Zaim Sina, Schesser Joel, Hirsch Linda S, Rockland Ronald
Division of Cardiology, UMDNJ-New Jersey Medical School, 185 South Orange Avenue, Newark, NJ 07101, USA.
Ann Noninvasive Electrocardiol. 2010 Jan;15(1):43-8. doi: 10.1111/j.1542-474X.2009.00338.x.
Abnormal heart rate recovery (HRR) following exercise testing has been shown to be a predictor for adverse cardiovascular events. The actual maximum heart rate (MHR) attained during the exercise test does not however have a distinct significance in traditional HRR assessment. The objective of this study was to investigate the role of MHR in HRR.
This prospective study consisted of 164 patients (62% male, mean age 53.7 + or - 11.7 years) who were referred for a symptom-limited standard Bruce Protocol treadmill exercise test, based on clinical indications. The patients were seated immediately at test completion and the heart rate (HR) recorded at one and two minutes postexercise. A normal HRR was defined as a HR drop of 18 beats per minute or more at the end of the first minute of recovery. The HRR profile of patients who reached > or = 85% of their maximum predicted heart rate (MPHR) during peak exercise were then compared to HRR profile of those who could not.
One hundred twelve patients (Group A) achieved a MHR > or = 85% of MPHR during peak exercise whereas 52 patients (Group B) did not. Chi-square analysis showed a higher incidence of normal HRR in Group A compared to Group B (p = 0.029). Analysis of variance with repeated measures showed that group A had a greater HRR at the first minute F(1,162)= 6.98, p = <0.01) but not the second minute (F(1,162)=1.83, p = .18) postexercise.
There is a relation between the peak heart rate attained during exercise and the subsequent HRR. A low peak heart rate increases the likelihood of a less than normal HRR. Assessment of the entire heart-rate response seems warranted for more thorough risk-stratification.
运动试验后异常的心率恢复（HRR）已被证明是心血管不良事件的一个预测指标。然而，运动试验期间达到的实际最大心率（MHR）在传统的HRR评估中并没有明显的意义。本研究的目的是调查MHR在HRR中的作用。
这项前瞻性研究包括164例患者（62%为男性，平均年龄53.7±11.7岁），他们根据临床指征被转诊进行症状限制的标准布鲁斯方案跑步机运动试验。试验结束后患者立即就座，并在运动后1分钟和2分钟记录心率（HR）。正常的HRR定义为恢复第一分钟末心率下降18次/分钟或更多。然后将运动高峰时达到≥其最大预测心率（MPHR）85%的患者的HRR情况与未达到该水平的患者的HRR情况进行比较。
112例患者（A组）在运动高峰时达到的MHR≥MPHR的85%，而52例患者（B组）未达到。卡方分析显示，A组正常HRR的发生率高于B组（p = 0.029）。重复测量方差分析显示，A组在运动后第一分钟的HRR更大（F(1,162)= 6.98，p = <0.01），但在第二分钟时没有差异（F(1,162)=1.83，p = 0.18）。
运动期间达到的峰值心率与随后的HRR之间存在关联。低峰值心率增加了HRR低于正常水平的可能性。为了更全面地进行风险分层，似乎有必要评估整个心率反应。
