心率恢复受损的预测因素：一项心肌灌注单光子发射计算机断层扫描研究

Predictors of impaired heart rate recovery: a myocardial perfusion SPECT study.

作者信息

Maeder Micha T, Duerring Cornelia, Engel Reto P, Boesch Claudia, Pfisterer Matthias E, Myers Jonathan, Müller-Brand Jan, Zellweger Michael J

机构信息

Department of Cardiology, University Hospital, Basel, Switzerland.

出版信息

Eur J Cardiovasc Prev Rehabil. 2010 Jun;17(3):303-8. doi: 10.1097/HJR.0b013e32833188e0.

DOI:10.1097/HJR.0b013e32833188e0

PMID:19940778

Abstract

BACKGROUND

Heart rate recovery (HRR) is an established prognostic predictor. However, a number of methodological issues have not been fully explored, including differences in HRR 1 versus 2 min after exercise termination, absolute versus relative HRR, and the impact of beta-blockers.

DESIGN

Cross-sectional study.

METHODS

Predictors of impaired absolute and relative HRR 1 (HRR-1, HRR-1%) and 2 min after exercise termination (HRR-2, HRR-2%), defined as their lowest quartiles, were assessed in 1667 patients undergoing cycle exercise myocardial perfusion single photon emission computed tomography, and measures of HRR were compared between patients undergoing myocardial perfusion single photon emission computed tomography with continued, discontinued, and without beta-blockers.

RESULTS

Higher resting heart rate was an independent predictor of all measures of impaired HRR (P<0.001 for all). Lower peak heart rate was independently associated with impaired HRR-1, HRR-2, and HRR-2% (P<0.001 for all) but not HRR-1%. Higher summed rest score as a marker of scar and in part left ventricular dysfunction was an independent predictor of impaired HRR-1 (P = 0.010) and HRR-1% (P = 0.025) but not HRR-2 and HRR-2%, whereas lower stroke volume index was an independent predictor of slow HRR-2 (P = 0.004) and HRR-2% (P = 0.02) but not HRR-1 and HRR-1%. HRR-1 (P = 0.98) and HRR-2 (P = 0.86) were similar in patients with continued, discontinued, and without beta-blocker therapy. In contrast, HRR-1% (P = 0.01) and HRR-2% (P = 0.001) were faster in patients on beta-blockers than in the other groups.

CONCLUSION

HRR-1 and HRR-2 as well as HRR-1% and HRR-2% reflect different pathophysiological processes. Relative but not absolute measures of HRR seem to be enhanced under beta-blockers.

摘要

背景

心率恢复（HRR）是一种公认的预后预测指标。然而，一些方法学问题尚未得到充分探讨，包括运动终止后1分钟与2分钟时HRR的差异、绝对HRR与相对HRR以及β受体阻滞剂的影响。

设计

横断面研究。

方法

在1667例接受自行车运动心肌灌注单光子发射计算机断层扫描的患者中，评估运动终止后1分钟（HRR-1，HRR-1%）和2分钟（HRR-2，HRR-2%）时绝对和相对HRR受损的预测因素（定义为其最低四分位数），并比较接受持续、停用和未使用β受体阻滞剂的心肌灌注单光子发射计算机断层扫描患者的HRR测量值。

结果

静息心率较高是所有HRR受损指标的独立预测因素（所有P<0.001）。较低的峰值心率与HRR-1、HRR-2和HRR-2%受损独立相关（所有P<0.001），但与HRR-1%无关。较高的静息总分作为瘢痕和部分左心室功能障碍的标志物是HRR-1受损（P = 0.010）和HRR-1%受损（P = 0.025）的独立预测因素，但与HRR-2和HRR-2%无关，而较低的每搏量指数是HRR-2减慢（P = 0.004）和HRR-2%减慢（P = 0.02）的独立预测因素，但与HRR-1和HRR-1%无关。在持续、停用和未使用β受体阻滞剂治疗的患者中，HRR-1（P = 0.98）和HRR-2（P = 0.86）相似。相比之下，使用β受体阻滞剂的患者的HRR-1%（P = 0.01）和HRR-2%（P = 0.001）比其他组更快。