Diller Gerhard-Paul, Dimopoulos Konstantinos, Okonko Darlington, Uebing Anselm, Broberg Craig S, Babu-Narayan Sonya, Bayne Stephanie, Poole-Wilson Philip A, Sutton Richard, Francis Darrel P, Gatzoulis Michael A
Adult Congenital Heart Program, Department of Cardiology, Royal Brompton Hospital, London, United Kingdom.
J Am Coll Cardiol. 2006 Sep 19;48(6):1250-6. doi: 10.1016/j.jacc.2006.05.051. Epub 2006 Aug 28.
To assess the prognostic value of heart rate response to exercise in adult congenital heart disease (ACHD) patients.
An abnormal heart rate response to exercise is related to autonomic dysfunction and may have prognostic implications in ACHD.
We identified 727 consecutive ACHD patients (mean age [+/- SD] 33 +/- 13 years) with varying diagnoses and without pacemakers. Peak oxygen consumption (peak VO2), resting heart rate, and the increase in heart rate from resting level to peak exercise ("heart rate reserve") were measured. We also quantified the decrease in heart rate ("heart rate recovery") after cessation of exercise.
During a median follow-up of 28 months, 38 patients died. Lower values of heart rate reserve, peak heart rate, heart rate recovery, and peak VO2 (p < 0.01 for each) were associated with increased mortality in univariate analysis. Furthermore, heart rate reserve predicted mortality independently of antiarrhythmic therapy, functional class, and peak VO2. Stratifying patients by diagnostic groups revealed that a lower heart rate reserve was also associated with a greater risk of death in patients with complex anatomy, Fontan circulation, and tetralogy of Fallot (p < 0.05 for each).
An abnormal heart rate response to exercise identifies ACHD patients with a higher risk of mortality in the midterm, even after accounting for antiarrhythmic medication and exercise capacity. Heart rate reserve is a simple and inexpensive way to identify ACHD patients at higher mortality risk.
评估运动时心率反应对成人先天性心脏病（ACHD）患者的预后价值。
运动时异常的心率反应与自主神经功能障碍有关，可能对ACHD患者的预后有影响。
我们纳入了727例连续的ACHD患者（平均年龄[±标准差]33±13岁），诊断各异且未植入起搏器。测量了峰值耗氧量（peak VO2）、静息心率以及从静息水平到运动峰值时心率的增加幅度（“心率储备”）。我们还对运动停止后心率的下降幅度（“心率恢复”）进行了量化。
在中位随访28个月期间，38例患者死亡。在单因素分析中，心率储备、峰值心率、心率恢复和peak VO2值较低（每项p<0.01）与死亡率增加相关。此外，心率储备独立于抗心律失常治疗、功能分级和peak VO2预测死亡率。按诊断组对患者进行分层显示，在解剖结构复杂、Fontan循环和法洛四联症患者中，较低的心率储备也与更高的死亡风险相关（每项p<0.05）。
运动时异常的心率反应可识别出中期死亡风险较高的ACHD患者，即使在考虑抗心律失常药物和运动能力之后。心率储备是识别死亡风险较高的ACHD患者的一种简单且经济的方法。
