| Background and ObjectiveThe coronary artery is composed of three parts:the subpericardial coronary artery,the anterior arteriole,and the arteriole[1].At present,coronary angiography,as the gold standard for the diagnosis of coronary artery disease,can only show the stenosis of the subpericardial coronary artery.However,the anterior arterioles and arterioles were not well developed.After decades of research,scholars at home and abroad have come to realize that these anterior arterioles and arterioles constitute the coronary microvascular system.A kind of coronary artery disease called coronary microvascular disease,which is caused by the abnormal structure and/or function of the anterior arteriole and the arteriole resulting in angina pectoris or objective evidence of myocardial ischemia.Although there have been more than 40 years of the basic and clinical research on CMVD,but there are still important scientific problems in this field[2],.and it faces great challenges in limited diagnostic techniques and objective evaluation of drug efficacy[3].Cardiopulmonary exercise testing?CPET?is a comprehensive,objective and noninvasive method for the diagnosis of coronary heart disease?at least one major coronary artery or its main branches with stenosis?50?.The role of curative effect evaluation and prognosis rehabilitation has been widely recognized.Then,is CPET also valuable in the diagnosis of CMVD and the evaluation of drug efficacy?.At present,there are only relevant case reports at home and abroad,and there is no clear clinical study.The purpose of this study was to provide a new method and theoretical basis for the diagnosis of coronary microvascular disease and the evaluation of therapeutic effect by analyzing the related indexes of cardiopulmonary exercise test in patients with coronary microvascular disease.MethodFrom January 2016 to May 2017,we choosed 100 patients who were diagnosed with CMVD as trial group,who were hospitalized in Department of Cardiology in the second affiliated Hospital of Zhengzhou University.According to the results of coronary angiography,they were divided into group A?10 males and 30 females?with normal epicardial coronary artery and group B?26 males and 34 females?with mild stenosis of epicardial coronary artery?stenosis<50%?.100 volunteers?48 males and52 females?who came to our hospital for physical examination in the same time period as control group?group C?.Age,body mass index,smoking status of all subjects were recorded.Three groups of people were tested with symptom-restricted cardiopulmonary exercise testing to record the peak oxygen uptake,oxygen pulse and anaerobic threshold,relative indexes in each group were statistical analysed.Then,the experimental group was treated with anti-myocardial ischemia therapy one mouth,and the cardiopulmonary exercise test was performed again.The changes of CPET indexes before and after treatment were compared.Results?1?Comparedwiththecontrolgroup,thepeakoxygenuptake?1.48±0.15vs1.79±0.12?L/min,peak oxygen pulse?12.8±0.8vs14.6±0.8?ml/beat and anaerobic threshold?15.8±2.9vs18.8±3.2?ml/?kg·min?of CMVD group were significantly lower than those in the control group?p<0.05?.?2?In male patients with CMVD,the corresponding indexes of CPET in control group?group C1?,coronary artery normal group?group A1?and coronary artery stenosis group?group B1?were significantly different?p<0.001?;in female patients with CMVD,the control group?group C2?were significantly different from those in the coronary artery stenosis group?group B2,p<0.001?,but there was no significant difference compared with the normal coronary artery group?group A2,p=0.82?.?3?The mean peak oxygen uptake?1.68±0.16vs1.48±0.15?L/min,oxygen pulse?14.2±0.8vs12.8±0.8?ml/beat and anaerobic threshold?17.9±2.6vs15.8±2.9?ml/?kg·min?in CMVD patients were significantly higher than those before anti-myocardial ischemia treatment?p<0.05?.Conclusion?1?The decrease of peak oxygen uptake,peak oxygen pulse and anaerobic threshold in CPET is helpful for clinical diagnosis of CMVD.?2?The role of CPET in auxiliary diagnosis of CMVD with normal coronary artery in men is superior to that in women.?3?The improvement of CPET related indexes can evaluate the efficacy of CMVD drug therapy objectively and quantitatively. |
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