cardiovascularКардиоваскулярная терапия и профилактикаCardiovascular Therapy and Prevention1728-88002619-0125«SILICEA-POLIGRAF» LLC10.15829/1728-8800-2012-2-44-52cardiovascular-1773Research ArticleИШЕМИЧЕСКАЯ БОЛЕЗНЬ СЕРДЦАCORONARY HEART DISEASEРоль отдельных показателей и интегральных индексов пробы с дозированной физической нагрузкой на тредмиле в оценке риска осложнений у пациентов с хронической ишемической болезнью сердцаRole of selected parameters and integral indices of treadmill test in the assessment of complication risk among patients with chronic coronary heart diseaseМарцевичС. Ю.MartsevichS. Yu.

руководитель отдела профилактической фармакотерапии, профессор кафедры доказательной медицины

Тел.: (495) 627-03-08

amalysheva@gnicpm.ruТолпыгинаС. Н.TolpyginaS. N.

в.н.с. отдела профилактической фармакотерапии

Тел.: (495) 627-03-08

amalysheva@gnicpm.ruМалышеваА. М.MalyshevaA. M.

(контактное лицо) — м.н.с. лаборатории клинических испытаний лекарственных препаратов отдела профилактической фармакотерапии

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amalysheva@gnicpm.ruПолянскаяЮ. Н.PolyanskayaYu. N.

н.с. лаборатории

Тел.: (495) 627-03-08

amalysheva@gnicpm.ruГофманЕ. А.HofmannE. A.

м.н.с. отдела профилактической фармакотерапии

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amalysheva@gnicpm.ruЛерманО. В.LermanO. V.

с.н.с. отдела

Тел.: (495) 627-03-08

amalysheva@gnicpm.ruМазаевВ. П.MazaevV. P.

руководитель отделения рентгенэндоваскулярных диагностики и лечения

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amalysheva@gnicpm.ruДеевА. Д.DeevA. D.

заведующий лабораторией биостатистики

Тел.: (495) 627-03-08

amalysheva@gnicpm.ruФГБУ Государственный научно-исследовательский центр профилактической медицины Минздравсоцразвития России. Москва, Россия; Кафедра доказательной медицины Первого Московского государственного медицинского университета имени И. М.Сеченова, МоскваState Research Centre for Preventive Medicine. Moscow, Russia; Evidence-based Medicine Department, I. M. Sechenov First Moscow State Medical University, MoscowФГБУ Государственный научно-исследовательский центр профилактической медицины Минздравсоцразвития России, МоскваState Research Centre for Preventive Medicine, Moscow2012200420121124452Copyright © Марцевич С.Ю., Толпыгина С.Н., Малышева А.М., Полянская Ю.Н., Гофман Е.А., Лерман О.В., Мазаев В.П., Деев А.Д., 20122012Марцевич С.Ю., Толпыгина С.Н., Малышева А.М., Полянская Ю.Н., Гофман Е.А., Лерман О.В., Мазаев В.П., Деев А.Д.Martsevich S.Y., Tolpygina S.N., Malysheva A.M., Polyanskaya Y.N., Hofmann E.A., Lerman O.V., Mazaev V.P., Deev A.D.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://cardiovascular.elpub.ru/jour/article/view/1773

Цель. Определить ценность показателей и интегральных индексов пробы с дозированной физической нагрузкой (ПДФН): Дьюка, индекса центра профилактической медицины (ИЦПМ) и модифицированного ИЦПМ для оценки риска развития сердечно-сосудистых осложнений (ССО) у пациентов с хронической ишемической болезнью сердца (ХИБС). Материал и методы. В исследование включали всех пациентов (n=260) с диагнозом ХИБС при поступлении, которым выполняли коронароангиографию (КАГ) и ПДФН на тредмиле в период с 01.01.2004г. по 31.12.2007г., постоянно проживающих в г. Москва или Московской области. Первичная конечная точка включала смерть от всех причин, нефатальные ССО: острый инфаркт миокарда, острое нарушение мозгового кровообращения, операции реваскуляризации — чрескожное вмешательство на коронарных артериях и коронарное шунтирование). Результаты. Среднее время наблюдения до развития первичной конечной точки составило 3,2 года. Возникновение первичной конечной точки наблюдалось у 71 (32,0 %) пациента. Первичная конечная точка чаще развивалась у пациентов с депрессией сегмента ST ≥1 мм во время ПДФН, положительным результатом пробы, возникновением боли. Достижение целевой частоты сердечных сокращений и общее время ФН ≥12 минут ассоциировалось с лучшим прогнозом. Частота первичной конечной точки у пациентов высокого и среднего риска на основании индекса Дьюка, ИЦПМ оказалась выше, чем у пациентов низкого риска. Модифицированный ИЦПМ показал хорошую корреляцию с наблюдаемой конечной точкой. Заключение. В работе важными для оценки риска осложнений ХИБС оказались такие показатели, как результат ПДФН, наличие депрессии сегмента ST≥1 мм, продолжительность достигаемой ФН, хронотропный ответ на ФН. Установлена прогностическая значимость ИЦПМ и модифицированного ИЦПМ для определения риска развития ССО у больных ХИБС.

Aim. To identify the value of selected parameters and integral indices of treadmill test (TT), such as Duke Treadmill Score (DTS), Centre for Preventive Medicine index (CPMI), and modified CPMI, in the assessment of cardiovascular complication (CVC) risk among patients with chronic coronary heart disease (CCHD). Material and methods. The study included all consecutive patients with the admission diagnosis of CCHD (n=260), who underwent coronary angiography (CAG) and TT in the period from January 1st 2004 to December 31st 2007, and were permanent residents of Moscow City or Moscow Region. Primary end-point was death from all causes; non-fatal CVC included acute myocardial infarction, acute cerebrovascular accident, and revascularization (percutaneous coronary intervention or coronary artery bypass graft surgery). Results. The mean time to the development of primary end-point was 3,2 years; it total, it was registered in 71 patients (32,0 %). The incidence of primary end-point was higher in patients with ST segment depression ≥1 mm at TT, positive TT result, or chest pain development during the test. Achievement of target heart rate and TT time ≥12 minutes was associated with a better prognosis. In patients with high and intermediate risk by DTS and CPMI, the incidence of primary end-point was higher than in patients with low risk. Modified CPMI demonstrated high correlation with the primary end-point. Conclusion. The highest prognostic value in the assessment of the risk of CCHD complications was demonstrated by TT result, ST segment depression ≥1 mm, TT time, and chronotropic TT response. The role of CPMI and modified CPMI as predictors of CVC risk in CCHD patients was assessed.

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The authors declare that there are no conflicts of interest present.