Akutsu Yasushi, Gregory Shawn A, Kardan Arash, Zervos Gerasimos D, Thomas Gregory S, Gewirtz Henry, Yasuda Tsunehiro
Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Yawkey 5E 55 Fruit Street, Boston, MA 02114, USA.
J Nucl Cardiol. 2009 Jan-Feb;16(1):54-62. doi: 10.1007/s12350-008-9014-4. Epub 2009 Jan 20.
Delayed heart rate (HR) recovery after treadmill exercise testing predicts mortality. Patients with suspected ischemic heart disease who cannot perform adequate treadmill exercise are typically evaluated with pharmacological stress myocardial perfusion imaging (MPI) studies, but little prognostic significance has been attributed to the hemodynamic response to vasodilator stress testing with low-level exercise. We hypothesized that a delay in HR recovery after adenosine stress testing with arm exercise is associated with increased mortality.
Technetium 99m-Sestamibi MPI was performed in 1,455 consecutive patients (70 +/- 12 years, 50.2% men) with adenosine stress and supplemental arm exercise. HRs were recorded at rest, continuously during infusion, and then 5 minutes post-infusion. Delayed HR recovery was defined as a decline of < or = 12 bpm from peak HR at 5 minutes after discontinuation of the infusion. Of 1,356 patients during 5 years of follow up, there were 135 deaths (10%). Delayed HR recovery was strongly predictive of all-cause mortality (16.5% vs 5.3% in those with normal HR recovery, P < .001) with an adjusted hazard ratio of 2.5 (95% CI, 1.7-3.6; P < .001).
Delayed HR recovery after adenosine stress testing with arm exercise is a readily available and powerful predictor of all-cause mortality.
平板运动试验后心率（HR）恢复延迟可预测死亡率。无法进行充分平板运动的疑似缺血性心脏病患者通常采用药物负荷心肌灌注成像（MPI）研究进行评估，但低水平运动的血管扩张剂负荷试验的血流动力学反应的预后意义不大。我们假设腺苷负荷试验联合手臂运动后心率恢复延迟与死亡率增加有关。
对1455例连续患者（70±12岁，男性占50.2%）进行了锝99m-甲氧基异丁基异腈MPI检查，采用腺苷负荷试验联合补充手臂运动。在静息时、输注过程中持续记录心率，然后在输注后5分钟记录。心率恢复延迟定义为输注停止后5分钟心率从峰值心率下降≤12次/分钟。在1356例患者5年的随访中，有135例死亡（10%）。心率恢复延迟是全因死亡率的强预测因素（心率恢复正常者为16.5%，而心率恢复正常者为5.3%，P<0.001），调整后的风险比为2.5（95%CI，1.7-3.6；P<0.001）。
腺苷负荷试验联合手臂运动后心率恢复延迟是全因死亡率的一个易于获得且强大的预测因素。
