Georgoulias Panagiotis, Orfanakis Alexandros, Demakopoulos Nikolaos, Xaplanteris Petros, Mortzos Georgios, Vardas Panos, Karkavitsas Nikolaos
Department of Nuclear Medicine, NIMTS Hospital, Greece.
J Nucl Cardiol. 2003 Sep-Oct;10(5):498-505. doi: 10.1016/s1071-3581(03)00530-0.
The increase in heart rate during exercise is considered to be attributed to sympathetic system activation combined with parasympathetic withdrawal. The prognostic importance of the chronotropic response to exercise and heart rate recovery 1 minute after exercise has already been established. The purpose of this study was to evaluate heart rate recovery as an index of myocardial ischemia, by correlating heart rate recovery with known parameters of myocardial ischemia.
Included in the study were 304 consecutive patients (73% men), aged 34 to 82 years. Patients whose heart rate recovery value or myocardial perfusion imaging could have been influenced by factors other than ischemic disease were excluded from the study. The patients underwent single photon emission computed tomography myocardial perfusion imaging combined with symptom-limited exercise testing with thallium 201 or technetium 99m tetrofosmin. The value for heart rate recovery was defined as the decrease in heart rate from peak exercise to 1 minute after termination of exercise. For semiquantitation of the scintigram, the uptake of the radiotracer was graded on a scale from 0 to 4. Twenty-one beats per minute was defined as the lowest normal value for heart rate recovery. We found 74 patients (24%) with an abnormal value. We also found a significant correlation between heart rate recovery 1 minute after exercise and stress myocardial perfusion score. In addition, there was a statistically significant relationship between heart rate recovery and chronotropic variables. Patients with an abnormal value of heart rate recovery were generally of an older age, were more likely men, had a higher frequency of risk factors for coronary artery disease, were mostly taking cardioactive medications, had lower efficiency during treadmill testing, and had more pathologic findings on the scintigram.
Myocardial ischemia, as assessed by myocardial perfusion imaging, is an important correlate of heart rate recovery. There is a significant correlation between chronotropic variables during exercise testing and heart rate recovery 1 minute after exercise. It seems that the heart rate recovery value 1 minute after peak exercise may be considered a reliable index of the severity of myocardial ischemia.
运动期间心率增加被认为归因于交感神经系统激活并伴有副交感神经活动减退。运动时变时性反应及运动后1分钟心率恢复的预后重要性已得到证实。本研究的目的是通过将心率恢复与已知的心肌缺血参数相关联，评估心率恢复作为心肌缺血的一项指标。
本研究纳入了304例连续患者（73%为男性），年龄在34至82岁之间。心率恢复值或心肌灌注成像可能受缺血性疾病以外因素影响的患者被排除在研究之外。患者接受单光子发射计算机断层扫描心肌灌注成像，并结合使用铊201或锝99m替曲膦进行症状限制性运动试验。心率恢复值定义为从运动峰值到运动终止后1分钟心率的下降值。对于闪烁图的半定量分析，放射性示踪剂的摄取按0至4级进行分级。每分钟21次心跳被定义为心率恢复的最低正常值。我们发现74例患者（24%）的值异常。我们还发现运动后1分钟心率恢复与应激心肌灌注评分之间存在显著相关性。此外，心率恢复与变时性变量之间存在统计学上的显著关系。心率恢复值异常的患者通常年龄较大，男性居多，患冠状动脉疾病危险因素的频率较高，大多正在服用心血管活性药物，在跑步机测试中的效率较低，并且在闪烁图上有更多的病理表现。
通过心肌灌注成像评估的心肌缺血是心率恢复的一个重要相关因素。运动试验期间的变时性变量与运动后1分钟心率恢复之间存在显著相关性。运动峰值后1分钟的心率恢复值似乎可被视为心肌缺血严重程度的可靠指标。
