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Kokyu to Junkan Volume 33, Issue 9 （September 1985）

呼吸と循環 33巻9号（1985年9月発行）

Japanese English

研究

トレッドミル運動負荷試験中の収縮期血圧上昇の程度から狭心症の重症度を判定することの試み Systolic blood pressure response during treadmill exercise test in detecting presence and severity of angina pectoris 長谷川浩一 ¹ , 鼠尾祥三 ¹ , 沢山俊民 ¹ , 原田頼続 ¹ , 寒川昌信 ¹ , 三竹啓敏 ¹ Kouichi Hasegawa ¹ , Shoso Nezuo ¹ , Toshitami Sawayama ¹ , Yoritsugu Harada ¹ , Masanobu Samukawa ¹ , Hirotoshi Mitake ¹ ¹川崎医科大学内科循環器部門 ¹Division of Cardiology, Department of Medicine, Kawasaki Medical School pp.1145-1150

発行日 1985年9月15日 Published Date 1985/9/15

DOI https://doi.org/10.11477/mf.1404204745

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Abstract 文献概要
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　冠動脈疾患（CAD）において，臨床的に重要な点は，重症度を判定し，各症例に応じた適切な医療を行うことにある。トレッドミル運動負荷試験法（T試験と略）は，CADの診断のみならず，冠予備能をも非侵襲的に予知できるといわれている^1〜4）。

　近年，CADにおけるT試験中の収縮期血圧低下が，虚血性ST低下と同様にその重症度判定の指標になりうるとの報告があり^1〜3），注目されている。しかし，彼らの方法によるとspecificityは極めて高い反面，sensitivi—tyが低く，日常臨床上の指標としては利用価値が低いと思われた。

Systolic blood pressure (SBP) response during submaximal treadmill exercise (T) test was inves-tigated for detecting presence and severity of an-gina pectoris (AP) in 117 patients (99 males and 18 females) with definite or suspected AP. The subjects were divided into three groups according to the degree of SBP response ; poor responder (ΔSBP≦25mmHg) as Group (A), moderate re-sponder (25<ΔSBP <60mmHg) as Group (B), and marked responder (ΔSBP≧60mmHg) as Group (C).

The following results were obtained. 1. Group (A) consisted of 18 patients, Group (B) and (C) of 57 and 42, respectively. 2. In 11 (77.8%) of Group (A), T test was interrupted by angina pain and/or ST depression of more than 2mm (marked ST depression), whereas 27 (6-1.3%) of Group (C) by achieved target heart rate. 3. Sixteen (88.9%) of Group (A) had effort AP with significant coro-nary artery stenosis (more than 50%), whereas 16 (38.1%) of Group (C) had vasospastic angina (0-vessel disease), and 16 (38.1%) had no cardiovas-cular diseases. 4. Of the 86 patients with AP, 12 (75.0%) of 16 in Group (A) had multi-vessel disease, whereas 25 (96.2%) of 26 in Group (C) had 0 or 1-vessel disease. 5. For detection of multi-vessel disease, the sensitivity of poor responder was 46.2%. It was identical to that of marked ST de-pression (42.3%), and the specificity was 93.4% and 87.9%, respectively. 6. Eight of Group (A) underwent coronary artery bypass surgery. At six-month follow-up, T time increased from 4.4 to 6.6 minutes, and ΔSBP increased from 19.0 to 54.0 mmHg (p<0.05).

In conclusion, the poor SBP response (ΔSBP≦25mmHg) induced by T test may be one of the valuable parameters for detecting severe AP with multi-vessel disease. The marked SBP response (ΔSBP≧60mmHg), on the other hand, may be an indicator in identifying mild AP with 0 or 1-vessel disease and chest pain syndrome without cardiovas-cular diseases.