Objective: To investigate the cut-off value of the breathing reserve for predicting a decline in cardiorespiratory fitness (CRF) among healthy middle-aged Chinese individuals. Methods: Healthy middle-aged individuals who underwent cardiopulmonary exercise testing (CPET) at the Peking University Third Hospital from May to October 2021 were selected. The study included 321 participants, with an average age of 48.8 ± 5.7 years. They were divided into two groups based on the peak oxygen uptake (VO2peak): the adequate CRF group and the CRF decline group. Multivariate logistic regression analysis was used to explore the factors influencing CRF. Results: In the male CRF decline group, heart rate, alanine aminotransferase, end-tidal partial pressure of carbon dioxide (PETCO2), and breathing reserve (BR%) were significantly higher, while the oxygen uptake at the anaerobic threshold (VO2@AT) was lower. An elevated BR% was independently associated with CRF decline (OR = 1.111, 95% CI: 1.068–1.156). The female CRF decline group had significantly higher FEV1/FVC and BR% and significantly lower age, fasting glucose, hemoglobin, and VO2@AT compared to the adequate CRF group. Elevated BR% was independently associated with CRF decline (OR = 1.086, 95% CI: 1.038–1.137). The receiver operating characteristic (ROC) curve for the males showed an area under the curve (AUC) of 0.769 (95% CI: 0.703–0.827) with an appropriate BR% cut-off value of 49.9%, sensitivity of 59.9%, and specificity of 77.8%. For the females, the ROC curve displayed an AUC of 0.694 (95% CI: 0.607–0.773) with an appropriate BR% cut-off value of 57.0%, sensitivity of 58.7%, and specificity of 86.0%. Conclusions: The breathing reserve was independently associated with CRF. The appropriate cut-off values for BR% to predict CRF decline were 49.9% for the males and 57.0% for the females.

Accurately quantifying cardiorespiratory fitness (CRF) through cardiopulmonary exercise testing (CPET) is increasingly important for improving risk assessment and guiding clinical decisions. However, research on V̇O2peak reference values and predictive equations for the Chinese population remains limited. This study aimed to establish a V̇O2peak predictive equation for Chinese adults. This study analyzed healthy participants who underwent CPET at Peking University Third Hospital (PUTH) from September 1, 2017, to September 1, 2023. Data from September 1, 2017, and August 31, 2021 were used as the derivation cohort, and September 1, 2021, to September 1, 2023 were utilized as an external validation cohort for temporal validation. The derivation cohort underwent backward multivariate regression analysis to generate the V̇O2peak prediction equation, which was compared with the widely-used Wasserman, FRIEND and Xiangya equations. The PUTH derivation cohort (N = 4531, mean age: 50.7 years, 18–88 years) and validation cohort (N = 4624, mean age: 46.1 years, 18–89 years) included 48.8 and 48.5% men, respectively. With increasing age, both men and women V̇O2peak exhibited a general decline. The predictive equation for V̇O2peak was established based on the derivation cohort: V̇O2peak (mL·min−1) = −24364.9 − 621.3 × Sex (Women = 1, Men = 2) −10.7 × Age + 0.2 × Height2 (cm) + 6464.7 × Log(BMI) −24997.2 × Log(BSA) +12388.6 × Log(LBM) (adjusted R2 = 0.624, p < 0.001). It demonstrated higher consistency between measured and predicted results compared to Xiangya, Wasserman, and FRIEND equations. This study presents the PUTH equation, a new V̇O2peak prediction equation for Chinese adults. Compared to existing equations, the PUTH equation shows reduced bias and improved accuracy, providing a more reliable tool for assessing CRF and guiding clinical interventions in the Chinese population.

Objective: To examine physical activity（PA） of post-percutaneous coronary intervention（PCI） patients and explore the demographic, clinical, and social psychological characteristics associated with PA levels. Methods: A total of 246 post-PCI patients from the Peking University Third Hospital in Beijing, China, were included in this crosssectional study through convenience sampling. Data were collected from a self-repor ted questionnaire. PA was categorized into low, moderate, or high levels. The ordinal multinomial logistic regression model was used to estimate the relationship among demographic, medical, and psychosocial characteristics. Results: The overall prevalence of low, moderate, and high PA was 20%, 70%, and 10%, respectively. For the domain-specific PA patterns, most par ticipants took par t in leisure-time PA（84.5%）; walking was the most common PA. Increased motivation and selfefficacy, lower monthly income, and unemployment were predictors of high PA. Conclusions: PA levels in post-PCI patients was not optimal, and leisure-time PA had the highest par ticipation rate. Analyses of influencing factors can provide medical staff and health workers information to focus on high-risk groups and introduce more tailored interventions. Future studies can explore more regions, and ecological models can be introduced to study more influencing factors.

We aimed to explore the effects of perioperative exercise on cardiorespiratory endurance in children with congenital heart disease (CHD) in plateau areas after surgical repair. Fifty children with CHD in the plateau admitted to our hospital were randomly divided into the exercise and control groups. The exercise group received a perioperative exercise intervention beginning within 24 h postoperatively, while the control group received routine nursing and treatment alone. To assess the 6 min walk distance (6MWD) at baseline and at end of intervention, children participated in a 6-min walk test before cardiac repair and at 1 week after general ward transfer. A subset of children in the study underwent the cardiopulmonary exercise test pre-operatively. The 6MWD of children with CHD at baseline was positively correlated with the peak oxygen uptake pre-operatively. No significant difference was reported in the preoperative baseline data of both groups. The 6MWD of the exercise group was significantly higher than that of the control group. Early exercise therapy after cardiac repair could significantly improve the cardiorespiratory endurance and exercise capacity of children with CHD in plateau areas.

目的 探讨心肺运动试验(CPET)摄氧量恢复延迟(VO2RD)对经皮冠状动脉介入治疗(PCI)术后心电图运动试验阴性患者预后的影响.方法 回顾性分析北京大学第三医院2018年1月至2019年9月在PCI术后半年内行CPET且心电图运动试验阴性患者1268例,收集患者的临床资料、冠状动脉造影及介入操作资料、实验室检查、超声心动图及CPET检查结果.所有患者通过门诊或电话随访,记录患者不良心血管事件,包括死亡、心肌梗死、卒中、短暂性脑缺血发作、非计划再次PCI、周围血管介入治疗、不稳定型心绞痛和急性心力衰竭事件引起的住院.采用多因素Cox回归分析探讨CPET VO2RD是否影响PCI术后心电图运动试验阴性患者的预后.结果 1268例入选患者中完成随访1218例,失访50例,随访14(10,20)个月,共发生不良心血管事件105例(8.6％).不良事件组年龄[(62.4±9.9)岁比(60.3±10.2)岁,P=0.020]、不完全血运重建比例(42.9％比31.6％,P=0.022)以及合并高脂血症比例(79.0％比68.0％,P=0.020)均显著高于无不良事件组;糖化血红蛋白值[(7.3±1.1)％比(6.6±1.2)％,P=0.001]、空腹血糖[(7.1±2.6)mmol/L比(6.5±1.9)mmol/L,P=0.010]及N末端B型脑钠肽前体[107.5(50.1,399.8)pg/ml比88.2(39.2,225.0)pg/ml,P=0.017]显著高于无不良事件组;峰值心率[(121±18)次/分比(126±20)次/分,P=0.012]、无氧阈心率[(99±12)次/分比(102±14)次/分,P=0.029]和峰值摄氧量[(17.3±4.7)ml/(min·kg)比(18.7±2.1)ml/(min·kg),P=0.003]显著低于无不良事件组,二氧化碳通气当量斜率[(33.3±9.2)比(28.1±5.1),P=0.001]和VO2RD[(21.4±4.5)s比(18.5±5.4)s,P=0.001]显著高于无不良事件组.多因素Cox回归分析显示VO2RD>20 s(HR 1.594,95％CI 1.026～2.476,P=0.038)是PCI术后心电图运动试验阴性患者发生不良心血管事件的独立危险因素.结论 PCI术后心电图运动试验阴性的患者仍有一定的不良心血管事件发生风险,CPET恢复期指标VO2RD>20 s是此类患者发生不良心血管事件的独立预测因素.

目的:应用心血管磁共振成像(CMR)评估中国男子篮球运动员左心房的容积和功能,为科学训练和医学监督提供参考依据.方法:纳入20名中国男子篮球运动员(年龄20.5±1.5岁,技术等级为国家二级运动员)为研究组,选取15名无运动习惯者为对照组(年龄21.6±2.8岁).所有被检者行CMR扫描获得电影序列,由2名医师独立应用心血管分析软件测量心脏容积和功能,应用CMR特征追踪(CMR feature tracking,CMR-FT)技术测量左心房应变和应变率等参数,两组间对比采用独立样本t检验.结果:与对照组相比,篮球运动员的左、右心室舒张末期容积指数(LVEDVI、RVEDVI)和左心室质量指数(LVMI)明显增大(P<0.05),左、右心室射血分数(LVEF、RVEF)减低(P<0.05),左心房的最大容积指数(LAVImax)、最小容积指数(LAVImin)增大(P<0.05).在左心房功能方面,左心房的总射血分数(LATEF)、被动射血分数(LAPEF)和主动射血分数(LAAEF)在两组间的差异无统计学意义(P>0.05).篮球运动员的左心房总应变(εs)、被动应变(εe)、收缩期正向峰值应变率(SRs)、舒张早期负向峰值应变率(SRe)、舒张晚期负向峰值应变率(SRa)明显低于对照组(P<0.05),而主动应变(εa)在两组间差异无统计学意义(P>0.05).结论:中国男子篮球运动员的左心房容积增大,左心房储存功能、导管功能和泵功能减低,可能是长期高强度训练引起的生理适应性改变.CMR可用于精准评估运动员左心房容积和功能的改变,有助于科学训练的指导和医学监督.

Background:Cardiopulmonary exercise testing (CPET) is used widely in the diagnosis, exercise therapy, and prognosis evaluation of patients with coronary heart disease (CHD). The current guideline for CPET does not provide any specific recommendations for cardiovascular (CV) safety on exercise stimulation mode, including bicycle ergometer, treadmill, and total body workout equipment.Objective:The aim of this study was to explore the effects of different exercise stimulation modes on the occurrence of safety events during CPET in patients with CHD.Methods:A total of 10,538 CPETs, including 5,674 performed using treadmill exercise and 4,864 performed using bicycle ergometer exercise at Peking University Third Hospital, were analyzed retrospectively. The incidences of CV events and serious adverse events during CPET were compared between the two exercise groups.Results:Cardiovascular events in enrolled patients occurred during 355 CPETs (3.4%), including 2 cases of adverse events (0.019%), both in the treadmill group. The incidences of overall events [235 (4.1%) vs. 120 (2.5%), P < 0.001], premature ventricular contractions (PVCs) [121 (2.1%) vs. 63 (1.3%), P = 0.001], angina pectoris [45 (0.8%) vs. 5 (0.1%), P < 0.001], and ventricular tachycardia (VT) [32 (0.6%) vs. 14 (0.3%), P = 0.032] were significantly higher in the treadmill group compared with the bicycle ergometer group. No significant difference was observed in the incidence of bradyarrhythmia and atrial arrhythmia between the two groups. Logistic regression analysis showed that the occurrence of overall CV events (P < 0.001), PVCs (P = 0.007), angina pectoris (P < 0.001), and VT (P = 0.008) was independently associated with the stimulation method of treadmill exercise. In male subjects, the occurrence of overall CV events, PVCs, angina pectoris, and VT were independently associated with treadmill exercise, while only the overall CV events and angina pectoris were independently associated with treadmill exercise in female subjects.Conclusion:In comparison with treadmill exercise, bicycle ergometer exercise appears to be a safer exercise stimulation mode for CPET in patients with CHD.

目的:采用超声心动图评价中国优秀女子足球运动员心脏结构和功能.方法:纳入28名专业女子足球运动员为研究组,年龄25.2±3.4岁,技术等级专业二级以上,运动年限14.2±3.4年;选取28名年龄、体表面积(BSA)相匹配的长期静坐健康女性志愿者为对照组.所有受试者进行超声心动图检查,测量心脏结构和功能的各项指标.结果:与对照组相比,经BSA矫正后女子足球运动员主动脉根部径、主肺动脉内径、左房前后径、左房面积、右房面积、右室舒张末期前后径、右室舒张末期中段横径、右室舒张末期基底段横径、左室舒张末期前后径、左室收缩末期前后径、左室心肌重量指数均增大(P<0.01);右室舒张末期上下径增大(P<0.05);舒张末期前室间隔厚度、舒张末期后室间隔厚度、舒张末期后壁厚度、左室壁厚度,左室相对室壁厚度均增加(P<0.01);三尖瓣环收缩期位移增大(P<0.01),二尖瓣瓣口舒张早期血流速度/二尖瓣瓣口舒张晚期血流速度增大(P<0.05);而左室射血分数、左室短轴缩短分数、左室舒张末期前后径/右室舒张末期前后径减小(P<0.01).结论:运动员左室壁厚度和心肌质量增加,左右心室增大,为运动的良性适应性反应,运动对右心室的重塑较左心室更为显著.超声心动图在运动员心脏监测中有优势,可用于指导科学训练和医学监督.

目的:分析经皮冠状动脉介入治疗(PCI)术后运动康复低危患者不同类型体力活动的参与情况,为护士未来对患者进行体力活动的健康教育提供依据.方法:采用方便抽样法对在北京市某三级甲等医院心血管内科进行PCI术并且长期随访的226名运动康复低危患者,利用自行设计的基本资料调查表和国际体力活动问卷进行调查.结果:患者参与率由高到低的体力活动类型依次是休闲相关体力活动(84.5％)、家务相关体力活动(47.3％)、工作相关体力活动(43.0％)、交通出行相关体力活动(40.3％).休闲相关体力活动中,不同性别、体力活动中是否存在不适症状以及不适症状影响体力活动不同程度的患者组间比较差异有统计学意义(P<0.05);家务相关体力活动中,不同性别患者组间比较差异有统计学意义(P<0.05);工作相关体力活动中,不同职业患者组间比较差异有统计学意义(P<0.05);交通出行相关体力活动中,不同性别、年龄、冠心病病程和手术中使用不同动脉的患者组间比较差异有统计学意义(P<0.05).结论:PCI术后运动康复低危患者的体力活动参与率较低,护士要重视对患者体力活动的健康教育,提供个性化的、科学的宣教与运动处方,并指导安全监测.

大众对不良姿态的认识还停留在一种不喜欢运动、懒得动的形象描述上,就连一些临床医生也忽视了不良姿态对于健康的影响,认为无须为那些程度轻微的、不需要手术矫正的不良姿态担心. 其实,长久保持不良姿态,颈椎变得僵硬、胸椎灵活性下降、腰肌劳损都是影响健康的隐性杀手.很多人知道不良姿态是导致疼痛的原因,殊不知不良姿态也会造成脊柱不对称受力,进而影响身体健康.简单地说,如果身体不能充分放松和及时休息恢复正常,就是一种不健康状态,这种不健康状态如果不能得到有效的调节,时间长了就会导致疾病.

目的 探讨冠心病介入术后患者合并吸气肌无力(inspiratory muscle weakness,IMW)的危险因素.方法 回顾性纳入2016年1月至2018年3月于北京大学第三医院住院并测定了最大吸气压力(maximal inspiratory pressure,MIP)的冠心病介入治疗术后患者196例,根据MIP/预计值(predicted normal value,PNV)的百分比将患者分为IMW组(52例)(MIP/PNV＜70％)和对照组(144例)(MIP/PNV≥70％);收集两组相关临床信息和MIP,分析合并IMW的危险因素.结果 在所有患者中合并IMW的比例为26.5％(52例),在无心力衰竭病史的患者合并的比例为20.5％(27例/132例).IMW组的心力衰竭病史患者比例(P=0.002)、氨基末端脑钠肽前体(P=0.011)、左心房压力(P=0.003)和二尖瓣舒张早期血流速度峰值与二尖瓣环舒张早期运动速度比值(the ratio of the peak blood flow velocity in the early diastole of the mitral valve to the early diastolic velocity of the mitral valve ring,E/EM)(P＜0.001)均显著高于对照组;血红蛋白(P=0.012)、左心室射血分数(P=0.025)和解剖完全血运重建的比例(P=0.004)显著低于对照组.回归分析结果显示,解剖完全血运重建(OR=0.369,95％CI 0.144～0.945)、心力衰竭病史(OR=2.537,95％CI 1.238～5.200)和E/EM(OR=1.104,95％CI 1.005～1.214)为IMW的独立危险因素.结论 冠心病介入术后患者合并IMW的危险因素为解剖未完全血运重建、心力衰竭病史和E/EM升高.

全球马拉松赛事越来越多，但马拉松运动导致的心脏性猝死事件时有发生，并引起人们的广泛关注。该文总结、分析近年来马拉松心脏安全事件，进一步评估马拉松运动的心脏安全性，并探讨马拉松运动导致心脏性猝死等心血管事件可能的机制。.

1病例资料 患者,女,65岁,入院前1年发现右侧臀部出现一包块,约8 cm×8 cm大,触之无疼痛,未作特别处理,后包块进行性长大,明显隆起,约10 cm×8 cm大,无肢体活动障碍,患者遂来甘孜藏族自治州人民医院就诊拟行手术治疗.查体:右侧臀部见一明显隆起包块,约15 cm×10 cm大,可推动,边界不清,质地韧,无明显压痛,无膨胀性搏动,与臀部皮肤无明显粘连.B超检查提示:右侧臀部皮下肌层内实性团块占位;核磁共振检查(图1a):见右侧臀部肌肉软组织内占位性病变,性质?脂肪纤维瘤?其他?完善术前检查后遂在全麻俯卧位下行右臀部包块切除术.

2019年11月27日,演员高以翔在某综艺节目录制时,在跑步过程中突然晕倒,后抢救无效死亡,现年35岁. 百度百科上,“追我家族与追逐团在夜晚的都市CBD中展开一场你追我逃的追逐战,热血对决争夺荣耀勋章,带来力量与智慧的双重较量,重新定义热血青春”是对该节目的介绍,从节目的部分镜头也可以看出,该综艺是以惊险、追逐、刺激为特点.

Objective:To investigate the effects of inspiratory muscle training (IMT) combined with endurance training on cardiorespiratory endurance and peripheral muscle strength in patients with viral myocarditis and heart failure.Methods:A total of 76 patients with viral myocarditis and heart failure admitted to our hospital were enrolled and randomly assigned by computer method, 38 in the rehabilitation group and 38 in the control group. Patients in the rehabilitation group were initially given IMT and endurance training and the control group had no special intervention except routine treatment. Patients in both groups were given PImax, left ventricular ejection fraction (LVEF), cardiopulmonary exercise (CPET) and Medical Research Council (MRC) 12 weeks after discharge to assess cardiopulmonary endurance and peripheral muscle strength.Results:After intervention, PImax in the rehabilitation group was higher than that in the control group and before intervention in the same group ( P<0.001). LVEF in rehabilitation group was higher than that in control group ( P<0.001). CPET: VO 2peak and VO 2at of the rehabilitation group were both higher than those of the control group, and the slope of CO 2 ventilation equivalent (VE/VCO 2 slope) of the rehabilitation group was lower than that of the control group with significant difference ( P<0.05). MRC of the rehabilitation group was higher than that of the control group ( P<0.001). Conclusion:Reasonable IMT combined with endurance training cardiac rehabilitation program can improve cardiorespiratory endurance and peripheral muscle strength in patients with viral myocarditis and heart failure, and improve the quality of life and prognosis.

目的:应用心脏磁共振特征追踪技术评价中国男性专业篮球运动员和举重运动员的心肌应变.方法:选取16名男子篮球运动员(年龄19.9±2.5岁)和15名男子举重运动员(年龄20.7±3.4岁)作为研究组,技术等级专业二级以上,选取年龄、性别相匹配的15名长期静坐工作者为对照组,所有受试者行心脏磁共振检查,采用特征追踪技术测量左室、右室的心肌应变参数,采用单因素方差分析比较三组间的差异.结果:与对照组相比,两组运动员的左室及右室舒张末期容积指数、左室每搏输出量指数、左室心肌质量指数增大(P<0.05),左室壁增厚(P<0.05),左室、右室射血分数减低(P<0.05).与举重运动员相比,篮球运动员的心率更慢,左、右室舒张末期容积指数更大,左、右室射血分数更低(P<0.05).篮球运动员和举重运动员的左室整体最大径向应变、最大周向应变、最大纵向应变和右室整体最大纵向应变低于对照组(P<0.05),篮球运动员的左室扭转、右室整体最大纵向应变低于举重运动员(P<0.05).结论:专业运动员的心脏重塑以左、右室均衡性增大,左室壁轻度增厚,左、右室射血分数减低伴随心肌应变参数减低为主要表现,是心脏功能储备增大的生理适应性改变.而与举重运动员相比,篮球运动员的左、右心室更大,心率、射血分数、心肌应变更低,表明耐力性、力量性运动形式不同引起心脏重塑方式不同.

新冠肺炎疫情，既考验了各国公共卫生体制和疾控部门的紧急响应能力，考验了各国科学家的迅疾的分子生物学研究和实用水平，也彰显了我国强大的号召力以及国民惊人的执行力，也考验了我国临床的救治能力。为了抗击病毒，基于"同情用药原则"，国内也开展了一些药物的临床试验的应用。现就有关同情用药、医学伦理、中药制剂与老药新用谈一些思考。

Objectives This study was aimed to analyze the effects of atorvastatin and rosuvastatin and different lipid-lowering intensity treatments on exercise tolerance in patients with coronary heart disease (CHD). Methods A retrospective analysis was conducted in 549 patients with CHD who underwent cardiopulmonary exercise testing (CPET) from February 2014 to August 2018. The CPET results of patients taking different types and doses of statins were compared from baseline to follow-up. Results No significant difference was found in baseline VO(2)peak between the rosuvastatin group and the atorvastatin group. The VO(2)peak growth of the rosuvastatin group was significantly greater than that of the atorvastatin group after treatment [1.52 +/- 4.03 ml/kg/minvs0.90 ml/kg/min (-1.60, 3.45),p= 0.018]. Multivariate analysis showed that atorvastatin was a negative independent influencing factor of Delta VO(2)peak (B= -0.665,SE = 0.321,t= -2.070,p= 0.039,95% CI: - 1.295 similar to-0.034). There was no significant difference between the median intensity and high-intensity lipid-lowering groups in parameters of CPET. Conclusions The exercise tolerance improvement was more considerable for patients with CHD taking rosuvastatin compared with those taking atorvastatin. The lipid-lowering intensity of statins was not independently associated with changes in exercise tolerance in patients with CHD.

Objective:To review the published literature reporting on the incidence of myocardial fibrosis (MF) in high-intensity endurance athletes measured by late gadolinium enhancement (LGE) with cardiac magnetic resonance imaging (CMR). Methods:Five databases (PubMed, Cochrane Controlled Trials Register, EMBASE, Web of Science, and SPORTDiscus) were searched to obtain case cohort studies published before November 10, 2019. From 96 abstracts or reports extracted, 18 full-text articles were reviewed. The incidence of LGE was reported as outcome measures. Subgroup analysis was performed by age (under or above 50 years). Pooled estimates were obtained using a fixed-effects model. Results:After a full-text assessment, 12 studies involving 1,359 participants were included for analysis. Among them, 163/772 participants in the endurance athletes group showed LGE positive, compared with 19/587 participants in the comparison group. The results of the meta-analysis suggested that the prevalence of LGE was higher in the athletes group with long-term endurance exercise (OR 7.20;95%CI: 4.51-11.49). In addition, the same conclusion was drawn after the stratification of age. Conclusions:The available evidence demonstrates that high-intensity endurance athletes is associated with an increased incidence of LGE positive.

目的 探讨吸气肌训练对急性心肌梗死行经皮冠状动脉介入治疗术后患者心肺功能和运动能力的影响.方法 将99例接受经皮冠状动脉介入治疗术的患者随机分为试验组(50例)和对照组(49例),试验组在7 d心脏康复运动程序的基础上增加吸气肌训练,对照组按照7d心脏康复运动程序进行康复训练.采用最大吸气压和5次坐立试验在患者术后、干预后7d、出院后4周时进行效果评价,采用6 min步行试验和心肺运动试验指标评价出院后4周时心肺功能改善程度.结果 相比对照组,试验组在干预7d、出院后4周时最大吸气压增加,5次坐立试验时间减少,重复测量方差分析结果显示,最大吸气压和5次坐立试验时间效应、组间效应、交互效应的比较,差异均具有统计学意义(P＜0.05);出院后4周,试验组与对照组6 min步行试验、峰值耗氧量、氧摄取效率斜率的比较,差异具有统计学意义(P＜0.05).结论 急性心肌梗死经皮冠状动脉介入治疗术后患者在常规心脏康复的同时,增加吸气肌训练可以提升患者的心肺功能.