六分钟步行试验后心率恢复可预测特发性肺纤维化患者的肺动脉高压。
Heart rate recovery after six-minute walk test predicts pulmonary hypertension in patients with idiopathic pulmonary fibrosis.
机构信息
Interstitial Lung Disease Program and Autoimmune Lung Center, National Jewish Health, Denver, Colorado 80206, USA.
出版信息
Respirology. 2011 Apr;16(3):439-45. doi: 10.1111/j.1440-1843.2010.01877.x.
BACKGROUND AND OBJECTIVE
In patients with IPF, we sought to validate that abnormal heart rate recovery at 1 min (HRR1) after six-minute walk test (6MWT) predicts mortality and to explore the relationship between abnormal HRR1 and pulmonary hypertension (PH).
METHODS
We identified IPF patients who performed a 6MWT as part of their clinical evaluation between 2006 and 2009 and were followed to lung transplantation or death. Right heart catheterization (RHC) data were collated and analysed for the subgroup who had this procedure.
RESULTS
There were 160 subjects who qualified for the survival analysis, and those with an abnormal HRR1 had worse survival than subjects with normal HRR1 (log-rank P = 0.01). Eighty-two subjects had a right heart catheter (RHC); among them, abnormal HRR1 was associated with RHC-confirmed PH (χ(2) = 4.83, P = 0.03) and had a sensitivity, specificity, positive predictive value and negative predictive value of 52%, 74%, 41% and 82%, respectively, for PH. In bivariate and multivariable analyses, abnormal HRR1 appeared to be the strongest predictor of RHC-confirmed PH (odds ratio (OR) = 4.0, 95% CI: 1.17-13.69, P = 0.02 in the multivariable analysis).
CONCLUSIONS
This study adds to data that support the validity of abnormal HRR1 as a predictor of mortality and of RHC-confirmed PH in IPF. Research is needed to further investigate the link between abnormal HRR1 and PH and to elucidate heart-lung interactions at work during exercise and recovery in patients with IPF.
背景与目的
在 IPF 患者中，我们试图验证 6 分钟步行试验（6MWT）后 1 分钟时的心率恢复异常（HRR1）是否可预测死亡率，并探讨异常 HRR1 与肺动脉高压（PH）之间的关系。
方法
我们鉴定了 2006 年至 2009 年间进行 6MWT 作为临床评估一部分的 IPF 患者，并对其进行了随访，直至肺移植或死亡。收集并分析了进行右心导管检查（RHC）的亚组患者的数据。
结果
有 160 名患者符合生存分析条件，HRR1 异常的患者比 HRR1 正常的患者生存更差（对数秩检验 P=0.01）。82 名患者进行了右心导管检查（RHC）；其中，异常 HRR1 与 RHC 确诊的 PH 相关（χ(2)=4.83，P=0.03），其对 PH 的敏感性、特异性、阳性预测值和阴性预测值分别为 52%、74%、41%和 82%。在单变量和多变量分析中，异常 HRR1 似乎是 RHC 确诊 PH 的最强预测因子（优势比（OR）=4.0，95%CI：1.17-13.69，P=0.02 在多变量分析中）。
结论
本研究进一步证实了异常 HRR1 可作为死亡率和 IPF 中 RHC 确诊 PH 的预测因子的有效性。需要进一步研究异常 HRR1 与 PH 之间的联系，并阐明 IPF 患者运动和恢复期心肺相互作用的机制。
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