A myocardial perfusion-based exercise rehabilitation method for post-pci angina pectoris patients

Abstract

The present application belongs to the technical field of sports rehabilitation, and aims at the technical problem that the current expert consensus is mainly to guide the patients after interventional therapy to carry out cardiac rehabilitation, and the population is not defined on the patients with angina after PCI, so the guidance of sports rehabilitation treatment is not accurate, and there is currently a lack of cardiac rehabilitation guidance technology for such patients. The present application adopts one-stop load myocardial perfusion technology, and combines cardiopulmonary exercise test to evaluate the cardiopulmonary function of the patient and formulate the exercise intensity. On the basis of the cardiopulmonary exercise test data and the clinical data of the patient, the transmural index of myocardial perfusion, a semi-quantitative index, is used to grade the microcirculation disorder, and the exercise intensity scheme of the patient is adjusted on this basis. After the evaluation of the present application by myocardial perfusion, the patient is given higher intensity training, and the degree of increase of VO2 is significantly improved compared with the traditional rehabilitation scheme.

Description

TECHNICAL FIELD

[0001] The application belongs to the technical field of sports rehabilitation, and particularly relates to a PCI postoperative angina pectoris patient sports rehabilitation method based on myocardial perfusion. BACKGROUND

[0002] At present, international sports rehabilitation is booming, and the Cath PCI registration research data of the American National Cardiovascular Database shows that the proportion of PCI postoperative participation in sports rehabilitation in the United States is about 60%. With the gradual deepening of the overall concept of medicine on coronary heart disease, sports rehabilitation has changed from the purpose of preventing long-term bed-related complications after acute myocardial infarction, improving symptoms and improving functional level to the purpose of slowing down / inhibiting the progression of atherosclerosis, preventing the development of coronary heart disease, reducing the occurrence of cardiovascular events and mortality, prolonging life, improving exercise tolerance and quality of life. China's PCI postoperative rehabilitation is still in its infancy. In recent years, with the continuous improvement of living standards, the role of unreasonable dietary structure and other factors, China has evolved from a low incidence of coronary heart disease country to close to the world average. At present, there are thousands of hospitals and thousands of interventional doctors in China to carry out PCI treatment. By 2021, the number of PCI treatments has exceeded 1 million. The huge population base and high prevalence rate make the problems brought by PCI postoperative angina pectoris particularly prominent in China. Therefore, China urgently needs to carry out PCI postoperative sports rehabilitation. However, from the safety point of view, whether in developed countries such as Europe and the United States or in developing countries such as China, the development of PCI postoperative sports rehabilitation is limited by the clinical symptoms of patients, especially those who still have angina pectoris after PCI. At present, the exercise risk stratification is usually carried out according to the expert consensus to guide the exercise rehabilitation treatment, but the expert consensus is mainly to guide the cardiac rehabilitation of patients after interventional treatment, and does not define the population to PCI postoperative angina pectoris patients, so its guidance for exercise rehabilitation treatment is not accurate, and at present there is a lack of cardiac rehabilitation guidance for such patients. SUMMARY

[0003] The purpose of the application is to overcome the shortcomings of the prior art and provide a PCI postoperative angina pectoris patient sports rehabilitation method based on myocardial perfusion.

[0004] The present invention takes patients who suffer from angina pectoris again after PCI as the research subjects. 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 plans, the proportion of angina pectoris after PCI caused by microcirculatory disorders is gradually increasing. Clinically, there is still a lack of more reliable methods for non-invasive evaluation of microcirculatory status. At the same time, based on patient safety considerations, once angina pectoris after PCI occurs, the coronary artery condition still needs to be clarified first. Therefore, the present invention adopts a one-stop load 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 cardiopulmonary exercise testing, the cardiopulmonary function of the patient is evaluated and the exercise intensity is formulated. Based on the cardiopulmonary exercise test data and the patient's clinical data, the semi-quantitative index of myocardial perfusion transmural index is used to grade microcirculatory disorders, and the patient's exercise intensity plan is adjusted based on this. Moderate-intensity and high-intensity intermittent exercise are used in the exercise plan, and HRmax is used as the intensity index to set an individualized target heart rate range.

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

[0006] A method for exercise rehabilitation of 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 in patients with angina after PCI;

[0008] S2. After the scan in step S1 is completed, a stress myocardial perfusion scan is performed every 15-20 minutes;

[0009] S3, reconstructing and analyzing the coronary artery images of the scanned images obtained in step S1 and step S2, and analyzing the myocardial perfusion state to obtain the transmural perfusion rate of the myocardial perfusion;

[0010] S4, obtaining different degrees of myocardial perfusion defect according to the numerical value of the transmural perfusion rate obtained in step S3;

[0011] S5, dividing the patients with angina pectoris after PCI into a low-risk group, a medium-risk group, and a high-risk group according to the degree of myocardial perfusion defect obtained in step S4;

[0012] S6. The low-risk group and the medium-risk group in step S5 adopt high-intensity intermittent exercise for rehabilitation training, and the high-risk group in step S5 adopt medium- and low-intensity intermittent exercise for rehabilitation training. The exercise frequency is at least 3 times a week, and the rehabilitation training cycle is 1 year.

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

[0014] Preferably, in step S1, the parameters of the 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] Adenosine disodium triphosphate for injection is used as the stress drug, and is continuously administered intravenously to the patient with angina pectoris after PCI at a speed of 170-180ug / kg / min. The increase of heart rate by 15-20 times is used as the standard of stress effectiveness. After the standard is reached, the stress myocardial perfusion imaging is started, and the drug stress is maintained until the end of the scan.

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

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

[0019] When the transmural perfusion rate is 2.5-0.99, it corresponds to the absence of myocardial perfusion defect.

[0020] When the transmural perfusion rate is 0.99-0.97, it corresponds to mild myocardial perfusion defect.

[0021] When the transmural perfusion rate is 0.97-0.94, it corresponds to moderate myocardial perfusion defect.

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

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

[0024] The patients with mild myocardial perfusion defect, moderate myocardial perfusion defect and severe myocardial perfusion defect after PCI are classified into low-risk group, moderate-risk group and high-risk group, respectively.

[0025] Preferably, in step S6, the exercise process of high-intensity intermittent exercise and low-to-moderate intensity intermittent exercise both includes 10 minutes of warm-up, 30-60 minutes of aerobic training, and 10 minutes of relaxation training.

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

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

[0028] Compared with the prior art, the present application has the beneficial effects of:

[0029] (1) The present application adopts the design of load myocardial perfusion, which can evaluate the perfusion states of coronary arteries and myocardium at the same time, and definitely excludes angina attacks caused by coronary stenosis, so that the safety of subsequent cardiac rehabilitation treatment is ensured.

[0030] (2) The present application adopts the semi-quantitative index of myocardial perfusion transmural perfusion rate to grade microcirculatory disorders, and uses it to group patients and adjust and formulate corresponding intensity of exercise rehabilitation programs, so as to ensure that the enrolled patients can fully ensure the exercise intensity during exercise.

[0031] (3) The present application can significantly change the maximum oxygen uptake of patients by implementing high-intensity intermittent exercise rehabilitation training programs for patients who are determined as high-risk patients by expert consensus but do not have severe ischemic changes in myocardial perfusion, and no serious adverse events occur in patients during training. Through the above results, it is shown that for high-risk PCI postoperative patients, after a one-stop load myocardial perfusion scan after the recurrence of angina pectoris, not only can the causes of angina pectoris (residual stenosis, in-stent restenosis, in-stent thrombosis, etc.) be further determined, but also can provide guidance for further exercise rehabilitation programs. BRIEF DESCRIPTION OF DRAWINGS

[0032] Figure 1 is a diagram of the degree of myocardial perfusion defect; (a) rest scan, (b) load scan;

[0033] Figure 2 is a flowchart of the enrollment of the load myocardial perfusion group and the traditional rehabilitation group;

[0034] Figure 3 is a flowchart of the enrollment of the load myocardial perfusion group and the traditional rehabilitation group;

[0035] Figure 4 is a flowchart of the enrollment of the load myocardial perfusion group and the traditional rehabilitation group. DETAILED DESCRIPTION

[0036] The specific implementation of the present application will be described below with reference to the accompanying drawings. Figures 1 to 4The technical solutions in the embodiments of the present application are clearly and completely described, and obviously, the described embodiments are only part of the embodiments of the present application, rather than all the embodiments. Based on the embodiments in the present application, all other embodiments obtained by those skilled in the art without creative work fall within the protection scope of the present application.

[0037] The embodiment of the present application provides a myocardial perfusion based exercise rehabilitation method for a PCI postoperative angina pectoris patient, which comprises the following steps:

[0038] S1, performing coronary artery imaging and resting myocardial perfusion scanning on the PCI postoperative angina pectoris patient;

[0039] S2, after the scanning in step S1 is completed, performing load myocardial perfusion scanning after 15-20 minutes;

[0040] The scanning sequences in step S1 and step S2 are basically the same, all the examinations adopt 320-row dynamic volume CT (manufacturer: Toshiba Company, Japan; place of production: Japan), adopts prospective electrocardio trigger technology target interval scanning mode (generally set as a heart cycle), and after all preparations are completed, performs double positioning image scanning, the scanning range is from the tracheal bifurcation to the left and right of the diaphragmatic surface of the heart, and the scanning is performed in a breath-holding manner. First, perform coronary artery calcification integral plain scanning, the scanning parameters are as follows: tube voltage 100KV, tube current 300-450mAs / rot (set according to the BMI value and the corresponding body shape of the examinee), layer thickness 0.5mm, interval 0.5mm, field of view (FOV) 180-220mm. Then, continuously collect scanning in a conventional dose under the electrocardio gated dynamic volume scanning mode, and in the scanning process, a double-barreled high-pressure injector is used to inject 50-60ml of non-ionic contrast agent iopromide (370mg I / mL) produced by Shengling Pharmaceutical Company through the right anterior jugular vein. After the injection is completed, the same flow rate is used to inject physiological saline to flush the pipe, the enhancement range is set to be consistent with that in the plain scanning, and the scanning parameters are as follows: tube voltage 120KV, tube current 350-450mAs / rot. The chest aorta proximal end is selected as the interest region for value monitoring by using the software intelligent trigger scanning system, when the density in the interest region reaches the preset value, the coronary artery imaging and resting myocardial perfusion scanning is automatically started, and the electrocardiogram is recorded synchronously in the scanning process. The heart is scanned by using the prospective electrocardio trigger technology interval scanning, and the scanning parameters are as follows: tube voltage 100KV, tube current 300-400mAs / rot.

[0041] After the scanning in step S1 is completed, load myocardial perfusion scanning is performed after 15-20 minutes; specifically, adenosine disodium triphosphate for injection is used as the load drug, an infusion pump is used to continuously intravenously administer the drug at a speed of 170-180ug / kg / min, the heart rate rising by 15-20 times is used as the standard of load effectiveness, the load myocardial perfusion imaging is started after the standard is reached, and the drug load is maintained until the scanning is completed.

[0042] S3, reconstructing and analyzing the coronary artery images of the scanning images obtained in steps S1 and S2, and analyzing the myocardial perfusion state to obtain a transmural perfusion rate of the myocardial perfusion;

[0043] After the scanning in step S2 is completed, the scanning image data obtained in steps S1 and S2 is transmitted to a post-processing workstation. Two experienced physicians (including a cardiovascular physician and a full-time radiologist) reconstruct and analyze the coronary artery images of the obtained CCTA images by three post-processing methods of maximum intensity projection (MIP), curved reconstruction (CPR) and volume rendering (VR) without knowing the clinical data and the results of the patient, and analyze the myocardial perfusion state by using myocardial perfusion software. For the controversial CCTA images, the two physicians jointly review the images and make a decision.

[0044] The myocardial perfusion software divides the left ventricle into three equal parts perpendicular to the long axis of the ventricle, i.e. a basal part, a middle part and an apical part, and displays 17 segments. The myocardial perfusion indicators include:

[0045] Attenuation (AD) = average HU of myocardium - baseline HU

[0046] Perfusion Index (PI): calculated for each segment and displayed on the polar map. It is calculated by the following formula:

[0047] PI = average attenuation of myocardium / attenuation of left ventricular blood pool

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

[0049] Contrast = average HU of myocardium - baseline HU

[0050] Transmural Perfusion Rate (TPR): calculated for each segment. The myocardium is divided into endocardium, muscle layer and epicardium. The ratio of the endocardial AD of each segment to the epicardial AD of the corresponding layer is the TPR.

[0051] S4, dividing the myocardial perfusion defect degree according to the value of the transmural perfusion rate obtained in step S3;

[0052] When TPR < 0.99, i.e. defined as the presence of myocardial perfusion defects, the 5-color map uses different colors to represent the degree of perfusion defects according to the TPR value, such as Figure 1 As shown in the figure, the specific degree of myocardial perfusion defects is divided by the following method:

[0053] When the value of transmural perfusion rate is between 2.5 and 0.99, it corresponds to the absence of myocardial perfusion defects, indicating low risk, and higher intensity exercise rehabilitation training can be performed; represented as blue;

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

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

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

[0057] S5, according to the degree of myocardial perfusion defects divided in step S4, the PCI postoperative angina patients are divided into low-risk group, medium-risk group and high-risk group, specifically comprising the following steps:

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

[0059] S6, the low-risk group and the medium-risk group in step S5 use high-intensity interval exercise for rehabilitation training, and the high-risk group in step S5 uses low-intensity interval exercise for rehabilitation training, and the exercise frequency is at least 3 times a week, and the rehabilitation training period is 1 year.

[0060] In the embodiment of the application, the exercise process of high-intensity interval exercise and low-intensity interval exercise both includes 10 minutes of warm-up, 30-60 minutes of aerobic training, and 10 minutes of relaxation training.

[0061] In the embodiment of the application, when the high-intensity interval exercise, the target heart rate of the low-risk group and the medium-risk group is 80%-90% of the maximum heart rate.

[0062] In the embodiment of the application, when the low-intensity interval exercise, the target heart rate of the high-risk group is 50%-70% of the maximum heart rate.

[0063] The effect of the PCI postoperative angina patient exercise rehabilitation method based on myocardial perfusion provided in the embodiment of the application is evaluated as follows

[0064] I. Research method

[0065] 1. Study subjects and grouping

[0066] As shown in Figure 2 and Figure 3 , patients who underwent PCI surgery and had postoperative angina between September 2017 and December 2020 were selected, and a total of 121 patients were included in the present application, and the inclusion criteria were:

[0067] (1) Having undergone PCI and having a residual stenosis of <50%;

[0068] (2) Having post-PCI angina symptoms, and there is currently no uniform definition of post-PCI angina. Based on the actual situation in the present application, the present application defines post-PCI angina as the recurrence of the same symptoms as before the operation 3 months after successful PCI, and more than 3 episodes within 6 months. Angina symptoms are defined as the absence of angina symptoms after 6 months of exercise rehabilitation treatment;

[0069] (3) Age 18-75 years old, gender not limited;

[0070] (4) Patients voluntarily participating in the present study and signing the informed consent form.

[0071] Exclusion criteria: (1) Angina not caused by PCI; (2) Allergic to related drugs (3) Those who do not cooperate with the present study, such as severe mental disorders, etc.; (4) Presence of hemodynamic instability; (5) Presence of severe left ventricular dysfunction (LVEF <40%); (6) Severe arrhythmia (such as sick sinus syndrome, second-degree or higher atrioventricular block, 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) Combined with severe renal dysfunction (creatinine >1.5 mg / dL); (10) Presence of severe artifacts and poor image quality; (11) Unable to perform exercise rehabilitation due to limb movement disorders caused by other diseases; (12) Chronic obstructive pulmonary disease, bronchial asthma, tumor, etc.

[0072] Grouping method: A total of 121 patients were included in the study, of which 47 patients were included in the loading myocardial perfusion group, and 74 patients were included in the traditional rehabilitation group. The loading myocardial perfusion group used the exercise rehabilitation method of the present application for training rehabilitation.

[0073] 2. Exercise rehabilitation requirements and operation process for patients with post-PCI angina

[0074] As shown in Figure 4As shown, the exercise rehabilitation program of all enrolled patients was implemented in reference to the "Chinese Expert Consensus on Exercise Therapy for Patients with Coronary Heart Disease", "Expert Consensus on Exercise Rehabilitation after Percutaneous Coronary Intervention" formulated by the Prevention and Rehabilitation Professional Committee of the Cardiovascular Branch of the Chinese Medical Association and the Cardiovascular Physicians Branch of the Chinese Physicians Association. The patients in the traditional rehabilitation group were stratified into low-risk (mild) patients, medium-risk (moderate) patients and high-risk (severe) patients according to the expert consensus. The patients in the stress myocardial perfusion group were no longer stratified by the exercise risk stratification after PCI in the expert consensus, but were divided into low-risk (mild) patients, medium-risk (moderate) patients and high-risk (severe) patients with mild, moderate and severe myocardial perfusion defects after PCI.

[0075] When the value of transmural perfusion rate is 2.5-0.99, it corresponds to the absence of myocardial perfusion defect.

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

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

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

[0079] In 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. The patients in the low-risk and medium-risk group used high-intensity interval exercise, and the patients in the high-risk group used low-intensity interval exercise for rehabilitation training. The exercise intensity was defined by the heart rate (HRmax) when the maximum oxygen consumption was reached. The target heart rate of the high-intensity group was 80%-90% HRmax, and the target heart rate of the 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 in-hospital supervised training, and thereafter the program was mainly based on home training. The exercise mode was freely chosen according to the patient's condition. The heart rate was recorded by wearable devices during the exercise process. The research group supervised once a week within 6 months of the program implementation, and after 6 months the patients managed themselves. All patients underwent cardiopulmonary exercise test before starting exercise rehabilitation, after 3 months of implementation, after 6 months of implementation, and after 12 months of implementation. The patients in the stress myocardial perfusion group underwent myocardial perfusion scanning before the implementation of the program and after 12 months of implementation.

[0080] 3. Evaluation index

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

[0082] Safety analysis: Adverse events were recorded during the implementation of the program. Major adverse events included worsening angina pectoris, acute myocardial infarction, sudden death, syncope, etc. Movement-related pain was also 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 with interquartile range, and categorical variables were expressed as percentages or frequencies. Continuous variables were tested for normal distribution. Pairwise comparisons of normal distributions were performed using the independent sample t-test. Continuous variables that did not meet the normal distribution test were compared using the Mann-Whitney U rank-sum test. Categorical variables were compared using the chi-square test or Fisher's exact test. Pearson correlation analysis or Spearman correlation coefficient analysis were used to analyze the correlation between TPR improvement and exercise intensity. All statistical analyses were two-sided, with P < 0.05 considered statistically significant.

[0085] 5. Quality Control

[0086] Three cardiologists with experience in CT image post-processing and one radiologist performed image processing and data measurement respectively. The data obtained by the three cardiologists were averaged. If a large bias was found, the radiologist would measure again to remove the data with large bias.

[0087] Exercise rehabilitation is implemented by the managing physician, who is familiar with the patient's condition. A deputy chief physician specializing in cardiac rehabilitation is responsible for quality management of exercise rehabilitation. For quality control, the patient's heart rate during exercise is monitored using either a heart rate monitor provided by the research team or a wearable device (such as a wristband) provided by the patient. Research team members summarize the patient's heart rate status weekly and provide focused supervision for those whose heart rates do not meet the target.

[0088] 2. Research Results

[0089] 1. Baseline characteristics description

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

[0091] Table 1 Patient baseline data

[0092]

[0093] Note: 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 maximum oxygen uptake); O2pulse: oxygen pulse; MET: metabolic equivalent.

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

[0095] 2. Stratification results

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

[0097] Table 2 Baseline data of traditional rehabilitation group

[0098]

[0099] Note: 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 maximum oxygen uptake); O2pulse: oxygen pulse; MET: metabolic equivalent.

[0100] Table 3 Baseline data of myocardial perfusion group

[0101]

[0102] As can be seen from the results of Table 2 and Table 3, whether it is a traditional rehabilitation group or a myocardial perfusion group, there is no significant statistical difference in cardiopulmonary exercise parameters between the high-risk group and the medium-low-risk group.

[0103] 3. Analysis of primary and secondary variables

[0104] 3.1, Angina symptoms

[0105] The subjects included in the study were patients with angina pectoris after PCI. There is no clear definition of angina pectoris after PCI at present. In this study, patients who had the same symptoms as before the operation again 3 months after successful PCI were defined as having angina pectoris after PCI, and the onset was more than 3 times within 6 months. The remission of angina pectoris was defined as no angina pectoris after 6 months of exercise rehabilitation treatment. The remission of angina pectoris in the two groups after training with the corresponding rehabilitation program is shown in Table 4.

[0106] Table 4 Remission of angina pectoris 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 load myocardial perfusion group was 78.72%, and there was no statistically significant difference between the two.

[0109] 3.2, VO2 change

[0110] The VO2 changes of patients in the traditional rehabilitation group and the load myocardial perfusion group after 6 months of exercise rehabilitation are shown in Tables 5 and 6.

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

[0112]

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

[0114] Table 6 VO2 changes in the load myocardial perfusion group

[0115]

[0116] As can be seen from the results in Table 6, after 6 months of exercise rehabilitation, the patients in the load myocardial perfusion group underwent cardiopulmonary exercise test, and the test results showed that there was no significant statistical difference between the high-risk group and the low-risk group.

[0117] 4, Multivariate analysis

[0118] 4.1, Comparison results between the low-risk group in the load myocardial perfusion group and the high-risk group in the traditional rehabilitation group

[0119] The results of the above study show that after 6 months of exercise rehabilitation, there is no significant statistical difference in VO2 change between the high-risk group and the low-risk group. Reanalysis found that the low-risk group in the stress myocardial perfusion group can be defined as the high-risk group according to the traditional rehabilitation group's judgment standard. The comparison results of cardiopulmonary exercise test after 6 months of exercise rehabilitation between the low-risk group in the stress myocardial perfusion group and the high-risk group in the traditional rehabilitation group are shown in Table 7.

[0120] Table 7 Comparison results of VO2 change

[0121]

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

[0123] From the results of Table 7, it can be seen that after evaluation by stress myocardial perfusion, a higher intensity training is given, and the degree of increase in VO2 is significantly higher than that of the traditional rehabilitation program.

[0124] In summary, the PCI postoperative cardiac rehabilitation expert consensus is very strict in risk stratification, especially for the determination of high-risk patients, but its purpose is mainly to guide the cardiac rehabilitation of patients after intervention treatment, and it does not define the population as PCI postoperative angina patients, and there is currently a lack of cardiac rehabilitation guidance for such patients. The present application found that by using the consensus recommendations for patient risk stratification, some PCI postoperative angina patients were determined as high-risk patients by the consensus, and based on safety considerations, they needed to perform moderate-intensity rehabilitation training, but their stress myocardial perfusion did not show severe ischemic changes. We found that based on this, we adjusted the patients to a high-intensity training program, and after 6 months of exercise rehabilitation, the maximum oxygen uptake was analyzed, and it was found that the maximum oxygen uptake of such patients changed more obviously, and no serious adverse events occurred during the training process. Accordingly, the present application believes that for high-risk PCI postoperative patients, one-stop stress myocardial perfusion scanning after recurrent angina can not only further clarify the cause of angina attack (residual stenosis, in-stent restenosis, in-stent thrombosis, etc.), but also provide guidance for further exercise rehabilitation programs.

[0125] The present application adopts VO2max as a main monitoring and evaluation index, which refers to the maximum oxygen amount that the human body can take in per unit time when the reserves of each link of the oxygen transport system have been mobilized to the highest level during the process of load exercise with large muscle groups participating. In the process of gradually increasing exercise load, VO2 no longer increases with the increase of exercise load, and a platform appears, calling the VO2 at this time VO2max. However, the subjects often terminate exercise before the platform appears, so the highest VO2 in exercise, i.e. peakVO2, is often used to replace VO2max in clinical practice. VO2max is currently recognized as an important indicator reflecting cardiopulmonary exercise function, and is the gold standard for evaluating aerobic exercise capacity. It has large individual differences with age, gender, height, body mass, exercise type and daily activity level. VO2max is related to exercise programs, the more muscle groups involved in exercise, the higher the value, so the value measured by treadmill exercise is generally 10%-11% higher than that measured by bicycle exercise. In the study, the present application 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 program is adopted, it can produce positive effects on improving the body's oxygen uptake capacity and cardiopulmonary function. Although there is no significant difference in VO2 between different exercise intensity groups in each group, by comparing the medium and low risk groups in the myocardial perfusion group with the high risk groups in the traditional rehabilitation group, it is found that after evaluation by myocardial perfusion, higher intensity training is given, and the degree of increase in VO2 is significantly higher than that of the traditional rehabilitation program. This result suggests that under the condition of ensuring safety measures, increasing exercise intensity is an effective means to improve the patient's condition.

[0126] Although the embodiments of the present application have been shown and described, those of ordinary skill in the art can understand that various changes, modifications, replacements and variations can be made to these embodiments without departing from the principles and purposes of the present application, and the scope of the present application 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: The following steps are involved: S1. Perform coronary artery imaging and resting myocardial perfusion scanning in patients with angina after PCI; S2. After the scan in step S1 is completed, a stress myocardial perfusion scan is performed every 15-20 minutes; S3, reconstructing and analyzing the coronary artery images of the scanned images obtained in step S1 and step S2, and analyzing the myocardial perfusion state to obtain the transmural perfusion rate of the myocardial perfusion; S4, obtaining different degrees of myocardial perfusion defect according to the numerical value of the transmural perfusion rate obtained in step S3; The degree of myocardial perfusion defect is classified as follows: When the transmural perfusion rate is between 2.5 and 0.99, there is no myocardial perfusion defect. When the value of transmural perfusion rate is between 0.99-0.97, it corresponds to mild myocardial perfusion defect; When the transmural perfusion rate value is between 0.97 and 0.94, it corresponds to moderate myocardial perfusion defect; When the value of transmural perfusion rate is between 0.94 and 0.60, it corresponds to severe myocardial perfusion defect; S5, dividing the patients with angina pectoris after PCI into a low-risk group, a medium-risk group, and a high-risk group according to the degree of myocardial perfusion defect obtained in step S4, comprising the following steps: Patients with angina pectoris after PCI with mild, moderate and severe myocardial perfusion defects were divided into low-risk, moderate-risk and high-risk groups respectively; S6. The low-risk group and the medium-risk group in step S5 adopt high-intensity intermittent exercise for rehabilitation training, and the high-risk group in step S5 adopt medium- and low-intensity intermittent exercise for rehabilitation training. The exercise frequency is at least 3 times a week, and the rehabilitation training cycle is 1 year.

2. The exercise rehabilitation method for patients with angina pectoris after PCI based on myocardial perfusion according to claim 1, characterized in that: In step S1 , the parameters of the coronary artery imaging scan are: tube voltage 100 kV, tube current 300-450 mAs / rot, slice thickness 0.5 mm, interval 0.5 mm, and field of view 180-220 mm.

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

4. The exercise rehabilitation method for patients with angina pectoris after PCI based on myocardial perfusion according to claim 1, characterized in that: In step S2, stress myocardial perfusion scanning is achieved by the following method: Adenosine triphosphate disodium for injection is used as a loading drug and is continuously administered intravenously to patients with angina pectoris after PCI at a rate of 170-180ug / kg / min. A heart rate increase of 15-20 times is used as the standard for effective loading. After reaching the standard, load myocardial perfusion imaging is started, and the drug loading is maintained until the end of the scan.

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

6. The exercise rehabilitation method for patients with angina pectoris after PCI based on myocardial perfusion according to claim 1, characterized in that: In step S6, the exercise process of high-intensity intermittent exercise and medium-low intensity intermittent exercise both includes warm-up for 10 minutes, aerobic training for 30-60 minutes, and relaxation training for 10 minutes.

7. The exercise rehabilitation method for patients with angina pectoris after PCI based on myocardial perfusion according to claim 1, characterized in that: In step S6, during high-intensity intermittent exercise, the target heart rate of the low-risk group patients and the moderate-risk group patients is 80%-90% of the maximum heart rate.

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

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