Analysis Of The Difference Between The Degree And Location Of Coronary Artery Disease And Cardiopulmonary Fitness

Objective:To explore the difference between coronary heart disease(CHD)and non-CHD cardiopulmonary fitness(CRF),as well as the difference in vascular CRF associated with different infarctions in acute myocardial infarction(AMI).At the same time,explore the correlation between the severity of coronary artery disease(Gensini score)and CRF.Methods:From July 2018 to December 2019,110 male patients(58.75 ± 8.70 years old)were selected from Chengdu No.2 people’s hospital who successfully received PCI for complete revascularization within 12 hours after AMI onset.In addition,30 male patients with stable CHD non-PCI results were selected for coronary angiography,with an average age(60.44 ± 5.39 years);30 male patients with non-CHD were used,with an average age(58.72 ± 7.60 years).All patients with AMI were single-vessel vascular lesions.They were divided into three groups according to the location of infarct-related vascular lesions: 50 cases of LAD(35 cases in the proximal section,15 cases in the middle and far section),30 cases of LCX,and 30 cases of RCA.All of the above patients were tested for CPET before discharge(1-2 weeks after PCI in AMI patients).Collect all patient data:(1)General clinical data: age,body mass index(BMI),smoking history,drinking history,history of hypertension,history of diabetes,history of hyperlipidemia,history of peripheral arteriosclerosis,high History of uric acidemia,medication history(including angiotensin converting enzyme inhibitor(ACEI)/angiotensin Ⅱ receptor blocker(ARB),β receptor blocker(beta blockers(β),calcium channel blockers(CCB),etc.(2)laboratory indicators:low-density lipoprotein cholesterol(LDL-C),hemoglobin(HGB),Glycated hemoglobin,Left ventricular ejection fraction(LVEF),etc.(3)CPET parameter indicators: Maximum oxygen consumption(VO2max),Peak oxygen consumption(Peak oxygen consumption,PVO2),peak oxygen uptake per kilogram of body weight(PVO2/kg),anaerobic threshold per kilogram(AT/kg),Peak metabolic equivalent(Peak MET),Oxygen consumption plus(O2 plus),Oxygen uptake related to work rate(△VO2/△WR),Carbon dioxide ventilation equivalent(Ventilatory equivalent for CO2,VE/VCO2),etc.Compare the CPET cardiac function-related parameters of infarction-related blood vessels in patients with different parts of AMI,and whether the CRF is different in patients with CHD and non-CHD.Correlation between cardiac function-related parameters of CPET in patients with CHD and Gensini score of coronary artery disease severity.Results:(1)For patients with AMI whose infarct-related blood vessels are LAD after PCI,they were divided into two groups according to the different lesion sites of LAD.The baseline data of the two groups were not statistically different(P>0.05),and they were comparable.The results were that PVO2/kg(16.66± 1.86 ml/kg/min vs 20.07±2.45ml/kg/min,P<0.001),AT/kg(15.94±1.79 ml/kg/ min vs 19.31±1.87 ml/kg/min,P<0.001),Peak MET(5.00±0.61 MET vs 6.05±0.91 MET,P=0.001),O2 plus(8.79±0.87 m L/beat vs9.9±1.44 m L/beat,P=0.008)VO2/△WR(8.07 ± 1.08 ml/kg/min/W vs 10.75±1.50ml/kg/min/W,P<0.001)are low,while VE/VCO2(29.14±1.96 vs 26.52±1.98,P<0.001)is high;(2)LAD,LCX,and RCA were divided into three groups according to the different infarct-related vascular diseases after PCI.The baseline data of the three groups were not statistically different(P>0.05),and were comparable.Results LAD lesion PVO2/kg17.87±2.76 ml/kg/min,AT/kg 16.95±2.37 ml/kg/min,Peak MET 5.31±0.85 MET,O2 plus9.14±1.19 m L/beat,△VO2/△WR 8.87±1.72 ml/kg/min/W compared with LCX lesion PVO2/kg 20.68±1.48ml/kg/min,AT/kg 19.05±1.52 ml/kg/min,Peak MET 5.90±0.41 MET,O2 plus 10.24±1.41 m L/beat,△VO2/△WR 10.64±1.60 ml/kg/min/W and RCA lesion PVO2/kg 19.94±2.37 ml/kg/min,AT/kg 18.00±2.33 ml/kg/min,Peak MET 5.71±0.92 MET,O2 plus 10.65±1.57 m L/beat,△VO2/△WR 10.18±0.99 ml/kg/min/W were low,and LAD lesions VE/VCO2 28.35±2.24 were higher than LCX lesions VE/VCO2 26.43±2.08 and RCA lesions VE/VCO2 26.36±2.39,and both were statistically significant P<0.05;but LCX lesions CPET parameters were not significantly different from RCA lesions,P>0.05.(3)The CRF of patients with CHD is worse than that of non-CHD patients.Their PVO2/kg,AT/kg,Peak MET,O2 plus,△VO2/△WR are all low,and VE/VCO2 is high,and all have statistical significance,P<0.05.According to the coronary angiography results of three groups of patients: PCI group,non-PCI group,and non-CHD patients,Gensini scores can be seen.There is a certain correlation between Gensini scores and CPET parameter indicators.Gensini scores and CPET parameter indicators PVO2/kg,AT/kg,Peak MET,O2 plus,△VO2/△WR showed a significant negative correlation(P<0.001),and a significant positive correlation with VE/VCO2(P<0.001).CONCLUSIONS:(1)The early CPET parameters are different for male AMI patients after complete revascularization of infarct-related blood vessels in different locations.LAD lesions in the near segment are worse than those in the middle and far segments;LAD lesions have worse CRFs than LCX and RCA lesions,but there is no significant difference in CRF between LCX and RCA lesions;All patients with AMI who underwent PCI for complete revascularization were safe and effective for early CPET testing,and no adverse cardiovascular events occurred during the period.(2)The CRF of male CHD patients is worse than that of non-CHD patients,and the Gensini score is significantly negatively correlated with the CPET parameters PVO2/kg,AT/kg,Peak MET,O2 plus,△VO2/△WR,and it is related to VE/VCO2 there was a clear positive correlation.