Cardiology Division, Department of Medicine, Queen Mary Hospital, Hong Kong SAR, China.
Heart Rhythm. 2010 Jul;7(7):929-36. doi: 10.1016/j.hrthm.2010.03.023. Epub 2010 Mar 23.
Heart rate recovery (HRR) at predischarge exercise stress test predicts all-cause mortality in patients with myocardial infarction (MI), but the relationship between improvement in HRR with exercise training and clinical outcomes remains unclear.
The purpose of this study was to evaluate the effect of change in HRR after exercise training on clinical outcomes in MI patients.
The study included 386 consecutive patients with recent MI who were enrolled into our cardiac rehabilitation program. All patients underwent symptom-limited treadmill testing at baseline and after exercise training, and were prospectively followed-up in the outpatient clinic.
Treadmill testing revealed significant improvement in HRR after 8 weeks of exercise training (17.5 +/- 10.0 bpm to 19.0 +/- 12.3 bpm, P = .011). After follow-up of 79 +/- 41 months, 40 (10.4%) patients died of cardiac events. Multivariate Cox regression analysis revealed that diabetes (hazard ratio [HR] 2.28, 95% confidence interval [CI] 1.01-5.19, P = .049), statin use (HR 0.36, 95% CI 0.16-0.80, P = .012), baseline resting heart rate > or =65 bpm (HR 5.37, 95% CI 1.33-21.61, P = .018), post-training HRR <12 bpm (HR 2.49, 95% CI 1.10-5.63, P = .028), left ventricular ejection fraction < or =30% (HR 4.70, 95% CI 1.34-16.46, P = .016), and exercise capacity < or =4 metabolic equivalents (HR 3.63, 95% CI 1.17-11.28, P = .026) were independent predictors of cardiac death. Patients who failed to improve HRR from <12 bpm to > or =12 bpm after exercise training had significantly higher mortality (HR 6.2, 95% CI 1.3-29.2, P = .022).
Exercise training improved HRR in patients with recent MI, and patients with HRR increased to > or =12 bpm had better cardiac survival.
在心肌梗死（MI）患者出院前的运动应激试验中心率恢复（HRR）可预测全因死亡率，但运动训练后 HRR 的改善与临床结果之间的关系尚不清楚。
本研究旨在评估 MI 患者运动训练后 HRR 变化对临床结局的影响。
本研究纳入了 386 例近期 MI 患者，他们被纳入我们的心脏康复计划。所有患者在基线和运动训练后均接受了症状限制的跑步机测试，并在门诊进行了前瞻性随访。
8 周运动训练后，HRR 显著改善（17.5 ± 10.0 bpm 至 19.0 ± 12.3 bpm，P =.011）。随访 79 ± 41 个月后，40 例（10.4%）患者因心脏事件死亡。多变量 Cox 回归分析显示，糖尿病（危险比 [HR] 2.28，95%置信区间 [CI] 1.01-5.19，P =.049）、他汀类药物的使用（HR 0.36，95%CI 0.16-0.80，P =.012）、静息心率≥65 bpm（HR 5.37，95%CI 1.33-21.61，P =.018）、运动后 HRR＜12 bpm（HR 2.49，95%CI 1.10-5.63，P =.028）、左心室射血分数≤30%（HR 4.70，95%CI 1.34-16.46，P =.016）和运动能力＜或=4 代谢当量（HR 3.63，95%CI 1.17-11.28，P =.026）是心脏死亡的独立预测因子。运动训练后 HRR 从＜12 bpm 增加至≥12 bpm 的患者死亡率显著降低（HR 6.2，95%CI 1.3-29.2，P =.022）。
运动训练改善了近期 MI 患者的 HRR，HRR 增加至≥12 bpm 的患者心脏生存率更好。
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