Exercise rehabilitation method for PCI postoperative angina pectoris patient based on myocardial perfusion

Abstract

The invention belongs to the technical field of exercise rehabilitation, and aims to solve the problems that at present, expert consensus is mainly used for guiding patients after interventional therapy to perform heart rehabilitation, people are not defined on patients suffering from angina pectoris after PCI (Peripheral Component Interconnect), so that the guidance of the patients on exercise rehabilitation is inaccurate, and the rehabilitation effect is poor. In order to solve the technical problems in the prior art that heart rehabilitation guidance for the patients is lacked at present, a one-stop load myocardial perfusion technology is adopted, cardiopulmonary function evaluation is performed on the patients and exercise intensity is formulated in combination with cardiopulmonary exercise tests, and on the basis of cardiopulmonary exercise test data and clinical data of the patients, the cardiopulmonary exercise intensity is formulated. The microcirculation disturbance is graded by adopting a semi-quantitative index, namely a myocardial perfusion transmural index, and the exercise intensity scheme of a patient is adjusted on this basis. After myocardial perfusion is adopted for evaluation, higher-intensity training is provided for a patient, and the VO2 rising degree is remarkably improved compared with a traditional rehabilitation scheme.

Description

Technical Field

[0001] The present invention belongs to the technical field of sports rehabilitation, and particularly relates to a sports rehabilitation method for patients with angina pectoris after PCI based on myocardial perfusion. Background Art

[0002] At present, international sports rehabilitation has developed vigorously. Data from the National Cardiovascular Data Registry Cath PCI in the United States shows that the proportion of patients participating in sports rehabilitation after PCI in the United States is about 60%. With the deepening of the overall medical concept's understanding of coronary heart disease, the purpose of sports rehabilitation has changed from preventing long-term bedridden-related complications after acute myocardial infarction, improving symptoms and enhancing functional levels to slowing down / inhibiting the progression of atherosclerosis, preventing the development of coronary heart disease, reducing the occurrence of cardiovascular events and lowering the recurrence rate and mortality, extending lifespan, and improving exercise tolerance and quality of life. The rehabilitation after PCI in China is still in its infancy. In recent years, with the continuous improvement of living standards and the influence of factors such as unreasonable dietary structure, China has evolved from a country with a low incidence of coronary heart disease to a level close to the world average. Currently, thousands of hospitals and thousands of interventional doctors in China carry out PCI treatment. By 2021, the number of cases of PCI treatment has exceeded 1 million. The huge population base and the high prevalence rate make the problems brought about by angina pectoris after PCI particularly prominent in China. Therefore, it is more urgent for China to carry out sports rehabilitation after PCI. However, from a safety perspective, whether in developed countries such as Europe and the United States or developing countries such as China, the implementation of sports rehabilitation after PCI is limited by the clinical symptoms of patients. Especially for those patients who still have angina pectoris after PCI, currently, the exercise risk stratification is usually carried out according to expert consensus to guide sports rehabilitation treatment. However, the expert consensus mainly focuses on guiding patients who have undergone interventional treatment to carry out cardiac rehabilitation, and does not define the population as patients with angina pectoris after PCI. Therefore, its guidance for sports rehabilitation treatment is not accurate. At the same time, there is currently a lack of cardiac rehabilitation guidance for such patients. Summary of the Invention

[0003] The purpose of the present invention is to overcome the deficiencies of the prior art and provide a sports rehabilitation method for patients with angina pectoris after PCI based on myocardial perfusion.

[0004] This invention takes patients with angina pectoris occurring again after PCI as the research object. There is currently no clear and unified definition and treatment plan for such patients. At the same time, with the development of interventional technology and the popularization of optimized drug treatment programs, the proportion of angina pectoris after PCI caused by microcirculation disorders is gradually increasing. Clinically, there is still a lack of more reliable methods for non-invasive evaluation of the microcirculation state. At the same time, considering patient safety, once angina pectoris occurs after PCI, the coronary artery situation still needs to be clarified first. Therefore, this invention adopts a one-stop stress myocardial perfusion technology, which can simultaneously evaluate the coronary artery and myocardial perfusion status, clearly exclude angina attacks caused by coronary artery stenosis, and ensure the safety of subsequent cardiac rehabilitation treatment. At the same time, combined with a cardiopulmonary exercise test to evaluate the cardiopulmonary function of patients and formulate exercise intensity. Based on the cardiopulmonary exercise test data and the clinical data of patients, a semi-quantitative index of myocardial perfusion transmural index is used to grade microcirculation disorders, and the exercise intensity plan of patients is adjusted accordingly. Medium-intensity and high-intensity interval exercises are used in the exercise plan, and the intensity index is HRmax, and an individualized target heart rate range is set.

[0005] To achieve the above object, the technical solution adopted by this invention is:

[0006] An exercise rehabilitation method for patients with angina pectoris after PCI based on myocardial perfusion, comprising the following steps:

[0007] S1. Perform coronary artery imaging and resting myocardial perfusion scanning on patients with angina pectoris after PCI;

[0008] S2. After the scanning in step S1 is completed, perform stress myocardial perfusion scanning at an interval of 15 - 20 minutes;

[0009] S3. Reconstruct and analyze the coronary artery images of the scanning images obtained in step S1 and step S2, and analyze the myocardial perfusion status to obtain the transmural perfusion rate of myocardial perfusion;

[0010] S4. Divide different degrees of myocardial perfusion defects according to the values of the transmural perfusion rate obtained in step S3;

[0011] S5. Divide the patients with angina pectoris after PCI into low-risk group patients, medium-risk group patients and high-risk group patients according to the degrees of myocardial perfusion defects obtained in step S4;

[0012] S6. The low-risk group patients and medium-risk group patients in step S5 are rehabilitated by high-intensity interval exercise, and the high-risk group patients in step S5 are rehabilitated by medium-low intensity interval exercise. The exercise frequency is at least 3 times a week, and the rehabilitation training period is 1 year.

[0013] Preferably, in step S1, the parameters for coronary artery imaging scan are: tube voltage 100KV, tube current 300 - 450mAs / rot, slice thickness 0.5mm, interval 0.5mm, field of view 180 - 220mm.

[0014] Preferably, in step S1, the parameters for resting myocardial perfusion scan are: tube voltage 120KV, tube current 350 - 450mAs / rot.

[0015] Preferably, in step S2, the stress myocardial perfusion scan is achieved by the following method:

[0016] Taking adenosine disodium triphosphate for injection as the stress drug, continuously intravenous administrating to patients with angina pectoris after PCI at a speed of 170 - 180ug / kg / min, using the increase of heart rate by 15 - 20 beats as the standard for effective stress, starting stress myocardial perfusion imaging after reaching the standard, and maintaining the drug stress until the end of the scan.

[0017] Preferably, in step S3, the reconstruction and analysis of coronary artery images are achieved by three post - processing methods: maximum intensity projection, curved planar reformation, and volume rendering.

[0018] Preferably, in step S4, the degree of myocardial perfusion defect is divided by the following method:

[0019] When the value of transmural perfusion rate is between 2.5 - 0.99, there is no corresponding myocardial perfusion defect;

[0020] When the value of transmural perfusion rate is between 0.99 - 0.97, it corresponds to mild myocardial perfusion defect;

[0021] When the value of transmural perfusion rate is between 0.97 - 0.94, it corresponds to moderate myocardial perfusion defect;

[0022] When the value of transmural perfusion rate is between 0.94 - 0.60, it corresponds to severe myocardial perfusion defect.

[0023] Preferably, step S5 includes the following steps:

[0024] Dividing patients with angina pectoris after PCI with mild myocardial perfusion defect, moderate myocardial perfusion defect, and severe myocardial perfusion defect into low - risk group patients, medium - risk group patients, and high - risk group patients respectively.

[0025] Preferably, in step S6, the exercise processes of high - intensity interval exercise and medium - low intensity interval exercise both include 10 - minute warm - up, 30 - 60 - minute aerobic training, and 10 - minute relaxation training.

[0026] Preferably, in step S6, during high - intensity interval exercise, the target heart rate of low - risk group patients and medium - risk group patients is 80% - 90% of the maximum heart rate.

[0027] Preferably, in step S6, during moderate-to-low intensity intermittent exercise, the target heart rate of high-risk group patients is 50%-70% of the maximum heart rate.

[0028] Compared with the prior art, the beneficial effects of the present invention are as follows:

[0029] (1) The present invention adopts a design of stress myocardial perfusion, which can simultaneously evaluate the coronary artery and myocardial perfusion status, clearly exclude angina attacks caused by coronary stenosis, and ensure the safety of subsequent cardiac rehabilitation treatment;

[0030] (2) The present invention uses the semi-quantitative index of myocardial perfusion transmural perfusion rate to grade microcirculation disorders, group patients based on this, and adjust and formulate corresponding intensity exercise rehabilitation programs to ensure that the enrolled patients can fully guarantee the exercise intensity during exercise;

[0031] (3) The present invention implements a high-intensity intermittent exercise rehabilitation training program for patients who are determined to be high-risk by expert consensus but whose myocardial perfusion does not indicate severe ischemic changes, which can significantly change the maximum oxygen uptake of the patients, and no serious adverse events occur during the training process. The above results show that for high-risk PCI postoperative patients, performing one-stop stress myocardial perfusion scanning after recurrent angina can not only further clarify the causes of angina attacks (residual stenosis, in-stent restenosis, in-stent thrombosis, etc.), but also provide guidance for further exercise rehabilitation programs. Brief Description of the Drawings

[0032] Figure 1 It is a diagram showing the degree of myocardial perfusion defect; (a) resting scan, (b) stress scan;

[0033] Figure 2 It is a flow chart of the enrollment of the stress myocardial perfusion group and the traditional rehabilitation group;

[0034] Figure 3 It is a road map of exercise rehabilitation for the stress myocardial perfusion group and the traditional rehabilitation group;

[0035] Figure 4 It is a flow chart of the grouping and exercise rehabilitation training of the stress myocardial perfusion group and the traditional rehabilitation group. Detailed Embodiments

[0036] The following will be combined with the embodiments of the present invention Figures 1 to 4, the technical solutions in the embodiments of the present invention are clearly and completely described. Obviously, the described embodiments are only a part of the embodiments of the present invention, rather than all the embodiments. Based on the embodiments of the present invention, all other embodiments obtained by those of ordinary skill in the art without creative efforts shall fall within the protection scope of the present invention.

[0037] An embodiment of the present invention provides a method for exercise rehabilitation of angina pectoris patients after PCI based on myocardial perfusion, including the following steps:

[0038] S1. Perform coronary artery imaging and resting myocardial perfusion scanning on angina pectoris patients after PCI;

[0039] S2. After the scanning in step S1 is completed, perform stress myocardial perfusion scanning at an interval of 15-20 minutes;

[0040] The scanning sequences of step S1 and step S2 are basically the same. All examinations are performed using a 320-slice dynamic volume CT (manufacturer: Toshiba Corporation, Japan; origin: Japan). The prospective electrocardiogram-triggered technology target interval scanning mode (generally set as the cardiac cycle) is adopted. After all preparations are ready, double localizer scans are performed. The scanning range is from the tracheal bifurcation to the left and right under the diaphragmatic surface of the heart, and breath-holding scanning is performed. First, perform a plain scan of the coronary artery calcium score. Scanning parameters: tube voltage 100KV, tube current 300-450mAs / rot (set according to the BMI value and corresponding body type of the subject), slice thickness 0.5mm, interval 0.5mm, field of view (FOV) 180-220mm. Then, continuous acquisition scanning is performed at a conventional dose in the electrocardiogram-gated dynamic volume scanning mode. During the scanning process, a non-ionic contrast agent iopromide (370mg I / mL) produced by Schering AG, 50-60ml, is injected through the right antecubital vein using a double-barrel high-pressure syringe. After injection, normal saline is injected to flush the tube at the same flow rate. The enhancement range is set to be the same as that in the plain scan. Scanning parameters: tube voltage 120KV, tube current 350-450mAs / rot. The intelligent trigger scanning system of the application software selects the proximal part of the thoracic aorta as the region of interest for value monitoring. When the density in the region of interest reaches the preset value, coronary artery imaging and resting myocardial perfusion scanning are automatically started, and the electrocardiogram is synchronously recorded during the scanning process. The heart is scanned using the prospective electrocardiogram-triggered technology interval scanning. Scanning parameters: tube voltage 100KV, tube current 300-400mAs / rot.

[0041] After the scanning in step S1 is completed, stress myocardial perfusion scanning is performed at an interval of 15-20 minutes; specifically, adenosine disodium triphosphate for injection is used as the stress drug, and it is continuously administered intravenously using an infusion pump at a speed of 170-180ug / kg / min. The standard for effective stress is an increase in heart rate by 15-20 beats. After reaching this standard, stress myocardial perfusion imaging is started, and the drug stress is maintained until the end of the scanning.

[0042] S3. Reconstruct and analyze the coronary artery images from the scan images obtained in steps S1 and S2, and analyze the myocardial perfusion status to obtain the transmural perfusion rate of myocardial perfusion.

[0043] After the scan in step S2 is completed, the scan image data obtained in steps S1 and S2 are transmitted to a post-processing workstation. Two experienced physicians (including a cardiologist and a full-time radiologist) reconstruct and analyze the obtained CCTA images by three post-processing methods: maximum intensity projection (MIP), curved reconstruction (CPR), and volume rendering (VR) without knowing the patient's clinical data and angiography results. At the same time, a myocardial perfusion software is used to analyze the myocardial perfusion status. For controversial CCTA images, the two doctors jointly review the films and discuss to resolve.

[0044] The myocardial perfusion software divides the left ventricle into three equal parts: the basal part, the middle part, and the apical part perpendicular to the long axis of the ventricle according to the standards formulated by the American Heart Association, and a total of 17 segments are displayed. Myocardial perfusion indicators include:

[0045] Attenuation density (AD) = mean myocardial HU - basal HU

[0046] Perfusion index (PI): Calculated segmentally and the values are displayed on a polar plot. Calculated by the following formula:

[0047] PI = mean myocardial density attenuation / left ventricular blood pool density attenuation

[0048] Contrast Map: Colors are assigned according to the value of AD for imaging; Contrast is calculated segmentally. This parameter reflects the distribution of contrast agent in the myocardium, and the calculation method is the same as that of AD. Calculated by the following formula:

[0049] Contrast = mean myocardial HU - basal HU

[0050] Transmural perfusion rate (TPR): Calculated segmentally. The myocardium is divided into endocardium, myocardium, and epicardium. The ratio of the endocardial AD of each segment to the epicardial AD of its corresponding layer is the TPR.

[0051] S4. Divide different degrees of myocardial perfusion defects according to the value of the transmural perfusion rate obtained in step S3.

[0052] When the TPR < 0.99, it is defined as the existence of myocardial perfusion defect. The 5-color map uses different colors to represent the degree of perfusion defect according to different TPR values. For example, Figure 1 As shown, the specific degree of myocardial perfusion defect is divided by the following method:

[0053] When the value of the transmural perfusion rate is between 2.5 - 0.99, there is no corresponding myocardial perfusion defect, indicating a low risk, and higher-intensity exercise rehabilitation training can be carried out; it is represented as blue;

[0054] When the value of the transmural perfusion rate is between 0.99 - 0.97, it corresponds to mild myocardial perfusion defect and is represented as green;

[0055] When the value of the transmural perfusion rate is between 0.97 - 0.94, it corresponds to moderate myocardial perfusion defect and is represented as yellow;

[0056] When the value of the transmural perfusion rate is between 0.94 - 0.60, it corresponds to severe myocardial perfusion defect and is represented as orange.

[0057] S5. According to the degree of myocardial perfusion defect obtained by dividing in step S4, the patients with angina pectoris after PCI are divided into low-risk group patients, medium-risk group patients, and high-risk group patients. The specific steps are as follows:

[0058] The patients with angina pectoris after PCI with mild myocardial perfusion defect, moderate myocardial perfusion defect, and severe myocardial perfusion defect are respectively divided into low-risk group patients, medium-risk group patients, and high-risk group patients.

[0059] S6. The low-risk group patients and medium-risk group patients in step S5 carry out rehabilitation training with high-intensity interval exercise, and the high-risk group patients in step S5 carry out rehabilitation training with medium-low-intensity interval exercise. The exercise frequency is at least 3 times per week, and the rehabilitation training period is 1 year.

[0060] In the embodiments of the present invention, the exercise processes of high-intensity interval exercise and medium-low-intensity interval exercise both include 10 minutes of warm-up, 30 - 60 minutes of aerobic training, and 10 minutes of relaxation training.

[0061] In the embodiments of the present invention, during high-intensity interval exercise, the target heart rate of the low-risk group patients and medium-risk group patients is 80% - 90% of the maximum heart rate.

[0062] In the embodiments of the present invention, during medium-low-intensity interval exercise, the target heart rate of the high-risk group patients is 50% - 70% of the maximum heart rate.

[0063] Next, the effect of the exercise rehabilitation method for patients with angina pectoris after PCI based on myocardial perfusion provided by the embodiments of the present invention is evaluated

[0064] I. Research method

[0065] 1. Research objects and grouping

[0066] As Figure 2 and Figure 3 shown, patients who underwent PCI surgery and developed angina pectoris after the surgery between September 2017 and December 2020 were selected. A total of 121 patients were included in this invention. Inclusion criteria:

[0067] (1) Having undergone PCI surgery and with residual vascular stenosis < 50%;

[0068] (2) Having angina pectoris symptoms after PCI surgery. Currently, there is no unified definition of angina pectoris after PCI surgery. Based on the actual situation during the development of this invention, the invention defines that the patient has the same symptoms as before the surgery again 3 months after successful PCI, and more than 3 attacks within half a year as angina pectoris after PCI surgery. The remission of angina pectoris symptoms is defined as no angina pectoris attack after 6 months of exercise rehabilitation treatment;

[0069] (3) Aged 18 - 75 years old, regardless of gender;

[0070] (4) The patient voluntarily participates in this study and signs an informed consent form.

[0071] Exclusion criteria: (1) Angina pectoris caused by non - PCI surgery; (2) Patients allergic to relevant drugs; (3) Those who do not cooperate with this study, such as patients with severe mental disorders, etc.; (4) Hemodynamic instability; (5) Severe left ventricular dysfunction (LVEF < 40%); (6) Severe arrhythmias (such as sick sinus syndrome, atrioventricular block above the second degree, etc.); (7) Systolic blood pressure higher than 200 mmHg or lower than 80 mmHg, or diastolic blood pressure lower than 50 mmHg; (8) Severe aortic stenosis and obstructive hypertrophic cardiomyopathy; (9) Complicated with severe renal insufficiency (creatinine > 1.5 mg / dL); (10) Severe artifacts and poor image quality; (11) Unable to perform exercise rehabilitation due to limb movement disorders caused by other diseases; (12) Patients with diseases such as chronic obstructive pulmonary disease, bronchial asthma, tumors, etc.

[0072] Grouping method: A total of 121 patients were included in the study. Among them, 47 patients were included in the stress myocardial perfusion group, and 74 patients were included in the traditional rehabilitation group. The stress myocardial perfusion group was trained and rehabilitated using the exercise rehabilitation method of the embodiment of this invention.

[0073] 2. Requirements and operation procedures for exercise rehabilitation of patients with angina pectoris after PCI

[0074] As Figure 4As shown, the exercise rehabilitation programs for all enrolled patients were implemented with reference to the "Chinese Expert Consensus on Exercise Therapy for Coronary Heart Disease Patients" and the "Expert Consensus on Exercise Rehabilitation after Percutaneous Coronary Intervention" formulated by the Chinese Society of Cardiology and the Professional Committee of Prevention and Rehabilitation of Cardiovascular Medicine of the Chinese Medical Doctor Association. In the traditional rehabilitation group, patients were stratified according to the exercise risk in the expert consensus, including low-risk group (mild group), medium-risk group (moderate group), and high-risk group (severe group) patients. In the load myocardial perfusion group, the exercise risk stratification after PCI in the expert consensus was no longer used. Instead, patients with angina pectoris after PCI with mild myocardial perfusion defect, moderate myocardial perfusion defect, and severe myocardial perfusion defect were classified as low-risk group (mild group), medium-risk group (moderate group), and high-risk group (severe group) patients, respectively.

[0075] Among them, when the value of the transmural perfusion rate is between 2.5 and 0.99, there is no corresponding myocardial perfusion defect;

[0076] When the value of the transmural perfusion rate is between 0.99 and 0.97, it corresponds to mild myocardial perfusion defect;

[0077] When the value of the transmural perfusion rate is between 0.97 and 0.94, it corresponds to moderate myocardial perfusion defect;

[0078] When the value of the transmural perfusion rate is between 0.94 and 0.60, it corresponds to severe myocardial perfusion defect.

[0079] During the specific implementation process, the exercise intensity was formulated according to the risk stratification and cardiopulmonary exercise test data of the two groups of patients. Patients in the low- and medium-risk groups adopted high-intensity interval exercise, and patients in the high-risk group adopted medium- and low-intensity interval exercise for rehabilitation training. The exercise intensity was defined by the heart rate (HRmax) at the maximum oxygen consumption. The target heart rate for the high-intensity group was 80%-90% HRmax, and the target heart rate for the medium- and low-intensity group was 50%-70% HRmax. The exercise process included warm-up (10 minutes), aerobic training (30-60 minutes), and relaxation training (10 minutes). The exercise frequency was at least 3 times a week. The first month of the program was supervised training in the hospital, and then mainly home training. The exercise method was freely selected according to the patient's condition. The heart rate compliance was recorded using wearable devices during the exercise process. The research group supervised once a week within 6 months after the implementation of the program, and the patients managed themselves after 6 months. All patients underwent cardiopulmonary exercise tests before starting exercise rehabilitation, 3 months, 6 months, and 12 months after implementation. At the same time, patients in the load myocardial perfusion group underwent myocardial perfusion scans before and 12 months after the implementation of the program.

[0080] 3. Evaluation indicators

[0081] The angina pectoris attack conditions, cardiopulmonary exercise test data, and myocardial perfusion indexes of the two groups of patients before and after exercise rehabilitation were evaluated, including attenuation density (AD), perfusion index (PI), contrast map, transmurally perfusion rate (TPR), etc.

[0082] Safety analysis: Adverse events were recorded during the implementation of the plan. The main adverse events included deterioration of angina pectoris, acute myocardial infarction, sudden death, syncope, etc.; at the same time, pain related to exercise was recorded, including pain in the limbs and trunk, joint pain, etc.

[0083] 4. Statistical analysis

[0084] All data were analyzed using SPSS statistical software version 19.0. Continuous variables were expressed as mean ± standard deviation or median and interquartile range, and categorical variables were expressed as percentages or frequencies. The normal distribution test was performed on continuous variables. For continuous variables that conform to the normal distribution, independent sample t-tests were used for pairwise comparisons. For continuous variables that did not conform to the normal distribution in the normality test, the Mann-Whitney U rank sum test was used. The statistics of categorical variables were compared using the χ2 test or Fisher's exact probability method. Pearson correlation analysis or Spearman correlation coefficient analysis was used to analyze the correlation between the improvement degree of TPR and exercise intensity. All statistical analyses used two-sided tests, and P < 0.05 was considered statistically significant.

[0085] 5. Quality control

[0086] Image processing and data measurement were performed by 3 cardiologists with experience in post-processing CT images and 1 radiologist respectively. The data obtained by the 3 cardiologists were averaged. If there were large biases, the radiologist would measure again to remove the data with large biases.

[0087] The implementation of exercise rehabilitation was the responsibility of the attending physician who was familiar with the patient's condition, and the quality management of exercise rehabilitation was the responsibility of a deputy chief physician of cardiology who specialized in cardiac rehabilitation. In terms of quality control, the exercise target heart rate of patients was monitored. The research group provided (heart rate belt) or the patients brought their own wearable devices (such as bracelets) for heart rate monitoring during exercise. The research group members summarized the exercise target heart rate of patients once a week, and focused on supervising those with unqualified exercise heart rates.

[0088] II. Research results

[0089] 1. Description of baseline characteristics

[0090] A total of 121 patients were finally included in this study, including 74 cases in the traditional rehabilitation group and 47 cases in the load myocardial perfusion rehabilitation group. The baseline characteristics of the two groups of patients are shown in Table 1 below.

[0091] Table 1 Baseline Data of Patients

[0092]

[0093] Note: The data in the table are expressed as percentage n(%), mean ± standard deviation. P < 0.05 indicates that there is a statistically significant difference between the two. VO2: maximal oxygen uptake; HR: heart rate (when reaching maximal oxygen uptake); O2pulse: oxygen pulse; MET: metabolic equivalent of task.

[0094] From the results of Table 1, it can be seen that there are significant differences in VO2 (L / min), prevalence of hyperlipidemia, and low-density lipoprotein cholesterol levels between the two groups of patients (P < 0.05), and there are no obvious differences in the remaining indicators.

[0095] 2. Stratified Statistical Results

[0096] According to the risk stratification method of the two groups described above, the two groups of patients were divided into high-risk group, medium-risk group, and low-risk group, and the medium-risk group and low-risk group were collectively referred to as the medium-low-risk group; the parameter statistics among the groups are shown in Table 2 and Table 3 as follows:

[0097] Table 2 Baseline Data of Traditional Rehabilitation Group

[0098]

[0099] Note: The data in the table are expressed as percentage n(%), mean ± standard deviation. P < 0.05 indicates that there is a statistically significant difference between the two. VO2: maximal oxygen uptake; HR: heart rate (when reaching maximal oxygen uptake); O2pulse: oxygen pulse; MET: metabolic equivalent of task.

[0100] Table 3 Baseline Data of Load Myocardial Perfusion Group

[0101]

[0102] From the results of Table 2 and Table 3, it can be seen that there are no obvious statistical differences in cardiopulmonary exercise parameters between the high-risk group and the medium-low-risk group, whether in the traditional rehabilitation group or the load myocardial perfusion group.

[0103] 3. Analysis of Main Variables and Secondary Variables

[0104] 3.1. Angina Symptoms

[0105] The research subjects included in the study were patients with angina pectoris after PCI. Currently, there is no clear definition for angina pectoris after PCI. In this study, patients who had the same symptoms as before surgery again 3 months after successful PCI and had more than 3 attacks within half a year were defined as having angina pectoris after PCI. The remission of angina pectoris symptoms was defined as no angina pectoris attacks after 6 months of exercise rehabilitation treatment. After the two groups of patients underwent the corresponding rehabilitation program training, the remission of angina pectoris symptoms was shown in Table 4 below.

[0106] Table 4 Remission of angina pectoris symptoms in the two groups

[0107]

[0108] The remission rate of angina pectoris in the traditional rehabilitation group was 82.43%, and the remission rate of angina pectoris in the stress myocardial perfusion group was 78.72%. There was no significant difference between the two.

[0109] 3.2. Changes in VO2

[0110] After 6 months of exercise rehabilitation, the changes in VO2 of the patients in the traditional rehabilitation group and the stress myocardial perfusion group were shown in Table 5 and Table 6 below.

[0111] Table 5 Changes in VO2 in the traditional rehabilitation group

[0112]

[0113] From the results in Table 5, it can be seen that after 6 months of exercise rehabilitation in the patients of the traditional rehabilitation group, a cardiopulmonary exercise test was performed, and the test results showed no significant statistical difference between the high-risk group and the medium-low risk group.

[0114] Table 6 Changes in VO2 in the stress myocardial perfusion group

[0115]

[0116] From the results in Table 6, it can be seen that after 6 months of exercise rehabilitation in the patients of the stress myocardial perfusion group, a cardiopulmonary exercise test was performed, and the test results showed no significant statistical difference between the high-risk group and the medium-low risk group.

[0117] 4. Multivariate analysis

[0118] 4.1. Comparison results between the medium-low risk group in the stress myocardial perfusion group and the high-risk group in the traditional rehabilitation group

[0119] The above research results show that after 6 months of exercise rehabilitation in the two groups of patients, there was no significant statistical difference in the change of VO2 between the high-risk group and the medium-low risk group. Re-analysis found that the medium-low risk group in the stress myocardial perfusion group could be defined as the high-risk group according to the judgment criteria of the traditional rehabilitation group. The comparison results of the cardiopulmonary exercise test of the medium-low risk group in the stress myocardial perfusion group and the high-risk group patients in the traditional rehabilitation group after 6 months of exercise rehabilitation are shown in Table 7 below.

[0120] Table 7 Comparison results of VO2 changes

[0121]

[0122] Note: The data in the table are expressed as percentage n(%), mean ± standard deviation. P < 0.05 indicates that there is a statistically significant difference between the two. VO2: maximum oxygen uptake; HR: heart rate (when reaching the maximum oxygen uptake); O2pulse: oxygen pulse; MET: metabolic equivalent; * represents a statistically significant difference; mo: month.

[0123] It can be seen from the results of Table 7 that after evaluation by myocardial perfusion and giving higher-intensity training, the increase in VO2 was significantly higher than that of the traditional rehabilitation program.

[0124] To sum up, the expert consensus on cardiac rehabilitation after PCI is very strict in risk stratification, especially for the determination of high-risk patients. However, its purpose is mainly to guide patients undergoing interventional treatment to carry out cardiac rehabilitation, and it does not define the population as patients with angina after PCI. At the same time, there is currently a lack of cardiac rehabilitation guidance for such patients. Through research, the present invention found that when using the suggestions of the consensus for risk stratification of patients, although some patients with angina after PCI were judged as high-risk patients by the consensus and needed to undergo moderate-intensity rehabilitation training based on safety considerations, their stress myocardial perfusion did not indicate severe ischemic changes. Based on this discovery, we re-adjusted the patients to a high-intensity training program. Analysis of the maximum oxygen uptake after 6 months of exercise rehabilitation found that the change in the maximum oxygen uptake of such patients was more obvious, and at the same time, no serious adverse events occurred during the training process. Therefore, the present invention believes that for high-risk patients after PCI, performing one-stop stress myocardial perfusion scanning after recurrent angina can not only further clarify the causes of angina attacks (residual stenosis, in-stent restenosis, in-stent thrombosis, etc.), but also provide guidance for further exercise rehabilitation programs.

[0125] The present invention uses VO2max as the main monitoring and evaluation index, which refers to the maximum amount of oxygen that the human body can uptake per unit time when all the reserves of each link of the oxygen transport system have been mobilized to the highest level during the load exercise participated by large muscle groups. During the exercise process with gradually increasing exercise load, when VO2 no longer increases with the increase of exercise load and a plateau appears, the VO2 at this time is called VO2max. However, subjects often terminate the exercise before the plateau appears. Therefore, peak VO2, which is the highest point of VO2 during exercise, is commonly used clinically to replace VO2max. VO2max is currently recognized as an important index reflecting cardiopulmonary exercise function and is the gold standard for evaluating aerobic exercise capacity. It has significant individual differences with different ages, genders, heights, body masses, exercise types, and daily activity levels. VO2max is related to the exercise program. The more muscle groups participating in the exercise, the larger its value. Therefore, the value measured by treadmill exercise is generally 10%-11% higher than that by cycle exercise. In the research, the present invention found that with the extension of exercise rehabilitation time, the VO2 of each group of patients showed an upward trend, indicating that no matter what kind of program is adopted, it can produce a positive effect on improving the body's oxygen uptake ability and cardiopulmonary function. Although there was no significant difference in VO2 among different exercise intensity groups within each group, by comparing the low- and medium-risk groups in the myocardial perfusion group with the high-risk group in the traditional rehabilitation group, it was found that after evaluation by myocardial perfusion and giving a higher-intensity training, the increase in VO2 was significantly higher than that of the traditional rehabilitation program. This result suggests that under the condition of ensuring safety measures, increasing the exercise intensity is an effective means to improve the patient's condition.

[0126] Although the embodiments of the present invention have been shown and described, those of ordinary skill in the art can understand that various changes, modifications, substitutions, and variations can be made to these embodiments without departing from the principles and purposes of the present invention. The scope of the present invention is defined by the claims and their equivalents.

Claims

1. A method for exercise rehabilitation of patients with angina pectoris after PCI based on myocardial perfusion, characterized in that, It includes the following steps: S1. Perform coronary angiography and resting myocardial perfusion scanning on patients with angina pectoris after PCI; S2. After the scanning in step S1 is completed, perform stress myocardial perfusion scanning at an interval of 15 - 20 minutes; S3. Reconstruct and analyze the coronary artery images of the scanning images obtained in steps S1 and S2, and analyze the myocardial perfusion status to obtain the transmural perfusion rate of myocardial perfusion; S4. Divide different degrees of myocardial perfusion defects according to the values of the transmural perfusion rate obtained in step S3; S5. Divide the patients with angina pectoris after PCI into low - risk group patients, medium - risk group patients and high - risk group patients according to the degrees of myocardial perfusion defects divided in step S4; S6. The low - risk group patients and medium - risk group patients in step S5 carry out rehabilitation training with high - intensity interval exercise, and the high - risk group patients in step S5 carry out rehabilitation training with medium - low - intensity interval exercise. The exercise frequency is at least 3 times per week, and the rehabilitation training period is 1 year.

2. The exercise rehabilitation method for angina pectoris patients after PCI based on myocardial perfusion according to claim 1, wherein In step S1, the parameters of coronary angiography scanning are: tube voltage 100KV, tube current 300 - 450mAs / rot, slice thickness 0.5mm, interval 0.5mm, field of view 180 - 220mm.

3. The method for exercise rehabilitation of angina pectoris patients after PCI based on myocardial perfusion according to claim 1, wherein In step S1, the parameters of resting myocardial perfusion scanning are: tube voltage 120KV, tube current 350 - 450mAs / rot.

4. The method for exercise rehabilitation of angina pectoris patients after PCI based on myocardial perfusion according to claim 1, wherein In step S2, the stress myocardial perfusion scanning is achieved by the following method: Take adenosine disodium triphosphate for injection as the stress drug, continuously administer it intravenously to the patients with angina pectoris after PCI at a speed of 170 - 180ug / kg / min. Take the increase in heart rate by 15 - 20 beats as the standard for effective stress. After reaching the standard, start stress myocardial perfusion imaging, and maintain the drug stress until the scanning is completed.

5. The exercise rehabilitation method for angina pectoris patients after PCI based on myocardial perfusion according to claim 1, wherein, In step S3, the reconstruction and analysis of coronary artery images are achieved through three post - processing methods: maximum intensity projection, curved planar reformation and volume rendering.

6. The method for exercise rehabilitation of angina pectoris patients after PCI based on myocardial perfusion according to claim 1, characterized in that In step S4, the degree of myocardial perfusion defect is divided by the following method: When the value of the transmural perfusion rate is between 2.5 - 0.99, there is no corresponding myocardial perfusion defect; When the value of the transmural perfusion rate is between 0.99 - 0.97, it corresponds to mild myocardial perfusion defect; When the value of the transmural perfusion rate is between 0.97 - 0.94, it corresponds to moderate myocardial perfusion defect; When the value of the transmural perfusion rate is between 0.94 - 0.60, it corresponds to severe myocardial perfusion defect.

7. The method for exercise rehabilitation of angina pectoris patients after PCI based on myocardial perfusion according to claim 6, wherein, Step S5 includes the following steps: Divide the patients with angina pectoris after PCI with mild myocardial perfusion defect, moderate myocardial perfusion defect and severe myocardial perfusion defect into low - risk group patients, medium - risk group patients and high - risk group patients respectively.

8. The method for exercise rehabilitation of angina pectoris patients after PCI based on myocardial perfusion according to claim 1, wherein In step S6, the exercise processes of high - intensity interval exercise and medium - low - intensity interval exercise both include 10 - minute warm - up, 30 - 60 - minute aerobic training and 10 - minute relaxation training.

9. The method for exercise rehabilitation of angina pectoris patients after PCI based on myocardial perfusion according to claim 1, wherein, In step S6, during high - intensity interval exercise, the target heart rate of low - risk group patients and medium - risk group patients is 80% - 90% of the maximum heart rate.

10. The method for exercise rehabilitation of angina pectoris patients after PCI based on myocardial perfusion according to claim 1, wherein, In step S6, during medium - low - intensity interval exercise, the target heart rate of high - risk group patients is 50% - 70% of the maximum heart rate.

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