预测接受β-肾上腺素能阻滞剂治疗的冠心病患者的最大心率。

Predicting maximum heart rate among patients with coronary heart disease receiving beta-adrenergic blockade therapy.

作者信息

Brawner Clinton A, Ehrman Jonathan K, Schairer John R, Cao Jie J, Keteyian Steven J

机构信息

Preventive Cardiology, Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, Mich, USA.

出版信息

Am Heart J. 2004 Nov;148(5):910-4. doi: 10.1016/j.ahj.2004.04.035.

DOI:10.1016/j.ahj.2004.04.035

PMID:15523326

Abstract

BACKGROUND

The use of beta-adrenergic blockade (BB) therapy is common among patients with coronary heart disease (CHD), and as a result, these patients often undergo exercise testing while taking these medications. However, evaluation of maximal voluntary effort during exercise testing is often in question because current equations to predict maximum heart rate (HR(max); eg, 220 - age) are based on subjects without heart disease or BB therapy. The purpose of this study was to develop and validate an age-specific equation to predict HR(max) in patients with CHD who are receiving BB therapy.

METHODS

We queried the Henry Ford Preventive Cardiology Outcomes database for patients with a history of myocardial infarction or revascularization procedure; preserved left ventricular function; age, 40 to 80 years; sinus rhythm; and a graded treadmill test with a respiratory exchange ratio > or =1.10. Data were split, based on date, such that tests performed between November 1996 and April 2001 were used as the BB prediction equation development group (n = 334; 73% men) and those performed between May 2001 and April 2002 were used as the BB cross-validation group (n = 94; 84% men). Linear regression was used to develop the equation to predict HR(max), based on age, and to calculate the correlation coefficient of the prediction equation among the cross-validation group.

RESULTS

The resultant prediction equation was HR(max) = 164 - 0.7 x age (r2 = 0.13), with a standard error of the estimate of 18 per minute. Among the cross-validation group, mean predicted HR(max) was not significantly different from mean measured HR(max) (P = .7). The mean error of prediction was -0.4 +/- 2.0 per minute (mean +/- SEM), and the correlation was r = 0.38.

CONCLUSIONS

This new equation provides a better estimate of HR(max) for patients with CHD receiving BB therapy than previously reported equations. Additional variables may improve the equation but may not be as convenient to use.

摘要

背景

β-肾上腺素能阻滞剂（BB）疗法在冠心病（CHD）患者中使用普遍，因此，这些患者在服用这些药物时常常要进行运动测试。然而，运动测试期间最大自主努力的评估常常受到质疑，因为目前预测最大心率（HR(max)；例如，220-年龄）的公式是基于无心脏病或未接受BB疗法的受试者得出的。本研究的目的是开发并验证一个针对接受BB疗法的冠心病患者的年龄特异性公式，以预测HR(max)。

方法

我们查询了亨利·福特预防心脏病学结果数据库，纳入有心肌梗死或血运重建手术史、左心室功能保留、年龄40至80岁、窦性心律且分级平板运动试验呼吸交换率≥1.10的患者。根据日期将数据分开，使得1996年11月至2001年4月期间进行的测试用作BB预测方程开发组（n = 334；73%为男性），2001年5月至2002年4月期间进行的测试用作BB交叉验证组（n = 94；84%为男性）。使用线性回归基于年龄开发预测HR(max)的方程，并计算交叉验证组中预测方程的相关系数。