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首页> 外文期刊>Psychosomatic Medicine: Journal of the American Psychosomatic Society >The Psychophysiological Investigations of Myocardial Ischemia (PIMI) study: objective, methods, and variability of measures.
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The Psychophysiological Investigations of Myocardial Ischemia (PIMI) study: objective, methods, and variability of measures.

机译：心肌缺血（PIMI）研究的心理生理调查：目的，方法和测量方法的可变性。

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OBJECTIVE: This study evaluated physiological, neuroendocrine, and psychological status and functioning of patients with coronary artery disease in order to clarify their role in the expression of symptoms during myocardial ischemia (MI), and to establish repeatability of responses to mental stress. Design and methods of the study are presented. METHODS: One hundred ninety-six coronary artery disease patients were examined during physical and mental stress tests in four hospitals. Eligibility criteria included narrowing of at least 50% in the diameter of at least one major coronary artery or verified history of myocardial infarction, and evidence of ischemia on an exercise treadmill test. Psychological, biochemical, and autonomic function data were obtained before, during, and after exposure to mental and exercise stressors during 2 or 3 half-days of testing. Ventricular function was assessed by radionuclide ventriculography, and daily ischemia by ambulatory electrocardiography. Sixty patients returned for a short-term mental stress repeatability study. Twenty-nine individuals presumed to be free of coronary disease were also examined to establish reference values for cardiac responses to mental stress. RESULTS: Study participants were 41 to 80 years of age; 83 (42%) had a history of MI, 6 (3%) of congestive heart failure, and 163 (83%) of chest pain; 170 (87%) were men; and 90 (46%) had ischemia accompanied by angina during exercise treadmill testing. Ischemia during ambulatory monitoring was found in 35 of 90 (39%) patients with and 48 of 106 (45%) patients without angina during exercise-provoked ischemia. Intraobserver variability of ejection fraction changes during bicycle exercise and two mental stress tests (Speech and Stroop) was good (kappa = 1.0, .90, and .76, respectively; percent agreement = 100, 97.5, and 93.8%, respectively). Variability of assessed wall motion abnormalities during bicycle exercise was better (kappa, agreement = 85%) than during Speech or Stroop kappa and .57, percent agreement = 70% and 82.5%, respectively). CONCLUSIONS: Study design, quality control data, and baseline characteristics of patients enrolled for a clinical study of symptomatic and asymptomatic myocardial ischemia are described. Lower repeatability of reading wall motion abnormalities during mental stress than during exercise may be due to smaller effects on wall motion and lack of an indicator for peak mental stress.
机译：目的：本研究评估了冠心病患者的生理，神经内分泌，心理状态和功能，以阐明其在心肌缺血（MI）症状表达中的作用，并确定对精神压力反应的可重复性。介绍了研究的设计和方法。方法：在四家医院的身体和精神压力测试中检查了196例冠心病患者。资格标准包括至少一根主冠状动脉直径缩小至少50％或证实的心肌梗塞病史，以及在跑步机测试中发现局部缺血的证据。在测试的2或3个半天中，在暴露于心理压力和运动压力之前，之中和之后，获得了心理，生化和自主功能数据。通过放射性核素心室造影评估心室功能，通过动态心电图评估每日缺血。 60名患者返回进行短期精神压力可重复性研究。还检查了29名无冠状动脉疾病的个体，以建立对精神压力的心脏反应的参考值。结果：研究参与者年龄在41至80岁之间。 83例（42％）有心梗史，6例（3％）患有充血性心力衰竭，163例（83％）有胸痛; 170名（87％）是男性;在运动跑步机测试中，有90％（46％）伴有缺血性心绞痛。在运动诱发性缺血期间，在90例无心绞痛的患者中，有90例（39％）的患者中有35例在非门诊监护期间发生缺血，在106例（45％）的患者中有48例（45％）。自行车运动和两种精神压力测试（Speech和Stroop）期间观察者的射血分数变化的观察者内变异性良好（kappa分别为1.0，.90和.76;百分同意率分别为100、97.5和93.8％）。自行车运动期间评估的壁运动异常的变异性（kappa，一致性= 85％）比语音或Stroop kappa和.57（一致性百分比分别为70％和82.5％）更好。结论：描述了有症状和无症状心肌缺血的临床研究入组患者的研究设计，质量控制数据和基线特征。在精神压力下比在运动期间阅读壁运动异常的可重复性较低，这可能是由于对壁运动的影响较小，并且缺少峰值精神压力的指标。

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