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 O2 pulse%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.
目的: 评估心肺运动试验（CPET）相关指标对于冠心病的诊断价值。方法: 选择156例疑诊为冠心病的患者（病情相对稳定,年龄在18~80岁）行CPET、运动负荷心电图及冠状动脉造影,以冠状动脉造影结果为标准,分析CPET相关指标（峰值摄氧量％预计值Peak VO2%pred、峰值氧脉搏％预计值Peak O2 pulse%pred、摄氧量对应功率的做功效率（ΔVO2/ΔWR）诊断冠心病的敏感度、特异度及其诊断价值。结果: Peak VO2%pred的最佳截断点是≤69%pred,其诊断冠心病的敏感度为55.1%,特异度为77.0%,AUC为0.698。Peak O2 pulse%pred最佳截断点诊断冠心病的敏感度为50.7%,特异度为72.4%,AUC为 0.58。ΔVO2/ΔWR最佳截断点处其诊断冠心病的敏感度为44.9%,特异度为87.4%,AUC为0.647。Peak VO2%pred及ΔVO2/ΔWR敏感度远高于负荷心电图,差异有统计学意义（P<0.01）。结论: CPET部分指标诊断冠心病的敏感度优于运动负荷心电图,最佳截断点处特异度及诊断价值均较高,而且CPET本身也包括连续动态全程心电图分析,不建议各自分割使用,主张所有指标整体整合分析使用。CPET相关指标对冠心病诊断有预测价值,可以早期、较准确的诊断冠心病。.
Keywords: cardiopulmonary exercise testing; coronary atherosclerotic heart disease; exercise ECG; oxygen uptake work efficiency; peak oxygen pulse; peak oxygen uptake.