射血分数保留的心力衰竭患者存在心率恢复受损和变时功能不全。
Impaired heart rate recovery and chronotropic incompetence in patients with heart failure with preserved ejection fraction.
机构信息
Department of Cardiovascular Medicine, University of Birmingham, Birmingham, United Kingdom.
出版信息
Circ Heart Fail. 2010 Jan;3(1):29-34. doi: 10.1161/CIRCHEARTFAILURE.109.877720. Epub 2009 Nov 16.
BACKGROUND
This study assessed the chronotropic response to exercise and heart rate (HR) recovery after exercise in a carefully phenotyped group of patients with heart failure with preserved left ventricular ejection fraction (HfpEF) and a control group of similar age and gender distribution.
METHODS AND RESULTS
We studied 41 patients with HfpEF, 41 healthy controls, and 16 hypertensive controls. None were taking HR-limiting medications. All study participants had clinical examination, 12-lead ECG, pulmonary function test, echocardiogram, and metabolic exercise test with HR monitoring throughout exercise. Chronotropic response was measured by the percentage of the HR reserve used during maximal exercise and the peak exercise HR as a percentage of predicted maximal HR. Patients with HfpEF were generally women (70%), overweight, aged 69+/-8 years. Controls were of similar gender (63%) and age (67+/-6 years). Patients with HfpEF had significantly reduced peak VO(2) compared with controls (20+/-4 mL kg(-1) min(-1) versus 31+/-6 mL kg(-1) min(-1), P<0.001) and greater minute ventilation-carbon dioxide production relationship (V(E)/V(CO2)) slope) (33+/-6 versus 29+/-4, P<0.001). Chronotropic incompetence was significantly more common in patients with HfpEF compared with matched healthy controls as measured by the percentage of the HR reserve used during maximal exercise (63% versus 2%, <0.001) and percentage of predicted maximal HR (34% versus 2%, <0.001). In addition, abnormal HR recovery 1-minute after exercise (defined as the reduction in the HR from peak exercise 1-minute after exercise) was also significantly more common in patients with HfpEF compared with controls (23% versus 2%, P=0.01). Hypertensive controls showed similar chronotropic response to peak exercise and HR recovery after exercise as healthy controls.
CONCLUSIONS
Patients with HfpEF have impaired chronotropic incompetence during maximal exercise and abnormal HR recovery after exercise.
背景
本研究评估了在精心表型分组的射血分数保留的心力衰竭（HFpEF）患者和年龄、性别分布相似的对照组中，运动时的变时性反应和运动后心率（HR）恢复情况。
方法和结果
我们研究了 41 例 HFpEF 患者、41 名健康对照者和 16 名高血压对照者。所有研究参与者均未服用 HR 限制药物。所有研究参与者均接受临床检查、12 导联心电图、肺功能检查、超声心动图和代谢运动试验，运动过程中监测 HR。变时性反应通过最大运动时 HR 储备的百分比和最大 HR 预测峰值的百分比来测量。HFpEF 患者通常为女性（70%）、超重、年龄 69±8 岁。对照组的性别（63%）和年龄（67±6 岁）相似。与对照组相比，HFpEF 患者的峰值 VO2 显著降低（20±4 mL·kg-1·min-1 与 31±6 mL·kg-1·min-1，P<0.001），分钟通气量-二氧化碳产量斜率（V（E）/V（CO2））更大（33±6 与 29±4，P<0.001）。与匹配的健康对照组相比，HFpEF 患者的变时性不全更为常见，最大运动时 HR 储备的百分比（63%比 2%，P<0.001）和最大 HR 预测值的百分比（34%比 2%，P<0.001）。此外，与对照组相比，HFpEF 患者运动后 1 分钟时 HR 恢复异常（定义为运动后 1 分钟时 HR 从峰值运动的降低）也更为常见（23%比 2%，P=0.01）。高血压对照组的最大运动时变时反应和运动后 HR 恢复与健康对照组相似。
结论
HFpEF 患者在最大运动时的变时性不全和运动后 HR 恢复异常。
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