心率恢复——接受β受体阻滞剂治疗的心力衰竭患者临床结局的潜在标志物。
Heart rate recovery--a potential marker of clinical outcomes in heart failure patients receiving beta-blocker therapy.
作者信息
Sheppard Richard J, Racine Normand, Roof Andre, Ducharme Anique, Blanchet Martine, White Michel
机构信息
Sir Mortimer B Davis-Jewish General Hospital, McGill University, Montreal, Quebec, Canada.
出版信息
Can J Cardiol. 2007 Dec;23(14):1135-8. doi: 10.1016/s0828-282x(07)70884-x.
BACKGROUND
Heart rate recovery (HRR) within the first few minutes of graded exercise has been associated with impaired clinical outcomes in patients being evaluated for coronary artery disease. HRR is abnormal in patients with heart failure (HF), but has not been associated with clinical outcomes in these patients. The objective of the present study was to determine whether HRR following cardiopulmonary exercise testing (CPET) correlates with peak oxygen consumption (VO(2)), and whether it impacts clinical outcomes, including HF hospitalizations and total mortality, or the need for cardiac transplantation.
METHODS
CPET was performed in 78 patients referred to the Montreal Heart Institute (Montreal, Quebec) with congestive HF between January 2000 and December 2002. All patients had New York Heart Association class II or III HF with a left ventricular ejection fraction of 45% or lower. Mean (+/- SD) age was 53+/-11 years and left ventricular ejection fraction was 27+/-9%. Forty-four per cent had ischemic cardiomyopathy, 88% received beta-blockers and 79% received angiotensin-converting enzyme inhibitors. HRR was defined as the difference from peak exercise HR to HR measured at specific time intervals. HRR was calculated 30 s, 60 s, 90 s and 120 s after exercise.
RESULTS
Mean peak VO(2) was 18.0+/-5.3 mL/kg/min, resting HR was 74+/-13 beats/min and peak HR was 119+/-22 beats/min. HRR measured was 10+/-9 beats/min after 30 s, 20+/-12 beats/min after 60 s, 25+/-15 beats/min after 90 s and 30+/-13 beats/min after 120 s. At 90 s, patients with an HRR below 24 beats/min were more likely to have an HF hospitalization at five-year follow-up (eight hospitalizations [22.2%] versus two hospitalizations [2.7%]; P=0.0134). There was a correlation between peak VO(2) and HRR 90 s and 120 s after completion of the exercise test (r=0.40 after 90 s, P=0.001, and r=0.41 after 120 s, P=0.008).
CONCLUSIONS
In patients with HF, blunted HRR 90 s and 120 s after CPET correlate with peak VO(2) and are associated with increased risk of worsening HF. HRR is easily measured and a useful marker for morbidity in patients with HF.
背景
在进行冠状动脉疾病评估的患者中，分级运动最初几分钟内心率恢复（HRR）与不良临床结局相关。心力衰竭（HF）患者的HRR异常，但尚未发现其与这些患者的临床结局相关。本研究的目的是确定心肺运动试验（CPET）后的HRR是否与峰值耗氧量（VO₂）相关，以及它是否会影响临床结局，包括HF住院率和总死亡率，或心脏移植需求。
方法
2000年1月至2002年12月期间，对78名转诊至蒙特利尔心脏研究所（魁北克省蒙特利尔）的充血性HF患者进行了CPET。所有患者均为纽约心脏协会II级或III级HF，左心室射血分数为45%或更低。平均（±标准差）年龄为53±11岁，左心室射血分数为27±9%。44%的患者患有缺血性心肌病，88%的患者接受β受体阻滞剂治疗，79%的患者接受血管紧张素转换酶抑制剂治疗。HRR定义为运动峰值心率与特定时间间隔测量的心率之差。运动后30秒、60秒、90秒和120秒计算HRR。
结果
平均峰值VO₂为18.0±5.3 mL/kg/min，静息心率为74±13次/分钟，峰值心率为119±22次/分钟。运动后30秒测量的HRR为10±9次/分钟，60秒后为20±12次/分钟，90秒后为25±15次/分钟，120秒后为30±13次/分钟。在90秒时，HRR低于24次/分钟的患者在五年随访中更有可能发生HF住院（8次住院[22.2%]对2次住院[2.7%]；P = 0.0134）。运动试验完成后90秒和120秒时，峰值VO₂与HRR之间存在相关性（90秒后r = 0.40，P = 0.001；120秒后r = 0.41，P = 0.008）。
结论
在HF患者中，CPET后90秒和120秒时HRR减弱与峰值VO₂相关，并与HF恶化风险增加相关。HRR易于测量，是HF患者发病率的有用标志物。
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