非診断的な運動誘発性STセグメント異常が,無症状のボランティアにおける将来の冠動脈イベントの予測における役割
Tomasz M Rywik1, Frances C O'Connor, Neil S Gittings
1Gerontology Research Center, National Institute on Aging, National Institutes of Health, Baltimore, Md, USA.
Circulation
|November 27, 2002
まとめ
軽度のうつ病の悪化を含む1mm以上の運動誘発性STセグメント低下は,無症状の個体における将来の冠動脈イベントを独立して予測します. 1mm未満のマイナーなSTうつ病は予知指標ではありません.
科学分野:
- 心臓病学 心臓病学
- 運動生理学 運動生理学
- 予防医学は,予防的な医療です.
背景:
- 将来の冠動脈イベント (CE) に対する無症状の個体における軽度の運動誘発性STセグメントうつ病 (<1mm) の予後値は不明である.
- 運動テスト中に特定のSTセグメントのうつ病パターンの予測的意義を評価することは,リスクの階層化にとって極めて重要です.
研究 の 目的:
- 運動誘発性STセグメントうつ病<1mmが,無症状の被験者における将来の冠動脈イベントを独立して予測するかどうかを調査する.
- 最大トレッドミルの運動テスト中に異なる程度とタイプのSTセグメントうつ病の予後値を決定する.
主な方法:
- マキシマム・トレッドミルのエクササイズテストは,ボルチモア・ロングティチューディナル・スタディ・オブ・エイジング (Baltimore Longitudinal Study of Aging) の1083人の無症状のボランティアに実施されました.
- 運動STセグメントの変化は,ミネソタ州のコード基準を用いて分類され,通常の運動ECGを受けた被験者と比較してCEのリスクが比較されました.
- コックス比例危険性分析は,平均7.9年の追跡期間におけるCEの独立した予測要因を特定するために使用されました.
主要な成果:
- 年齢,男性性別,血コレステロール,運動の持続時間は,CESのリスクの増加と関連していました.
- 11:1 (≥1ミリメートル平らまたは下り坂のうつ状態) と 11:5 (運動前の軽微なうつ状態が≥1ミリメートルまで悪化) とコードされたSTセグメントの変化は,CEの独立した予測因子でした.
- ゆっくり上昇するST抑うつ (11:4) も,1mm未満の水平ST抑うつ (11:2) も独立してCEsを予測しませんでした.
結論:
- 典型的な不血性STセグメント運動反応 (≥1mm低圧) は,無症状の個体における将来の冠動脈イベントを独立して予測します.
- 運動前の軽度のSTうつ病の悪化が運動中にまたは運動後に≥1mmに達すると,将来の冠動脈事件も独立して予測されます.
- 軽度のSTうつ病 (<1mm) または運動中にゆっくりと上昇するSTセグメントは,この集団における将来の冠動脈イベントの有意な予測要因ではありません.
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