Correlation Between Cardiopulmonary Exercise Test And Severity Of Coronary Artery Disease And Its Diagnostic Value In Stable Coronary Heart Disease

Objective:To analyze the correlation between Cardiopulmonary Exercise Test(CPET)and the severity of coronary stenosis(Syntax score),and to explore the diagnostic value of Cardiopulmonary Exercise Test in Stable Coronary Artery Disease(SCAD).Methods:A total of 220 patients who underwent coronary angiography in the Department of Cardiovascular Medicine,Chengdu Second People’s Hospital affiliated to Zunyi Medical University from January 2020 to May 2021 and met the inclusion criteria and complete general clinical data were selected.According to the results of coronary angiography,the patients were divided into a coronary heart disease group(110 cases with stenosis of major vessels and branches>50%)and a non-coronary heart disease group(110 cases with stenosis of major vessels and branches<50%or no stenosis)and clinical status stability.According to the degree of coronary stenosis,the patients were scored with SYNTAX(SYNTAX score calculation system:www.syntaxscore.com),and the patients with SCAD were divided into three groups according to the scores:mild group(69 cases(0-22 points)),moderate group(21 cases(23-32 points)),severe group(20 cases(≥33 points)).According to the number of lesions,the SCAD was divided into three groups,namely,60 cases in the single-vessel group,23 cases in the double-vessel group,and 27 in the multi-vessel group.All SCAD patients completed CPET.Accurately collect the data of each group of patients:(1)General information:gender,age,body mass index(BMI),smoking history,drinking history,past medical history(including hypertension,diabetes,hyperlipidemia),medication history(including beta-blockers,ACEI/ARB,statins),Systolic blood pressure(SBP),Diastolic blood pressure(DBP)、Resting heart rate(RHR).(2)Serological indicators:red blood cell(RBC),hemoglobin(HGB),glycation(HbAlc),creatinine(CREA),high-density lipoprotein(HDL),triglyceride(TG),cholesterol(TC),low-density lipoprotein(LDL).(3)CPET related parameters:Oxygen uptake related to work rate(△VO2/△WR),Peak metabolic equivalent(Peak Mets),Anaerobic threshold(AT),Peak oxygen consumption per kilogram(Peak VO2/kg),Metabolic equivalent an anaerobic threshold(Met@AT),oxygen pulse(Oxygen consumption plus,O2 plus).(4)Echocardiographic indicators:Left ventricular ejection fraction(LVEF).SPSS26.0 and Graphpad Prism8 were used for statistical analysis,and the general clinical data,serological indexes,CPET-related parameters and LVEF were compared between the two groups of patients.Differences in CPET parameters between patients,and the correlation between CPET parameters and the severity of coronary artery disease were explored,and the ROC curve of CPET parameters to predict stable coronary heart disease was obtained to obtain the diagnostic value.Results:1.The baseline data between the SCAD group and the non-SCAD group were not statistically significant(P>0.05).The results showed that the non-SCAD group had peak VO2/kg,AT,peak Mets,Met@AT,O2 plus,△VO2/△WR was higher than that of SCAD group,and the difference was statistically significant(P<0.001).2.There was no statistical significance in the general data of the severity of coronary artery lesions in the SCAD group(P>0.05).The CPET parameters of the three groups were compared.The peak Mets,Met@AT,O2 plus,△VO2/△WR were significantly higher than those in the mild group(P<0.05).The severe group had peak VO2/kg,AT,peak Mets,Met@AT,△VO2/△WR compared with the moderate group,that was statistically significant(P<0.05),while the O2 plus of the severe group was not statistically significant compared with the moderate group(P>0.05).Overall,the peak VO2/kg,AT,peak Mets,Met@AT,O2 plus,△VO2/△WR of the mild group were higher than those of the moderate and severe groups.3.There was no statistical significance in the general data comparison of patients with different number of lesion branches in the SCAD group(P>0.05).The comparison results of CPET parameters among the three groups showed that the peak VO2/kg,AT,peak Mets,Met@AT,O2 plus,△VO2/△WR were significantly higher than those in the single-branch and double-branch groups(P<0.05).And compared with the single-branch group,the double-branch group had higher peak VO2/kg,AT,peak Mets,O2 plus,△VO2/△WR;there was a statistical significance(P<0.05).While the double-branch Met@AT group had no statistical significance compared with the single-branch group(P>0.05).Overall,the peak VO2/kg,AT,peak Mets,Met@AT,O2 plus,△VO2/△WR of the single-branch group were higher than those in the double-branch group and the multi-branch group.4.Correlation analysis between Syntax score and CPET parameters in SCAD group showed that peak VO2/kg,AT,peak Mets,Met@AT,O2 plus,△VO2/△WR were negatively correlated with coronary Syntax score(P<0.001).5.ROC curve analysis had showed that Peak VO2/kg,AT,peak Mets,Met@AT,O2 plus,△VO2/△WR all have certain diagnostic value in SCAD.The maximum area under the curve for the joint diagnosis SCAD of the above six indicators is 0.924.the sensitivity was 83.6%,and the specificity was 90.9%.Conclusion:1.CPET has a significant negative correlation with the Syntax score of patients with SCAD,and it has certain clinical value in evaluating the degree of coronary stenosis and diagnosing SCAD.