Henkens Ivo R, Van Wolferen Serge A, Gan C Tji-Joong, Boonstra Anco, Swenne Cees A, Twisk Jos W, Kamp Otto, van der Wall Ernst E, Schalij Martin J, Vonk-Noordegraaf Anton, Vliegen Hubert W
Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
Am J Cardiol. 2009 May 15;103(10):1451-6. doi: 10.1016/j.amjcard.2009.01.359. Epub 2009 Apr 1.
Heart rate (HR) at rest is an important marker of prognosis in heart failure, but has not been addressed in pulmonary arterial hypertension (PAH). To determine the prognostic value of HR at rest in patients with PAH, we retrospectively analyzed 140 consecutive patients with idiopathic PAH. Electrocardiogram (ECG)-derived HR at rest was evaluated as a potential predictor of adverse prognosis (death or lung transplantation), in addition to World Health Organization functional class, 6-minute walk distance, and hemodynamics before and approximately 1 year and 2 years after initiation of PAH treatment. During follow-up, 49 patients (35%) died, and 5 patients (4%) underwent lung transplantation. Before treatment initiation and after 1 year and 2 years of treatment, respectively, a higher HR at rest was an independent predictor of adverse prognosis (hazard ratios per 10-beats/min increase 1.76, 95% confidence interval 1.42 to 2.18, 2.31, 95% confidence interval 1.58 to 3.38, 2.1, 95% confidence interval 1.39 to 3.19, respectively, p <0.001 for all). Change in HR between the first and last ECG also independently predicted prognosis (hazard ratio per 1-beat/min increase 1.03, 95% confidence interval 1.01 to 1.06). In conclusion, a higher HR at rest and an important increase in HR at rest during follow-up signify a considerable risk of death in patients with PAH. ECG-derived HR at rest is an important marker of prognosis and should be assessed before and at frequent intervals after initiation of treatment for PAH.
静息心率（HR）是心力衰竭预后的重要指标，但在肺动脉高压（PAH）中尚未得到研究。为了确定静息心率在PAH患者中的预后价值，我们回顾性分析了140例连续的特发性PAH患者。除了世界卫生组织功能分级、6分钟步行距离以及PAH治疗开始前、治疗后约1年和2年的血流动力学指标外，还将心电图（ECG）得出的静息心率评估为不良预后（死亡或肺移植）的潜在预测指标。在随访期间，49例患者（35%）死亡，5例患者（4%）接受了肺移植。在治疗开始前以及治疗1年和2年后，静息心率较高分别是不良预后的独立预测指标（每增加10次/分钟的风险比分别为1.76，95%置信区间为1.42至2.18；2.31，95%置信区间为1.58至3.38；2.1，95%置信区间为1.39至3.19，所有p<0.001）。首次和末次心电图之间的心率变化也独立预测了预后（每增加1次/分钟的风险比为1.03，95%置信区间为1.01至1.06）。总之，静息心率较高以及随访期间静息心率显著增加表明PAH患者有相当大的死亡风险。ECG得出的静息心率是预后的重要指标，在PAH治疗开始前及治疗后应定期进行评估。
