Jouven Xavier, Schwartz Peter J, Escolano Sylvie, Straczek Céline, Tafflet Muriel, Desnos Michel, Empana Jean Philippe, Ducimetière Pierre
INSERM, Unit 909, Cardiovascular Epidemiology and Sudden Death, Hopital Européen Georges Pompidou, 75015 Paris, France.
Eur Heart J. 2009 Jul;30(14):1703-10. doi: 10.1093/eurheartj/ehp160. Epub 2009 Apr 28.
The aim of this study involves the early identification, among apparently healthy individuals, of those at high risk for sudden cardiac death. We tested the hypothesis that individuals who respond to mild mental stress in preparation for exercise test with the largest heart rate increases might be at highest risk.
Data from 7746 civil servants participating in the Paris Prospective Study I, followed-up for 23 years, allowed to compare heart rate changes between rest and mild mental stress (preparation prior to an exercise test) between subjects who suffered sudden cardiac death (n = 81), non-sudden (n = 129) coronary death, or death from any cause (n = 1306). The mean heart rate increase during mild mental stress was 8.9 +/- 10.8 b.p.m. Risk of sudden cardiac death increased progressively with heart rate increase during mental stress and the relative risk of the third vs. the first tertile was 2.09 (95% confidence interval, 1.13-3.86) after adjustment for confounders. This relationship was not observed for non-sudden coronary death.
An important heart rate increase produced by a mild mental stress predicts long-term risk for sudden cardiac death. Heart rate changes before an exercise test may provide a simple tool for risk stratification.
本研究旨在早期识别表面健康个体中具有心源性猝死高风险的人群。我们检验了这样一个假设：在为运动试验做准备时，对轻度精神应激反应时心率增加幅度最大的个体可能风险最高。
来自参与巴黎前瞻性研究I的7746名公务员的数据，随访23年，可用于比较心源性猝死（n = 81）、非心源性（n = 129）冠状动脉死亡或任何原因死亡（n = 1306）的受试者在静息和轻度精神应激（运动试验前准备）期间的心率变化。轻度精神应激期间的平均心率增加为8.9±10.8次/分钟。心源性猝死风险随着精神应激期间心率的增加而逐渐增加，在调整混杂因素后，第三分位数与第一分位数相比的相对风险为2.09（95%置信区间，1.13 - 3.86）。非心源性冠状动脉死亡未观察到这种关系。
轻度精神应激引起的显著心率增加预示着心源性猝死的长期风险。运动试验前的心率变化可能为风险分层提供一个简单的工具。
