Lorgis Luc, Zeller Marianne, Jourdain Patrick, Beaune Jacques, Cambou Jean-Pierre, Vaisse Bernard, Chamontin Bernard, Cottin Yves
Service de cardiologie, CHU Bocage, boulevard Maréchal-de-Lattre-de Tassigny, Dijon, France.
Arch Cardiovasc Dis. 2009 Jun-Jul;102(6-7):541-7. doi: 10.1016/j.acvd.2009.05.003. Epub 2009 Jul 25.
Heart rate is a key determinant of both myocardial ischaemia and prognosis in patients with coronary disease. Reducing heart rate is known to relieve ischaemia and improve cardiovascular prognosis. Currently there is no information about heart rate distribution and predictors of high heart rate in patients with stable coronary artery disease (CAD).
The L'Hypertendu Coronarien Vu En Médecine Générale (LHYCORNE) cohort was a prospective observational study involving consecutive stable CAD patients with treated hypertension. Patients with atrial fibrillation were excluded from the analysis. Heart rate distribution and factors independently associated with heart rate above that of the cohort mean were analysed.
The study population comprised 8922 stable CAD patients in sinus rhythm (76% were men; mean age 66+/-11 years; mean systolic/diastolic blood pressures 141/82mmHg; 26% had diabetes). The mean resting heart rate was 70+/-6 bpm; the distribution was: 7% for <60 bpm, 38% for 60-69, 38% for 70-79bpm, 14% for 80-89bpm, and 2% for>90bpm. The mean resting heart rate of the patients on beta-blockers (62% of the population) was 69+/-8bpm versus 73+/-8bpm in subjects not on beta-blockers (p<0.001). Eight independent predictors of heart rate>/=70bpm were identified.
Data from this large cohort demonstrate that few patients meet recommendations to lower heart rate to <60bpm. Over 50% of stable CAD patients had a heart rate>/=70bpm, presenting a particularly high-risk profile. Given the therapeutic and prognostic role of resting heart rate in CAD patients, our findings emphasize the need to consider heart rate in these high-risk patients.
心率是冠心病患者心肌缺血和预后的关键决定因素。已知降低心率可缓解缺血并改善心血管预后。目前尚无关于稳定型冠状动脉疾病（CAD）患者心率分布及高心率预测因素的信息。
“一般医学中所见的冠状动脉高血压”（LHYCORNE）队列研究是一项前瞻性观察性研究，纳入连续的患有高血压且接受治疗的稳定型CAD患者。分析时排除心房颤动患者。分析心率分布以及与高于队列平均心率独立相关的因素。
研究人群包括8922例窦性心律的稳定型CAD患者（76%为男性；平均年龄66±11岁；平均收缩压/舒张压为141/82mmHg；26%患有糖尿病）。静息心率平均为70±6次/分钟；分布情况为：<60次/分钟的占7%，60 - 69次/分钟的占38%，70 - 79次/分钟的占38%，80 - 89次/分钟的占14%，>90次/分钟的占2%。使用β受体阻滞剂的患者（占人群的62%）静息心率平均为69±8次/分钟，未使用β受体阻滞剂的患者静息心率平均为73±8次/分钟（p<0.001）。确定了心率≥70次/分钟的8个独立预测因素。
来自这个大型队列的数据表明，很少有患者达到将心率降至<60次/分钟的建议。超过50%的稳定型CAD患者心率≥70次/分钟，呈现出特别高的风险特征。鉴于静息心率在CAD患者中的治疗和预后作用，我们的研究结果强调在这些高危患者中考虑心率的必要性。
