Bigi Riccardo, Cortigiani Lauro, Gregori Dario, Bax Jeroen J, Fiorentini Cesare
Cardiology Unit, Department of Medicine and Surgery, University School of Medicine, Milan, Italy.
Arch Intern Med. 2005 Jun 13;165(11):1253-8. doi: 10.1001/archinte.165.11.1253.
Heart rate-adjusted ST-segment depression (ST/HR) analysis improves the diagnostic accuracy of exercise testing, but its prognostic value has not been evaluated in unselected populations. We prospectively used comparative exercise-recovery ST/HR analysis to predict outcome in a consecutive cohort of outpatients referred for exercise testing.
The stress-recovery index, defined as the difference between ST/HR areas during exercise and recovery,was derived in 1163 patients (median age, 60 years; interquartile range, 54-65 years). All-cause mortality and the combination of death or nonfatal myocardial infarction were target end points. The individual effect of clinical and exercise-testing data on outcome was evaluated by Cox regression analysis using separate models for each group of variables. Model validation was performed using bootstrap methods adjusted by the degree of optimism in estimates. Survival analysis was performed with the product-limit Kaplan-Meier method.
During a 33-month follow-up, 48 deaths and 72 nonfatal myocardial infarctions occurred. After adjusting for confounding variables, hypertension (hazard ratio, 1.80; 95% confidence interval, 1.26-2.59), ST/HR index (hazard ratio, 1.32; 95% confidence interval, 1.04-1.66; for interquartile difference), and stress-recovery index (hazard ratio, 0.75; 95% confidence interval, 0.65-0.86; for interquartile difference) were predictive of death or nonfatal myocardial infarction, whereas hypertension (hazard ratio, 3.67; 95% confidence interval, 2.00-6.73) and stress-recovery index (hazard ratio, 0.55; 95% confidence interval, 0.48-0.63; for interquartile difference) were predictive of all-cause mortality. In addition, stress-recovery index increased the prognostic power of the model on top of clinical and exercise-testing variables and provided significant discrimination for survival.
Combined evaluation of ST/HR analysis during exercise and recovery improves the prognostic capacity of standard exercise electrocardiography.
心率校正的ST段压低（ST/HR）分析可提高运动试验的诊断准确性，但其预后价值尚未在未选择的人群中进行评估。我们前瞻性地使用比较运动-恢复ST/HR分析来预测连续队列中接受运动试验的门诊患者的预后。
在1163例患者（中位年龄60岁；四分位间距54 - 65岁）中得出应激-恢复指数，定义为运动和恢复期间ST/HR面积的差值。全因死亡率以及死亡或非致命性心肌梗死的组合为目标终点。通过Cox回归分析，使用针对每组变量的单独模型评估临床和运动试验数据对预后的个体影响。使用根据估计中的乐观程度进行调整的自助法进行模型验证。采用乘积限Kaplan-Meier法进行生存分析。
在33个月的随访期间，发生了48例死亡和72例非致命性心肌梗死。在调整混杂变量后，高血压（风险比1.80；95%置信区间1.26 - 2.59）、ST/HR指数（风险比1.32；95%置信区间1.04 - 1.66；四分位间距差值）和应激-恢复指数（风险比0.75；95%置信区间0.65 - 0.86；四分位间距差值）可预测死亡或非致命性心肌梗死，而高血压（风险比3.67；95%置信区间2.00 - 6.73）和应激-恢复指数（风险比0.55；95%置信区间0.48 - 0.63；四分位间距差值）可预测全因死亡率。此外，应激-恢复指数在临床和运动试验变量之上增加了模型的预后能力，并对生存提供了显著的区分度。
运动和恢复期间ST/HR分析的联合评估提高了标准运动心电图的预后能力。
Zotero 插件