运动后早期心率恢复情况可预测慢性心力衰竭患者的死亡率。

Early heart rate recovery after exercise predicts mortality in patients with chronic heart failure.

作者信息

Nanas Serafim, Anastasiou-Nana Maria, Dimopoulos Stavros, Sakellariou Dimitrios, Alexopoulos George, Kapsimalakou Smaragdo, Papazoglou Panagiotis, Tsolakis Elias, Papazachou Ourania, Roussos Charis, Nanas John

机构信息

Pulmonary and Critical Care Medicine Department, Cardiopulmonary Exercise Testing and Rehabilitation Laboratory, Evgenidio Hospital, National and Kapodestrian University of Athens, 20, Papadiamantopoulou str, Athens, 11528, Greece.

出版信息

Int J Cardiol. 2006 Jun 28;110(3):393-400. doi: 10.1016/j.ijcard.2005.10.032. Epub 2005 Dec 20.

DOI:10.1016/j.ijcard.2005.10.032

PMID:16371237

Abstract

BACKGROUND

Patients with chronic heart failure (CHF) have multiple abnormalities of autonomic regulation that have been associated to their high mortality rate. Heart rate recovery immediately after exercise is an index of parasympathetic activity, but its prognostic role in CHF patients has not been determined yet.

METHODS

Ninety-two stable CHF patients (83M/9F, mean age: 51+/-12 years) performed an incremental symptom-limited cardiopulmonary exercise testing. Measurements included peak O2 uptake (VO2p), ventilatory response to exercise (VE/VCO2 slope), the first-degree slope of VO2 for the 1st minute of recovery (VO2/t-slope), heart rate recovery [(HRR1, bpm): HR difference from peak to 1 min after exercise] and chronotropic response to exercise [%chronotropic reserve (CR, %)=(peak HR-resting HR/220-age-resting HR)x100]. Left ventricular ejection fraction (LVEF, %) was also measured by radionuclide ventriculography.

RESULTS

Fatal events occurred in 24 patients (26%) during 21+/-6 months of follow-up. HRR1 was lower in non-survivors (11.4+/-6.4 vs. 20.4+/-8.1; p<0.001). All cause-mortality rate was 65% in patients with HRR1<or=12 bpm versus 11% in patients with HRR1>12 bpm (log-rank: 32.6; p<0.001). By multivariate survival analysis, HRR1 resulted as an independent predictor of mortality (chi2=19.2; odds ratio: 0.87; p<0.001) after adjustment for LVEF, VO2p, VE/VCO2 slope, CR and VO2/t-slope. In a subgroup of patients with intermediate exercise capacity (VO2p: 10-18, ml/kg/min), HRR1 was a strong predictor of mortality (chi2: 14.3; odds ratio: 0.8; p<0.001).

CONCLUSIONS

Early heart rate recovery is an independent prognostic risk indicator in CHF patients and could be used in CHF risk stratification.

摘要

背景

慢性心力衰竭（CHF）患者存在多种自主神经调节异常，这与他们的高死亡率相关。运动后立即出现的心率恢复是副交感神经活动的一个指标，但其在CHF患者中的预后作用尚未确定。

方法

92例病情稳定的CHF患者（83例男性/9例女性，平均年龄：51±12岁）进行了递增症状限制心肺运动试验。测量指标包括峰值摄氧量（VO2p）、运动时的通气反应（VE/VCO2斜率）、恢复第1分钟VO2的一级斜率（VO2/t斜率）、心率恢复情况[（HRR1，次/分钟）：运动峰值到运动后1分钟的心率差值]以及运动时的变时反应[变时储备百分比（CR，%）=（运动峰值心率-静息心率/220-年龄-静息心率）×100]。还通过放射性核素心室造影测量左心室射血分数（LVEF，%）。

结果

在21±6个月的随访期间，24例患者（26%）发生了致命事件。非幸存者的HRR1较低（11.4±6.4对20.4±8.1；p<0.001）。HRR1≤12次/分钟的患者全因死亡率为65%，而HRR1>12次/分钟的患者为11%（对数秩检验：32.6；p<0.001）。通过多因素生存分析，在对LVEF、VO2p、VE/VCO2斜率、CR和VO2/t斜率进行调整后，HRR1是死亡率的独立预测因素（χ2=19.2；比值比：0.87；p<0.001）。在运动能力中等（VO2p：10-18，毫升/千克/分钟）的患者亚组中，HRR1是死亡率的强预测因素（χ2：14.3；比值比：0.8；p<0.001）。