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ST-segment elevation on Q leads at rest and during exercise:: Relation with myocardial viability and left ventricular remodeling within the first 6 months after infarction

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AMERICAN HEART JOURNAL 1999年第6期137卷 1107-1115页

作者： Bodi, V Sanchis, J Llàcer, A Insa, L Chorro, FJ López-Merino, V Marins Baixa Hosp Cardiol Unit La Vila Joiosa Spain Univ Clin Hosp Dept Cardiol Valencia Spain

Background Resting ST-segment elevation on Q leads after an acute myocardial infarction has been related to a greater infarct size. Otherwise, the relation between exercise-induced ST-segment elevation and myocardial viability is controversial. We investigated the relation between ST-segment elevation on Q leads at rest and during exercise and regional dysfunction and its evolution, contractile reserve, left ventricular dilation, and coronary patency. Methods and Results Exercise testing and cardiac catheterization were performed at the first week after infarction in 51 patients. The study group was divided according to the existence (in 2 or more Q leads;n = 36) or not (n = 15) of resting ST-segment elevation and according to the existence (n = 28) or not (n = 23) of exercise-induced ST-segment elevation. Left ventricular end-diastolic and end-systolic volumes (mL/m(2)), regional wall motion (SD/chord), contractile reserve (wall motion percentage improvement with low-dose dobutamine), and coronary potency in the culprit artery were analyzed. Cardiac catheterization was repeated at the sixth month in 35 patients;systolic recovery (wall motion percentage improvement), left ventricular volumes, and coronary patency were again evaluated. Patients with resting ST-segment elevation showed poorer wall motion (2.1 +/- 0.8 SD/chord vs 1.2 +/- 1 SD/chord, P = .002), lesser contractile reserve (17% [0% to 39%] vs 41% [4% to 92%], P = .04), greater end-systolic volume (32 +/- 15 mL/m(2) vs 23 +/- 11 mL/m(2), P = .04), and higher percentage of occlusion (36% vs 7%, P = .04) than did patients without ST-segment elevation. likewise, patients with exercise-induced ST-segment elevation showed lesser contractile reserve (8% [0% to 40%] vs 35% [12% to 86%], P = .03) than did patients without exercise-induced ST-segment elevation. The only independent predictors of contractile reserve were wall motion <2 SD/chord (odds ratio [OR] 7.1, confidence interval [CI] 6.3 to 7.9, P = .01) and

关键词：方差分析冠状血管造影术/方法冠状血管造影术/统计学和数值数据心电描记术/统计学和数值数据运动试验/方法运动试验/统计学和数值数据心脏导管插入术/方法 Logistic模型心肌梗死/诊断心肌梗死/病理生理学心肌/病理学统计学非参数时间因素组织存活心室重构老年人女(雌)性人类男(雄)性中年人

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Doppler myocardial imaging in patients with heart failure receiving biventricular pacing treatment

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AMERICAN HEART JOURNAL 2001年第5期142卷 881-896页

作者： Ansalone, G Giannantoni, P Ricci, R Trambaiolo, P Laurenti, A Fedele, F Santini, M San Filippo Neri Hosp Dept Heart Dis Rome Italy Sandro Pertini Hosp Div Cardiol Rome Italy Univ Roma La Sapienza Dept Cardiac & Resp Sci Rome Italy

Background In patients with heart failure, biventricular pacing (BIV) improves left ventricular (LV) performance by counteracting LV unsynchronized contraction caused by the presence of left bundle branch block (LBBB). However, no data are yet available on regional long-axis function in patients with LBBB or on BIV effectiveness in improving such a function in patients with heart failure and LBBB. Methods and Results We studied with standard 2D echocardiography and tissue Doppler imaging (TDI) 21 nonischemic patients in New York Heart Association (NYHA) class III-IV, with LBBB and QRS greater than or equal to 120 ms, receiving BIV. To assess long-axis function, TDI qualitative analysis at the basal level of each LV wall was performed in M-mode color and pulsed wave Doppler modalities before and after BIV. By analysis of the interventricular septum, the inferior, posterior, lateral, and anterior walls, of 105 basal segments, the following electromechanical patterns were identified: normal (pattern I), mildly unsynchronized (pattern IIA), severely unsynchronized (pattern IIB), reversed early in systole (pattern IIIA);reversed late in systole (pattern IIIB), and reversed throughout all the systole (pattern IV). After BIV, (1) 49 (46.7%) of 105 segments showed unsynchronized contraction of the same degree as before;(2) 36 (34.3%) of 105 and 20 (19%) of 105 showed unsynchronized contraction of lesser and greater degree, respectively, than before;and (3) a preexcitation pattern was found in 1 1 (10.5%) of 105, but no segment with pattern IV was observed. According to TDI analysis, patients were divided into group 1 (10 of 21), with less severe LV asynchrony than before BIV, and group 2 (11 of 21), with no change or more severe LV asynchrony than before BIV. In group 1, (1) the LV ejection fraction increased significantly (P = .01);(2) the exercise tolerance, expressed as time and work capacity on the bicycle stress testing, increased significantly (P = .01, P = .003, resp

关键词：束支传导阻滞/诊断束支传导阻滞/病理生理学束支传导阻滞/治疗心脏起搏人工/方法超声心动描记术/统计学和数值数据超声心动描记术多普勒/统计学和数值数据心电描记术/统计学和数值数据运动试验/统计学和数值数据心脏/病理生理学心肌收缩/生理学心室功能障碍/诊断心室功能障碍/病理生理学心室功能障碍/治疗人类

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Stress testing: National patterns and predictors of test ordering

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AMERICAN HEART JOURNAL 1999年第6期138卷 1019-1024页

作者： Cohen, MC Stafford, RS Misra, B Maine Med Ctr Div Cardiol Portland ME 04102 USA Univ Vermont Coll Med Burlington VT USA Harvard Univ Sch Med Massachusetts Gen Hosp Div Gen Med Boston MA USA

Objective To determine predictors of ordering of exercise stress tests. Background Because exercise stress testing is routinely used and widely available and may have an effect on subsequent evaluation of and therapy for heart disease, understanding current patterns of ordering exercise stress rests may have important implications for national health care costs. We hypothesized that factors other than clinical condition exert an influence on ordering of exercise stress tests. Methods Data from the 1991 and 1992 National Ambulatory Medical Core Surveys conducted by the National Center for Health Statistics were analyzed by means of multivariate logistic regression. Results In an estimated 1.12 billion adult visits to office-based physicians in the United Stares (95% confidence interval [CI], 1.07-1.16 billion), 6.2 million (95% CI, 4.8-7.6 million) exercise stress tests were ordered. After adjustment for clinical and nonclinical variables associated with the office visit, cardiologists were 3.7 (95% CI, 2.7-5.1) times more likely to order exercise stress tests than were internists, who were more likely to order an exercise stress test than were family and general practitioners (0.5, 95% CI, 0.3-0.7). Nonclinical factors associated with increased ordering of exercise stress tests included male sex (odds ratio 2.5;95% CI, 2.0-3.2), white race (odds ratio 1.6;95% CI, 1.1-2.3), new referral status (odds ratio 3.8;95% CI, 2.5-5.8), and private insurance (odds ratio 1.4;95% CI, 1.1-1.8). Medicare recipients were about half (95% CI, 0.4-0.9) as likely as other patients to have an exercise stress test ordered. Conclusions Factors other than clinical condition exert an influence on ordering of exercise stress tests and may represent modifiable elements associated with appropriate practice.

关键词：运动试验/统计学和数值数据运动试验/利用医师诊疗模式/统计学和数值数据美国成年人老年人女(雌)性人类男(雄)性中年人

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Sex differences in chest pain in patients with documented coronary artery disease and exercise-induced ischemia: Results from the PIMI study

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AMERICAN HEART JOURNAL 2001年第5期142卷 864-871页

作者： Sheps, DS Kaufmann, PG Sheffield, D Light, KC McMahon, RP Bonsall, R Maixner, W Carney, RM Freedland, KE Cohen, JD Goldberg, AD Ketterer, MW Raczynski, JM Pepine, CJ Univ Florida Coll Med Gainesville FL 32610 USA Malcom Randall Vet Affairs Med Ctr Gainesville FL USA Dept Vet Affairs Med Res Serv Gainesville FL USA NHLBI Bethesda MD 20892 USA Maryland Psychiat Res Ctr Baltimore MD 21228 USA Univ N Carolina Chapel Hill NC USA Emory Univ Sch Med Atlanta GA USA St Louis Univ Hlth Sci Ctr St Louis MO 63103 USA Washington Univ Sch Med St Louis MO USA Henry Ford Hosp Detroit MI 48202 USA Univ Alabama Birmingham AL USA

Background Sex differences in the pathophysiologic course of coronary artery disease (CAD) are widely recognized, yet accurate diagnosis of coronary artery disease in women remains challenging. Methods To determine sex differences in the clinical manifestation of CAD, we studied chest pain reported during daily activities, exercise, and mental stress in 170 men and 26 women. All patients had documented CAD (> 50% narrowing in at least 1 major coronary artery or prior myocardial infarction) and all had 1-mm ST-segment depression on treadmill exercise. We collected psychologic test results, serum samples (potassium, epinephrine, norepinephrine, cortisol, beta -endorphin, and glucose), and cardiac function, sensory threshold, and autonomic function data at specified times before, during, or after exercise and mental stress tests to assess measures of depression, anxiety, and neurohormonal and thermal pain perception. Results Women reported chest pain more often than men during daily activities (P = .04) and during laboratory mental stressors (P = .01) but not during exercise. Men had lower scores than women on measures of depression, trait anxiety, harm avoidance, and reward dependence (P < .05 for all). Women had significantly lower plasma (beta -endorphin levels at rest (4.2 +/- 3.9 vs 5.0 +/- 2.5 pmol/L for men;P = .005) and at maximal mental stress (6.4 +/- 5.1 vs 7.4 +/- 3.5 pmol/L for men, P < .01). A higher proportion of women than men had marked pain sensitivity to graded heat stimuli applied to skin (hot pain threshold < 41 degreesC, 33% vs 10%, P = .001). Conclusions Our results reflect sex differences in the affective and discriminative aspects of pain perception and may help explain sex-related differences in clinical presentations.

关键词：日常生活活动胸痛/诊断胸痛/流行病学胸痛/病理生理学冠心病/诊断冠心病/病理生理学运动试验/统计学和数值数据用力/生理学热/诊断应用心肌缺血/诊断心肌缺血/病理生理学疼痛测定/方法疼痛测定/统计学和数值数据痛阈/生理学心理学试验性别因素应激心理学/诊断应激心理学/病理生理学女(雌)性人类男(雄)性中年人

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Comparison of the right and left ventricle as a systemic ventricle during exercise in patients with congenital heart disease

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AMERICAN HEART JOURNAL 1999年第6期137卷 1185-1194页

作者： Ohuchi, H Hiraumi, Y Tasato, H Kuwahara, A Chado, H Toyohara, K Arakaki, Y Yagihara, T Kamiya, T Natl Cardiovasc Ctr Dept Pediat Suita Osaka 565 Japan Natl Cardiovasc Ctr Dept Thorac Surg Suita Osaka 565 Japan

Background Few studies have investigated the clinical advantages of surgical correction with the morphologic left ventricle (MLV) instead of the morphologic right ventricle as a systemic ventricle (SV) in patients with congenital heart disease. Methods Twenty-four healthy control subjects (group A1), 6 patients with isolated congenitally corrected transposition of the greet arteries (TGA) (group A2), 16 patients with TGA who had undergone an arterial switch operation (group B1), 18 patients with TGA who had undergone a venous switch operation (group B2), 9 patients with atrioventricular and ventriculoarterial discordance who had undergone a double switch operation (group C1), and 6 patients with atrioventricular and ventriculoarterial discordance who had undergone a conventional external conduit operation From the MLV to the pulmonary artery (group C2), performed treadmill exercise testing. Their heart rate (HR), oxygen uptake ((V)over dotO(2)), and oxygen pulse (O-2 pulse), which reflects individual stroke volume, were measured, and contractile function was assessed by echocardiography. Results The peak HR for the patients after a definitive operation were significantly lower than that in group Al and was correlated with peak(V)over dotO(2) (r = .67 P < .0001). The peak(V)over dotO(2) and peak O-2 pulse for the groups A2 and B2 were significantly lower than those for the groups Al and B1, respectively. The peak O-2 pulse data were strongly correlated with those of peak(V)over dotO(2) (r = 0.91, P < .0001). The left ventricular ejection fraction was significantly lower in groups B1 and C1 than in group Al and was correlated with peak(V)over dotO(2) (r = .50, P < .01). No significant differences in (V)over dotO(2), HR, and O-2 pulse at peak exercise were observed between groups C1 and C2. Conclusions Chronotropic incompetence and an impaired response of the stroke volume of the MRV during exercise are partly responsible for the reduced exercise capacity in groups A2

关键词：方差分析超声心动描记术/统计学和数值数据运动试验/统计学和数值数据随访研究心脏缺损先天性/病理生理学心脏缺损先天性/外科学心脏缺损先天性/超声检查心室/病理生理学手术后期间肺换气回归分析呼吸功能试验/统计学和数值数据心室功能左心室功能右青少年儿童儿童学龄前人类婴儿

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Effect of intravenous contrast for left ventricular opacification and border definition on sensitivity and specificity of dobutamine stress echocardiography compared with coronary angiography in technically difficult patients

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AMERICAN HEART JOURNAL 2001年第5期142卷 908-915页

作者： Dolan, MS Riad, K El-Shafei, A Puri, S Tamirisa, K Bierig, M St Vrain, J McKinney, L Havens, E Habermehl, K Pyatt, L Kern, M Labovitz, AJ St Louis Univ Hlth Sci Ctr Dept Internal Med Div Cardiol St Louis MO 63110 USA

Background The study evaluates whether Optison used during dobutamine stress echocardiography (DSE) will improve endocardial border definition and whether this will translate to an improvement in sensitivity and specificity of the test in patients with poor echocardiographic windows. DSE is extremely valuable in the workup of patients with coronary artery disease. The test is limited in patients with suboptimal endocardial border visualization. Frequent studies have demonstrated improved endocardial border visualization with intravenous contrast agents at rest. Methods and Results We studied 229 patients: 112 had good rest echocardiography with no contrast and 117 had poor rest echocardiography with Optison injection during DSE. Percentage of endocardial border visualization, wall thickening, sensitivity, and specificity were compared in both groups, as was interobserver variability. Both groups were matched with respect to age, percentage of previous myocardial infarctions, resting wall motion abnormality, percentage of coronary stenosis, and number of diseased coronary arteries. Optison significantly improved endocardial border visualization, especially at peak stress. The ability to measure wall thickening was significantly higher in the contrast DSE group with suboptimal images versus the noncontrast group with optimal images (89% ability to measure wall thickening vs 71%, P = .01). This resulted in a comparable sensitivity (79% vs 71%, P = not significant [NS]), specificity (76% vs 82%, P = NS), and diagnostic accuracy (80% vs 76%, P = NS). Agreement on test interpretation was higher among 3 observers in contrast DSE versus noncontrast DSE groups (79% vs 69%, P = .01). Conclusions In patients with poor echocardiographic windows, the use of Optison during DSE improves endocardial border visualization, which translates to a comparable sensitivity and specificity to noncontrast DSE tests in patients with good echocardiographic windows.

关键词：冠状血管造影术/统计学和数值数据冠心病/诊断冠心病/病理生理学冠心病/放射摄影术多巴酚丁胺/投药和剂量多巴酚丁胺/诊断应用超声心动描记术/统计学和数值数据运动试验/方法运动试验/统计学和数值数据心室/生理学心室/病理生理学心室/放射摄影术图像处理计算机辅助输注静脉内心肌收缩/生理学敏感性与特异性心室功能障碍左/诊断心室功能障碍左/病理生理学心室功能障碍左/放射摄影术成年人老年人老年人 80以上女(雌)性人类男(雄)性中年人

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Delayed systolic blood pressure recovery after graded exercise - An independent correlate of angiographic coronary disease

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JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY 1999年第3期34卷 754-759页

作者： McHam, SA Marwick, TH Pashkow, FJ Lauer, MS Cleveland Clin Fdn Dept Cardiol Sect Heart Failure & Cardiac Transplantat Med Cleveland OH 44195 USA

OBJECTIVE This study was performed to determine whether a delayed decline in systolic blood pressure (SBP) after graded exercise is an independent correlate of angiographic coronary disease. BACKGROUND The predictive importance of the rate of SBP decline after exercise relative to blood pressure changes during exercise has not been well explored. METHODS Among adults who underwent symptom-limited exercise treadmill testing and who underwent coronary angiography within 90 days, a delayed decline in SBP during recovery was defined as a ratio of SBPs at 3 min of recovery to SBP at 1 min of recovery >1.0. Severe angiographic coronary artery disease was defined as left main disease, three-vessel disease or two-vessel disease with involvement of the proximal left anterior descending artery. RESULTS There were 493 subjects eligible for analyses (age 59 +/- 11 years, 78% male). Severe angiographic coronary disease was noted in 102 (21%). There were associations noted between a delayed decline in SEP during recovery and severe angiographic coronary disease (34% vs. 17%, odds ratio [OR] 2.59, confidence interval [CI] 1.58 to 4.25, p = 0.001). In multivariate logistic regression analyses adjusting for SEP changes during exercise and other potential confounders, a delayed decline in SBP during recovery remained predictive of severe angiographic coronary disease (adjusted OR 2.22, 95% CI 1.27 to 3.87, p = 0.005). CONCLUSIONS delayed decline in SEP during recovery is associated with a greater likelihood of severe angiographic coronary disease even after accounting for the change in SBP during exercise. (J Am Coll Cardiol 1999;34:754-9) (C) 1999 by the American College of Cardiology.

关键词：血压置信区间冠状血管造影术/方法冠状血管造影术/统计学和数值数据冠心病/诊断显像冠心病/病理生理学运动(Exercise)/生理学运动试验/方法运动试验/统计学和数值数据 Logistic模型比值比预后前瞻性研究心缩期时间因素老年人女(雌)性人类男(雄)性中年人

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Ergometric score, systems after myocardial infarction: Prognostic performance of the Duke Treadmill Score, Veterans Administration Medical Center Score, and of a novel score system, GISSI-2 Index, in a cohort of survivors of acute myocardial infarction

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AMERICAN HEART JOURNAL 2003年第3期145卷 475-483页

作者： Villela, M Villela, A Santoro, L Santoro, E Franzosi, MG Maggioni, AP Casa Sollievo Sofferenza Hosp IRCCS Dept Cardiol I-71013 San Giovanni Rotondo Italy F Lastaria Hosp Dept Cardiol Lucera Italy Ist Ric Farmacol Mario Negri Lab Clin Drug Evaluat Milan Italy Ist Ric Farmacol Mario Negri Lab Med Informat Milan Italy Ctr ANMCO Florence Italy

Background The aims of the study were to evaluate the performance of the Duke Treadmill Score (DTS) and. the Veteran Affairs Medical Center Score (VAMCS) in predicting 6-month death in GISSI-2 study survivors of acute myocardial infarction treated with thrombolytic agents, and to develop a simple predictive scoring system from the same database. Methods Patients of the GISSI-2 study (n = 6251) performed a maximal symptom-limited exercise test 1 month after myocardial infarction. We calculated for each patient the DTS and the VAMCS. Based on the coefficients of a multivariate analysis of our database, we developed a simple predictive scoring system and performed an internal validation. The prognostic value of each scoring system was assessed by multivariate analysis. Results six-month mortality rates in the subgroups of each scoring system were as follows: DTS: low risk 0.6%, moderate risk 1.8%, high risk 3.4% (P less than or equal to .0001);VAMCS: low risk 0.6%, moderate risk 1.9%, high risk 4.7% (P less than or equal to .0001);GISSI-2 Index: low risk 0.5%, moderate risk 1.9%, high risk 6.1% (P less than or equal to .0001). The results of multivariate analysis (relative risk [RR] and 95% Cl) were as follows: DTS: moderate risk 2.50 (1.47-12.59), high risk 5.13 (3.61-15.55);VAMCS: moderate risk 2.65 (1.53-4.59), high risk 5.97 (3.10-11.49);GISSI-2 Index: moderate risk 3.16 (1.81-5.52), high risk 8.65 (4.36-17.18). Conclusions The use of ergometric-derived prognostic score systems in a population of survivors of acute myocardial infarction treated with thrombolytic drugs distinguishes subgroups at different risks of death and allows an appropriate recourse to more costly procedures.

关键词：急性病队列研究心电描记术/统计学和数值数据测力法/统计学和数值数据运动试验/统计学和数值数据纤维蛋白溶解药/治疗应用多元分析心肌梗死/诊断心肌梗死/药物疗法心肌梗死/死亡率预后比例危险度模型 ROC曲线危险危险因素存活率分析幸存患者/统计学和数值数据老年人女(雌)性人类男(雄)性中年人

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A neural link to explain the "muscle hypothesis" of exercise intolerance in chronic heart failure

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AMERICAN HEART JOURNAL 1999年第6期137卷 1050-1056页

作者： Piepoli, M Ponikowski, P Clark, AL Banasiak, W Capucci, A Coats, AJS Gen Hosp Dept Cardiol I-29100 Piacenza Italy Royal Brompton Hosp Dept Cardiac Med London SW3 6LY England

Background In chronic heart failure the cause of exercise imitation it still unclear: ergoreceptors, muscle afferents sensitive to exercise metabolites, are proposed as a neural link between muscular abnormalities and the limited exercise responses in this syndrome. Methods In 92 stable patients with heart failure (34 in New York Heart Association class 1, 27 in class II, and 31 in class III) and 28 age-matched normal controls, we assessed exercise tolerance (maximal upright bicycle) and ergoreflex activity (2 dynamic handgrips, one control and one followed by 3 minutes of local circulatory occlusion to isolate the ergoreflex component by metabolite trapping). Results Patients, with respect to the controls. showed reduced exercise tolerance (peak (V) over dot O-2 20 vs 33 mL/kg/min), increased ergoreflex effects on ventilation (9 vs 4 L/min), systolic pressure (37 vs 13 mm Hg), and leg vascular resistance (45 vs 22 units) tall P <.005);with the progression of the symptoms, a progressive increase in ergoreflex contribution to the ventilatory response to exercise was observed. The indexes of exercise limitation during arm and leg exercise tie, peak (V) over dot O-2 (V) over dot/(V) over dot CO2 slope) correlated highly with the ergoreflex contribution to ventilatory response during handgrip test (r less than or equal to 0.7 P <.0001) but weakly with left ventricular election fraction (r less than or equal to 0.5). Conclusion In chronic heart failure, the overactivity of the ergoreflex is related to a degree of functional limitation and appears, through direct ventilatory and cardiovascular responses, to contribute to the abnormal responses to exercise, explaining the "muscle hypothesis."

关键词：方差分析慢性病运动试验/方法运动试验/统计学和数值数据运动耐量/生理学肌骨骼/神经支配肌骨骼/病理生理学感受器感觉/病理生理学反射/生理学回归分析呼吸老年人女(雌)性人类男(雄)性中年人

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Reliability, validity, and responsiveness of the six-minute walk test in patients with heart failure

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AMERICAN HEART JOURNAL 2001年第4期142卷 698-703页

作者： Demers, C McKelvie, RS Negassa, A Yusuf, S Hamilton Hlth Sci Corp Gen Div Div Cardiol Prevent Cardiol & Therapeut Res Program Hamilton ON L8L 2X2 Canada McMaster Univ Hamilton ON Canada Albert Einstein Coll Med Dept Epidemiol & Social Med Bronx NY 10467 USA

Background Our purpose was to evaluate the reliability, validity, and responsiveness of the 6-minute walk test (6MWT) in patients with heart failure (HF) enrolled in the Randomized Evaluation of Strategies for Left Ventricular Dysfunction (RESOLVD) pilot study. Methods A total of 768 patients was enrolled in a multicenter randomized clinical trial evaluating the effect of candesartan, enalapril, and metoprolol on left ventricular ejection fraction (LVEF), 6MWT distance, neurohormones, and quality of life. The 6MWT was performed once at screening and twice at baseline, 18 weeks, and 43 weeks by a standardized method. Results Test-retest reliability at baseline (intraclass correlation coefficient [ICC] = 0.90), 18 weeks (ICC = 0.88), and 43 weeks (ICC = 0.91) was very good. Baseline 6MWT distance was weakly inversely correlated to the quality-of-life cumulative score (r = -0.26, P = .0001) and moderately inversely correlated to the New York Heart Association functional classification (NYHA-FC) (r = -0.43, P = .001). In the RESOLVD study, the 6MWT was not responsive to change when effect sizes and standardized response means were used. Disease-specific quality of life was responsive to change in patients treated with candesartan and enalapril and NYHA-FC was responsive to change in the candesartan and enalapril combination and for enalapril alone with small effect sizes. The 6MWT, NYHA-FC, and quality of life were not responsive to change during the metoprolol or placebo phase. Conclusions The 6MWT is highly reproducible in patients with symptoms of HF. It is somewhat correlated to NYHA-FC and quality of life. Overall, quality of life was most responsive to change, whereas 6MWT and NYHA-FC were comparable but less responsive to change in the RESOLVD study.

关键词：血管紧张素转换酶抑制药/治疗应用抗高血压药/治疗应用苯咪唑类/治疗应用药物疗法联合依那普利/治疗应用运动试验/统计学和数值数据健康状况心力衰竭/诊断心力衰竭/药物疗法美托洛尔/治疗应用试点项目生活质量问卷调查可重复性结果疾病影响状态调查每搏输出量/药物作用四唑类/治疗应用治疗结果心室功能左/药物作用步行/统计学和数值数据女(雌)性人类男(雄)性中年人

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