Clinical Studies On Radial Artery Pulse Waves In The Overall Management Of Chronic Disease With Cardiopulmonary Exercise Test As The Core

PartⅠEvaluate the efficacy of intensive control after individualized exercise program for chronic cardiovascular disease by cardiopulmonary exercise testObjective:To investigate and evaluate the improvement of the overall function of intensive control after individualized precision exercise program on patients with chronic cardiovascular disease after 3 months by cardiopulmonary exercise test（CPET）.Methods:42 patients with cardiovascular chronic disease who were treated with stable condition were selected from December 2014 to December 2016 in Fuwai hospital,Chinese Academy of Medical Sciences.They were divided into two groups according to the random principle and the patients’willingness.The patients of exercise group（n=22）were given conventional treatment and individualized intensive treatment.The patients of control group（n=20）were treated with only conventional treatment.General data collection and CPET were performed for all patients before treatment.And an overall management plan with individualized moderate exercise intensity as the core was formulated for the exercise group.CPET was performed again for all patients after 3 months of treatment.Then changes in general data,CPET major observation indexes before and after treatment were analyzed and compared between the two groups.Results:All patients completed the treatment safely during the study period.（1）Before treatment,there were no statistically differences in age,gender,body mass index,disease diagnosis and CPET major observation indexes between the two groups（all P>0.05）.Fasting blood glucose,resting blood pressure and heart rate in exercise group after treatment were lower than those in the control group before treatment and the exercise group after treatment（all P<0.05）.（2）CPET main observation indexes in the two groups,（1）Circulation indexes:compared with the control group after treatment,peak oxygen uptake（Peak VO₂）,anaerobic threshold（AT）,peak oxygen pulse（Peak O₂p）,peak work rate（Peak WR）,ramp exercise duration（Ex-Duration）,peak systolic blood pressure（Peak SBP）,peak heart rate（Peak HR）and peak rate pressure product（Peak RPP）were significantly higher in patients of the exercise group after treatment（all P<0.05）.And there was no significant difference in peak diastolic blood pressure（Peak DBP）between the two groups（P>0.05）.Compared with the exercise group before treatment,there was no significant difference in Peak DBP of the exercise group after treatment（P>0.05）,and the other indexes significantly increased in the exercise group after treatment（all P<0.05）.Compared with the control group before treatment,Ex-duration and Peak SBP were increased in the control group after treatment（all P<0.05）.（2）Respiratory indicators:compared with the control group after treatment,peak ventilation（Peak V_E）was higher and end tidal oxygen partial pressure at peak(P_ETO_2@peak)was lower in patients of the exercise group after the treatment（all P<0.05）,but end tidal carbon dioxide partial pressure at peak(P_ETCO_2@peak),peak respiratory exchange rate（Peak RER）,peak tidal volume（Peak V_T）and peak breath frequency（Peak BF）were no differences（all P>0.05）.Compared with the exercise group before treatment,the Peak V_Eand Peak V_T increased and PETO_2@peak decreased in the exercise group after treatment（all P<0.05）.Compared with the control group before treatment,Peak V_T was higher in the control group after treatment（P<0.05）.（3）The matching of circulation and respiration:compared with the control group after treatment,oxygen uptake efficiency plateau（OUEP）was higher in the exercise group（P<0.05）,while lowest value of carbon dioxide ventilatory efficiency（lowest V_E/VCO₂）and slope of ventilatory equivalent for carbon dioxide（V_E/VCO₂ slope）were lower in the exercise group after treatment（all P<0.05）.Compared with the exercise group before treatment,OUEP increased（P<0.05）,V_E/VCO₂ slope and V_E/VCO₂ slope decreased in the exercise group after treatment（all P<0.05）.Compared with the control group before treatment,the V_E/VCO₂ slope was lower in the control group after treatment（P<0.05）.Conclusion:CPET can safely,objectively and quantitatively evaluate the overall function and therapeutic effect,and guide the formulation of individual precisely exercise intensity.The intensive control for three months can safely and effectively improve the overall functional status and abnormal indexes of patients with chronic cardiovascular disease.Part Ⅱ Effects of resting radial artery pulse wave in patients with long-term chronic disease who have been intensively controlled by the individualized exercise holistic programObjective: To observe the resting radial artery pulse wave of patients with long-term chronic diseases who have been routinely treated and intensively controlled by the holistic program of individualized exercise.Methods: There were 20 cases of healthy normal persons without diagnosis of any disease（normal）,20 cases of chronic disease without intensive control for routine treatment（without intensive control）and 20 cases of long-term chronic disease patients with routine treatment and intensively controlled by the holistic program of individualized exercise（intensive control）.They were from January 2019 to May 2020.Then we collected and recorded the pulse wave data of their left radial artery for 50 seconds.Then the similarities and differences of pulse waveforms and main indexes were analyzed qualitatively and quantitatively,including the proportion of the crest obvious dicrotic wave,main wave peak amplitude ratio(Y_P1),dicrotic wave trough amplitude(Y_PL),dicrotic wave peak amplitude(Y_P2),main wave ascending branch slope（S₁）,dicrotic wave ascending branch slope（S₂）,dicrotic wave amplitude(Y_P2-Y_PL).Results:（1）There were statistical differences in age,body mass index and systolic blood pressure among three groups（all P<0.05）,while there were no statistical differences in other general information（all P>0.05）.（2）From the point of view of the radial artery pulse waveform,the patients with intensive control had similar dicrotic wave characteristics with young healthy people,which is different from the non-intensive control patients without obvious dicrotic wave characteristics.（3）According to the analysis of main indexes,compared with young normal people,the proportion of the crest obvious dicrotic wave（94.7% vs 24.5%）,Y_P1,S₁,S₂ and Y_P2-Y_PL in patients without intensive control were lower and YPL was higher（all P<0.05）.Compared with patients without intensive control,the proportion of the crest obvious dicrotic wave（24.5% vs 95.4%）,Y_P1,S₁,S₂ and Y_P2-Y_PL in patients with intensive control were higher and YPL was lower（all P<0.05）.（4）Influencing factors analysis of main indexes: after including age,body mass index and systolic blood pressure as covariates, multivariate analysis of variance also showed that there were statistical differences in Y_P1,Y_PL,S₁,S₂ and Y_P2-Y_PL between the patients without intensive control and the normal control（all P<0.05）,while there was no statistical difference in YP2（P>0.05）.There were no statistical differences in the above indexes between patients with intensive control and the normal control（all P>0.05）.Conclusions: The resting pulse wave of radial artery in patients with intensive control is similar to that of young normal people: the peak of the main wave is high and narrow,the amplitude of dicrotic wave is large,and the trough point is low.It is significantly different from the characteristic of long-term chronic disease patients without intensive control.After intensive control,the improvement of main wave and dicrotic wave in patients with long-term chronic disease may be used as one of the objective and quantitative evaluation indexes for effective treatment of chronic disease.