Department of Cardiology, Okazaki City Hospital, 3-1 Goshoai Koryuji-cho, Okazaki, Aichi 444-8553, Japan.
Europace. 2011 Jan;13(1):114-20. doi: 10.1093/europace/euq422. Epub 2010 Nov 17.
Several treadmill exercise testing prognostic parameters have been identified in various populations. However, despite the widespread use of treadmill exercise testing, the prognostic value in very elderly patients has not been well characterized. The aim of this study was to assess the results of treadmill exercise testing in octogenarians, and to examine various parameters in order to identify a prognostic marker of mortality.
This study included 97 consecutive octogenarians (age, 81.1 ± 1.8 years; 66% male) who were referred for treadmill exercise testing. During the follow-up period (2.6 ± 1.6 years), all-cause death occurred in 20 patients (21%). Univariate Cox proportional hazard regression analysis showed that abnormal heart rate recovery (HRR) (defined as a decreased heart rate of ≤ 18 beats per minute after peak exercise) [hazard ratio (HR), 2.82; 95% confidence interval (CI), 1.06-7.47; P = 0.037] and ischaemic ST-segment change (HR, 2.56; 95% CI, 1.01-6.46; P = 0.047) were significantly associated with all-cause mortality. After adjusting for age and sex, multivariate Cox proportional hazard analysis showed that abnormal HRR was the only independent predictor of all-cause death (HR, 2.86; 95% CI, 1.01-8.11; P = 0.048).
Attenuated HRR is a significant prognostic marker for all-cause death among octogenarians. The results may provide helpful support for risk stratification in clinical practice.
在不同人群中已经确定了几种跑步机运动测试的预后参数。然而，尽管跑步机运动测试得到了广泛的应用，但在非常高龄患者中的预后价值尚未得到很好的描述。本研究旨在评估 80 岁以上患者的跑步机运动测试结果，并检查各种参数，以确定死亡率的预后标志物。
本研究纳入了 97 例连续的 80 岁以上患者（年龄 81.1±1.8 岁，66%为男性），他们因跑步机运动测试而被转诊。在随访期间（2.6±1.6 年），20 例患者（21%）发生全因死亡。单变量 Cox 比例风险回归分析显示，异常心率恢复（HRR）（定义为峰值运动后心率降低≤18 次/分钟）[风险比（HR），2.82；95%置信区间（CI），1.06-7.47；P=0.037]和缺血性 ST 段改变（HR，2.56；95%CI，1.01-6.46；P=0.047）与全因死亡率显著相关。在校正年龄和性别后，多变量 Cox 比例风险分析显示，异常 HRR 是全因死亡的唯一独立预测因素（HR，2.86；95%CI，1.01-8.11；P=0.048）。
HRR 减弱是 80 岁以上患者全因死亡的重要预后标志物。研究结果可能为临床实践中的风险分层提供有益支持。
