| Promoting the value of cardiopulmonary exercise test(CPET)clinically when evaluating and making prognoses has attracted much interest within the field of medicine,especially in the diagnosis of cardiovascular diseases.Treatment of coronary heart disease(CHD)including percutaneous coronary intervention(PCI)and cardiac rehabilitation(CR)are proposed by guidelines and recommended as la level.The recovery of cardiorespiratory function(CRF)in patients with CHD after PCI is inseparable from CR with exercise prescription as the fundament.Previous studies have confirmed that exercise prescriptions tailored to patients based on CPET results can improve CRF and reduce the recurrence and mortality of cardiovascular diseases.In the early stage,we found that drugs for promoting blood circulation and removing blood stasis can protect myocardial vessels and prevent coronary arterial plaques from rupturing again.However,few reports have discussed the influence of CR based on evaluations made by CPET indicators post-intervention,which include the use of medications for promoting blood circulation and removing stasis,in conjunction with exercise therapy in patients with CHD.On the basis of this,it can be hypothesized that the CRF in patients with CHD after intervention can be improved through the evaluation of CPET peak oxygen uptake(peak V02kg)and exercise metabolic equivalent(METs),along with the injection of Salvia miltiorrhiza polyphenolates.To investigate the mechanism of CRF on various parameters,the traditional Chinese medicine(TCM)belief that hearts are responsible for circulation and lungs responsible for respiration,and whether there is a certain correlation between CPET parameters and different syndrome factors of cardiovascular disease patients,the significant factors related to CPET parameters and TCM syndrome factors were determined by the Logistic multi-factor regression analysis,and then the diagnostic model of Different TCM syndromes diagnosis models of CHD was established.This study will start from the novel viewpoint of clinical evaluation and functions of CPET in making diagnoses.lay a foundation for revealing the mechanism of Salvia miltiorrhiza polyphenolates in promoting CRF,and provide objective data to support TCM syndrome differentiation,as well as diagnosing and evaluating the prognosis of CHD.Study 2:The study on the relationship between CPET parameters and TCM syndrome factors in patients with coronary heart diseaseObjective:To explore the correlation between TCM syndrome factors,CPET parameters,and CHD.Research methods:All patients who underwent CPET examination due to physical discomfort were included,diagnostic information was collected,the distribution of TCM syndrome elements was summarized,and the CPET examination results and other general clinical conditions were recorded.According to the diagnostic criteria of coronary heart disease,patients were divided into coronary heart disease group and non-coronary heart disease group.The distribution of various observation indices and TCM syndrome elements of the two groups were compared.The Logistic regression was used to analyze the relevant factors that may affect CHD.The results of the study are as follows:1 A total of 1128 adult CPET subjects were included in this study,in which 35.2%belonged to the CHD group and 64.8%to the non-coronary heart disease group:1.1 In the CHD group,there were 332 patients(34.87%)having Qi-deficiency syndrome factors,266 cases(27.94%)had blood stasis syndrome factors,and 240 cases(25.21%)had turbid-phlegm syndrome factors.1.2 In the non-coronary heart disease group,there were 495 patients(36.32%)who had Qi-deficiency syndrome factors,394 patients(28.91%)had turbid-phlegm syndrome factors,and 211 cases(15.48%)had blood stasis syndrome factors.2 Among the parameters of CPET,VTVO2,ATVO2kg,METs,ATO2Plus,O2Plus,and respiratory quotient(ATRER)(P<0.05)were significantly correlated with CHD.The predictive regression model of CHD was established.The area of ROC curve was 0.767(95%CI:0.738,-0.795).According to its sensitivity and specificity,the highest Youden index was calculated to be 0.401,and the best cut-off point was 0.610.3 correlation analysis of CHD and CPET indices of different TCM syndromes:3.1 VTVO2,ATVO2kg,peakVO2%pred,METs,ATO2Plus,and O2Plus were significantly correlated with the factors of CHD Qi-deficiency syndrome factors(P<0.05),the area of ROC curve was 0.795 on the predictive regression model(95%CI:0.763,-0.828).According to its sensitivity and specificity,the highest Youden index was 0.456,and the best cut-off point was 0.643.3.2 Among the CPET parameters,VTVO2 and ATO2Plus were significantly correlated with the factors of CHD Qi-stagnation syndrome(P<0.05).The pretest regression model of the CHD Qi-stagnation syndrome factors was established,and the area under the ROC was 0.820(95%CI:0.697,-0.943).According to its sensitivity and specificity,the highest Youden index was 0.61,and the best cut-off point was 0.602.3.3 The significant correlations between CPET parameters and CHD phlegm-turbid syndrome factors were VTVO2,METs,ATRER and ATO2PIus(P<0.05).The predictive regression model of CHD phlegm-turbid syndrome factors was established,and the ROC curve area was 0.756(95%CI:0.718,-0.793).According to its sensitivity and specificity,the highest Youden index was 0.393,and the best cut-off point was 0.589.3.4 CPET parameters and CHD blood stasis syndrome factors were significantly correlated with VTVO2,METs,ATO2Plus,and O2Plus(P<0.05).The predictive regression model of CHD blood stasis syndrome factors was established,and the ROC curve area was 0.738(95%CI:0.696,-0.781).The highest Youden index was 0.364,and the best cut-off point was 0.389 based its sensitivity and specificity.3.5 Among the CPET parameters,VTVO2,ATVO2kg,peakVO2kg,peakVO2%pred,and O2Plus had a significant correlation with the factors of CHD Yang-deficiency syndrome factors(P<0.05).The predictive regression model of the syndrome factors was established and the ROC curve area was 0.758(95%CI:0.673,-0.844).According to its sensitivity and specificity,the highest Youden index was 0.513,and the best cut-off point was 0.693.3.6 Among the CPET parameters,METs and ATO2Plus were significantly correlated with the factors of CHD Yin-deficiency syndrome factors(P<0.05).The predictive regression model of the syndrome factors was constructed,and the curve area of ROC was 0.860(95%CI:0.775,-0.944).According to its sensitivity and specificity,the highest Youden index was 0.636,and the best cut-off point was 0.709.Conclusion:1 A total of 1128 patients with CPET were included in this study.In terms of TCM syndrome factors,the top three syndrome factors in CHD group and non-coronary heart disease group were Qi-deficiency,turbid-phlegm,and blood stasis syndromes.2 In the analysis of the correlation between CHD and CPET parameters,it was discovered that VT VO2,AT VO2kg,METs,ATO22Plus,O2Plus,AT RER(P<0.05)as six independent risk factors for CHD.3 The correlation analysis of CHD and CPET parameters in different TCM syndrome factors3.1 According to the regression model,CHD Qi-deficiency syndrome was predicted and diagnosed,and the independent risk factors were as follows:VTVO2,ATVO2kg,peakVO2kg%pred,METs,AT O2Plus,and O2Plus(P<0.05).3.2 According to the regression model,the CHD Qi-stagnation syndrome was predicted and diagnosed,and the independent risk factors:VTVO2,ATO2Plus(P<0.05).3.3 According to the regression model,the turbid-phlegm syndrome of CHD was predicted and diagnosed,and the independent risk factors:VTVO2,METs,ATRER,and ATO2Plus(P<0.05).3.4 The diagnosis of CHD blood stasis syndrome was predicted based on the regression model,and the independent risk factors:VTVO2,METs,ATO2Plus,O2Plus(P<0.05).3.5 CHD Yang-deficiency syndrome was predicted and diagnosed,and the independent risk factors were VTVO2,ATVO2kg,peakVO2kg,peak2kg%pred,and O2Plus(P<0.05).3.6 According to the regression model,CHD Yin-deficiency syndrome was predicted and diagnosed,and the independent risk factors were METs and ATO2Plus(P<0.05).Study 2:The clinical study on the effect of Salvia miltiorrhiza injection on the cardiopulmonary function in patients with CHD after interventional therapyObjective:To explore the mechanism of salvia miltiorrhiza injection on improving CRF in patients with CHD after interventional therapy by using CPET parameters and mechanism metabolism index.Methods:A randomized,double-blind,placebo trial involving 60 patients with stable CHD who received interventional therapy within 1 year was conducted.The patients were randomly divided into two groups:Salvia miltiorrhiza polyphenolates treatment group(n=30)and placebo control group(n=30).The patients were treated with the intervention for one week and followed up for one month.The main efficacy indicators were VO2kgpeak,the percentage of peak oxygen uptake to the predicted value(VO2kgpeak%pred),and METs;the secondary efficacy indicators include other parameters of CPET which contain blood stasis syndrome,TCM symptom scale,anxiety and depression scale,and so on.The metabolic indicators of the mechanism included adenosine triphosphate(ATP),adenosine diphosphate(ADP),adenosine monophosphate(AMP),Catalase(CAT),malondialdehyde(MDA)activity,superoxide dismutase(SOD)content,and reactive oxygen species(ROS)expression.Paired T-test was used for intra-group comparison before and after treatment,and an independent T-test was used for inter-group comparison.Results:In the end a total of 60 subjects were included,in which 30 cases were in the treatment group and 30 in the control group.There was no statistically significant difference in baseline information and data between the two groups(P>0.05).1 main efficacy indicators1.1 The peakV02kg results showed that after 4 weeks of treatment,the covariance analysis with the baseline as the covariable showed that the treatment group and the control group increased by 0.231 and 0.102,respectively;and the degree of improvement of the treatment group was 0.129 higher than that of the control group.1.2 The results of peakVO2kg%pred demonstrated that after 4 weeks of treatment,the analysis of covariance with the baseline as the covariable showed that the two groups increased by 0.826 and 0.840,respectively,and the corrected mean difference and 95%CI of the two groups were-0.014(95%CI:-5.118,5.091,P>0.014).1.3 The results of 1.3METs value showed that after 4 weeks of treatment,the METS values of the two groups increased by 0.068 and 0.042,respectively,and that of the treatment group increased by 0.026 compared with that of the control group(95%CI:0.384,0.435,P>0.05).To sum up,there was no statistically significant difference in the main curative effect indices between the two groups(P>0.05).2.1CPET other parameters2.1.1 In terms of the anaerobic threshold kilogram oxygen uptake(ATVO2kg),the covariance analysis was carried out with the baseline covariate.After 4 weeks of treatment,the ATVO2kg decreased by 1.422 compared with the baseline,while the control group increased by 1.159.The corrected mean difference between the two groups was-2.581(95%CI:5.966,0.805,P>0.05).2.1.2 With regards to oxygen uptake(O2Plus)and anaerobic threshold oxygen pulse(ATO2Plus),the covariance analysis revealed that these indicators increased by 0.296 and 0.154,and 2.742 and 0.498,respectively,within the two groups,compared with the baseline;and compared with the control,the treatment group increased 0.142 more(95%CI:-0.687,0.972)and 2.244 more(95%CI:-2.780,7.267,P>0.05).2.1.3 As of end-expiratory CO2 partial pressure(PETCO2),the covariance analysis showed that after 4 weeks of treatment,the PETCO2 of the treatment group decreased by 0.341 compared with the baseline,while the control group increased by 2.493.The corrected mean difference between the two groups was-2.835(95%CI:-5.536,-0.133).The difference between the two groups was statistically significant.In terms of anaerobic threshold end-expiratory CO2 partial pressure(AT PETCO2),after 4 weeks of treatment,the AT PET CO2 of the treatment group decreased by 0.552 compared with the baseline;on the other hand,that of the control group increased by 2.213 compared with the baseline.The corrected mean difference between the two groups was-2.764.2.1.4 Regarding the equivalent slope of carbon dioxide ventilation(VE/VCO2slope),the covariance analysis demonstrated a decrease by 0.773 of this factor in the treatment group compared with the baseline after one week of treatment,while an increase of 0.347 was observed in the control group.The corrected mean difference between the two groups was-1.120.2.2 Blood stasis syndrome score and TCM symptom scale:according to the covariance analysis,after 4 weeks of treatment,the scores of blood stasis syndrome decreased by 5.177 and 3.389,respectively;and the TCM symptom scale decreased by 2.333 and 1.867,respectively;the decreased in the treatment group was 1.788 more than the control group.2.3 The analysis of covariance showed that after 4 weeks of treatment,the anxiety and depression scales of the treatment group decreased by 0.711 and 0.611,respectively,compared with the baseline level,and the decrease level of the treatment group was 1.321 lower than that of the control group.2.4 Markers of myocardial injury:based on the covariance analysis,the levels of troponin T(TnT),creatine kinase isoenzyme(CKMB),and N-terminal-pre-B type natriuretic peptide(NT-proBNP)in the treatment group had downward trends compared with the baseline level,but there was no statistically significant difference between the two groups(P>0.05).2.5 Cardiac color Doppler ultrasound index:According to the analysis of covariance,the left ventricular ejection fraction(LVEF)in the treatment group was 0.573 higher than the baseline after one week of treatment,and that in the control group was 0.227 higher than the baseline;the difference between the treatment and control groups was 0.347.The left ventricular end-diastolic diameter(LVDD)in the treatment group decreased by 0.608 compared with the baseline,while that in the control group increased by 0.141 compared with the baseline.The corrected mean difference and 95%CI between the two groups were-0.749.In summary,except for PETCO2,there was no statistically significant difference in other minor efficacy indices between the two groups(P>0.05).3.1 Concentrations of ATP,ADP,and AMP3.1.1 ATP:After 4 weeks of treatment,the covariance analysis showed that the ATP content of the treatment group increased by 0.891 compared with the baseline level,and that of the control group increased by 0.185;the difference in the increase between the 2 groups was 0.706(95%CI:-1.500,2.911,P>0.05).3.1.2 ADP:One week after treatment,the covariance analysis showed that the ADP concentration in the treatment group increased by 0.674 compared with the baseline level,while that in the control group decreased by 0.045.The corrected mean difference between the two groups was 0.719(95%CI:-1.588,3.027,P>0.05).3.1.3 AMP:The covariance analysis showed that the concentration of AMP in the treatment group decreased by 0.228 compared with the baseline level after 4 weeks of treatment,while that in the control group decreased by 0.571.The corrected mean difference and 95%CI between the two groups were 0.343(95%CI:-0.310,0.996,P>0.05).3.2 CAT,MDA activity,SOD content and ROS expression3.2.1 CAT:Results of the covariance analysis showed that the content of CAT in the treatment group increased by 0.290 compared with the baseline level after 4 weeks of treatment,and the control group increased by 0.188,which was 0.0103 less than that the treatment group(95%CI:-0.319,0.525,P>0.05).3.2.2 MDA:After 4 weeks of treatment,the covariance analysis showed that the content of MDA in the treatment group decreased by 0.294 compared with the baseline level,while that in the control group decreased by 0.242.The corrected mean difference and 95%CI between the two groups were-0.052(95%CI:-0.351,0.247,P>0.05).3.2.3 SOD:SOD in the treatment group increased by 0.382 compared with the baseline level after 1 week of treatment as indicated by the results of the covariance analysis,while that in the control group increased by 0.491.The corrected mean difference and 95%CI between the two groups were-0.109(95%CI:-0.924,0.707,P>0.05).3.2.4 ROS:After 4 weeks of treatment,the covariance analysis showed that the content of ROS in the treatment group decreased by 16.399 compared with the baseline.while that in the control group decreased by 2.542,and the degree of reduction in the treatment group was higher than that in the control group by 13.856(95%CI:-72.010,44.298,P>0.05).To sum up,there was no statistically significant difference in metabolic indices between the two groups.4.Safety of the experiment:no adverse reactions occurred among the two groups.Conclusion:1 Salvia miltiorrhiza polyphenols combined with rehabilitation treatment group can improve CRF in CHD patients post-intervention.The effect of routine rehabilitation alone on improving CRF was not significant as seen in the control group.2 Improvements on the blood stasis syndrome score,the TCM symptom scale,the markers of myocardial injury,and the levels of LVEF and LVDD in patients with CHD after interventional therapy were observed in both groups,although this improvement was less obvious for markers of myocardial injury among the two.The improvements of the remaining indices were superior in the treatment group compared with the control group.3 After treatment,the change of ATP content in the two groups showed an upward trend,while that of AMP showed a downward trend,and the degree change of the treatment group was more noticeable than that of the control group.In terms of ADP content,the content of ADP increased in the treatment group and decreased in the control group.4 The active contents of CAT and SOD increased,and the content of MDA decreased in both groups.The growth of the CAT activity in the treatment group was greater than that in the control group.In terms of ROS,both groups displayed a downward trend after treatment,and the degree of decline in the treatment group was more significant than that in the control group. |
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