652.8±435.5)ml/min,a lower percentage of peak VO2 (18.3±4.7)ml · min-1 ·kg-1 vs.(22.0±4.4)ml · min 1 · kg-1,a lower peak O2-pulse(65.6±14.8)％ vs.(85.5±14.9)％ and a lower △VO2/△WR slope to expected value(8.0 ± 1.1)ml · min-1 · W-1 vs.(9.1 ± 1.5)ml ·min-1 · W 1,compared with those in the non-CAD group(all P＜0.05).However,there was no significant difference in other indexes between the groups.Furthermore,in the CAD group,△VO2/△WRall-Ex,△VO2/△WR＞AT and △VO2/△WRRatio to expected value were lower in Group B(7.5 ± 1.3vs.8.3±1.0,t=2.317,P=0.026),(6.2±1.9 vs.7.6±1.2,t=2.815,P=0.008)and(0.7±0.2vs.0.9±0.1,t=2.957,P =0.005).There was no difference in △VO2/△WR＜AT (P＞0.05).Conclusions Exercise tolerance is lower in elderly CAD patients than those without CAD,and △VO2/△WR is decreased during the process of exercise,especially after the AT,which may be associated with low cardiac output due to left ventricular myocardial isehemia.This finding suggests that CPET can provide evidence of ischemia in patients with coronary heart disease and is valuable for the development of diagnostic and therapeutic strategies.