摘要
Objectives To investigate the relationship between the chronotropic incompetence and angiographic severity of coronary artery disease, and the clinical value of inappropriate chronotropic responses in exercise. Methods Coronary angiography was performed in 130 patients suspected or diagnosed as coronary heart disease （ CHD）, and angiographic severity of coronary artery disease was quantitated by Duke score and Gensini score. The patients were divided into 4 groups ： non-CHD group （39 cases）, CHD group with only one coronary artery involved （ CHD1, 30 cases）, CHD group with two coronary arteries involved （ CHD2, 31 cases） and CHD group with three coronary arteries involved （CHD3 group, 30 cases ）. A month before coronary angiography, symptom-limited bicycle ergometor exercise had been accomplished, the chronotropic response had been measured and expressed as ratio of heart rate reserve （HRR） and the maximal age-predicted heart rate achieved （rHR）. Results Analysis of variance showed that rHR and HRR were much significantly lower （all P 〈0. 01 ） in CHD2 group （rHR 0. 793 ±0. 078, HRR 0. 626±0. 110） and CHD3 group （ rHR 0. 775 ± 0. 065, HRR 0. 586 ± 0. 125 ） than that in non-CHD group （ rHR 0. 888 ± 0. 062, HRR 0. 798 ±0. 105）and CHD1 group（rHR 0. 857 ±0. 084, HRR 0. 735 ±0. 146）. rHR was similar both between non-CHD group and CHD1 group（ P 〉 0. 05 ） and between CHD2 group and CHD3 group （ P 〉 0. 05 ）. HRR has no difference between CHD2 group and CHD3 group （ P 〉 0. 05 ）, but was significantly different between non-CHD group and CHD1 group （P 〈0. 05 ）. There was a significantly negative correlation between rHR, HRR and Duke score （r = -0. 554, - 0. 578, respectively, all P 〈0. 01 ）, Gensini score （ r = -0. 453, -0. 467 ,respectively, all P 〈0. 01 ）. CHD proportion reached 75% in patients who had positive rHR （ or HRR） and non-ST depression. Diagnostic value [ sensitivity 0. 868 （P 〈0. 01 ）, 0. 846（P 〈0. 01 ）, specificity 0. 462, 0. 462, accuracy 0. 746（P 〈0. 05）, 0. 731, positive predictive value 0. 790, 0. 786, negative predictive value 0. 600, 0. 563, respectively ~ of rHR 〈 85 % or HRR 〈 72% which were used as annexed positive. Standard in the patients without ST depression in symptom-limited exercise treadmill tests was a little higher than that of traditional ST standard （ sensitivity 0. 637, specificity 0. 641, accuracy 0. 638, positive predictive value 0. 806, negative predictive value 0. 431 ）. Conclusions There is negative correlation between cardiac chronotropic and angiographic severity of coronary artery disease and the chronotropic incompetence may predict angiographic severity of coronary disease. In patients with positive rHR （or HRR） and non-ST depression, CHD proportion is very high. rHR 〈 85% or HRR 〈72% may be used as annexed positive standard in symptom-limited exercise treadmill tests.
Objectives To investigate the relationship between the chronotropic incompetence and angiographic severity of coronary artery disease, and the clinical value of inappropriate chronotropic responses in exercise. Methods Coronary angiography was performed in 130 patients suspected or diagnosed as coronary heart disease （ CHD）, and angiographic severity of coronary artery disease was quantitated by Duke score and Gensini score. The patients were divided into 4 groups ： non-CHD group （39 cases）, CHD group with only one coronary artery involved （ CHD1, 30 cases）, CHD group with two coronary arteries involved （ CHD2, 31 cases） and CHD group with three coronary arteries involved （CHD3 group, 30 cases ）. A month before coronary angiography, symptom-limited bicycle ergometor exercise had been accomplished, the chronotropic response had been measured and expressed as ratio of heart rate reserve （HRR） and the maximal age-predicted heart rate achieved （rHR）. Results Analysis of variance showed that rHR and HRR were much significantly lower （all P 〈0. 01 ） in CHD2 group （rHR 0. 793 ±0. 078, HRR 0. 626±0. 110） and CHD3 group （ rHR 0. 775 ± 0. 065, HRR 0. 586 ± 0. 125 ） than that in non-CHD group （ rHR 0. 888 ± 0. 062, HRR 0. 798 ±0. 105）and CHD1 group（rHR 0. 857 ±0. 084, HRR 0. 735 ±0. 146）. rHR was similar both between non-CHD group and CHD1 group（ P 〉 0. 05 ） and between CHD2 group and CHD3 group （ P 〉 0. 05 ）. HRR has no difference between CHD2 group and CHD3 group （ P 〉 0. 05 ）, but was significantly different between non-CHD group and CHD1 group （P 〈0. 05 ）. There was a significantly negative correlation between rHR, HRR and Duke score （r = -0. 554, - 0. 578, respectively, all P 〈0. 01 ）, Gensini score （ r = -0. 453, -0. 467 ,respectively, all P 〈0. 01 ）. CHD proportion reached 75% in patients who had positive rHR （ or HRR） and non-ST depression. Diagnostic value [ sensitivity 0. 868 （P 〈0. 01 ）, 0. 846（P 〈0. 01 ）, specificity 0. 462, 0. 462, accuracy 0. 746（P 〈0. 05）, 0. 731, positive predictive value 0. 790, 0. 786, negative predictive value 0. 600, 0. 563, respectively ~ of rHR 〈 85 % or HRR 〈 72% which were used as annexed positive. Standard in the patients without ST depression in symptom-limited exercise treadmill tests was a little higher than that of traditional ST standard （ sensitivity 0. 637, specificity 0. 641, accuracy 0. 638, positive predictive value 0. 806, negative predictive value 0. 431 ）. Conclusions There is negative correlation between cardiac chronotropic and angiographic severity of coronary artery disease and the chronotropic incompetence may predict angiographic severity of coronary disease. In patients with positive rHR （or HRR） and non-ST depression, CHD proportion is very high. rHR 〈 85% or HRR 〈72% may be used as annexed positive standard in symptom-limited exercise treadmill tests.
