Montreal Heart Institute Cardiovascular and Prevention Centre (Centre ÉPIC), Montreal, Québec, Canada.
Can J Cardiol. 2012 Mar-Apr;28(2):201-7. doi: 10.1016/j.cjca.2011.12.004. Epub 2012 Feb 14.
The long-term prognostic value of heart rate recovery (HRR) has been incompletely documented in patients with coronary artery disease (CAD). We sought to confirm the prognostic value of HRR in a large cohort with stable CAD.
From the Coronary Artery Surgery Study registry, a database of 24,958 patients with CAD who underwent cardiac catheterization between 1974 and 1979, we identified 4097 patients with baseline exercise stress testing data. HRR was measured at 3 minutes post exercise during a passive recovery. Clinical outcomes were evaluated according to HRR in both threshold and continuous models.
Median long-term follow-up was 14.7 years (interquartile range, 9.8-16.2). HRR < 46 beats per minute (Bpm) most appropriately differentiated nonsurvivors from survivors (area under receiver operating characteristic curve = 0.613) and was associated with an increased risk of all-cause death (adjusted hazard ratio = 1.15; P = 0.011). Increasing HRR was associated with a lower risk of all-cause (adjusted hazard ratio = 0.94 per 10 Bpm; 95% confidence interval, 0.91-0.97; P = 0.0005) and cardiovascular (CV) mortality (adjusted hazard ratio = 0.94 per 10 Bpm; 95% confidence interval, 0.90-0.98; P = 0.003).
HRR at 3 minutes independently predicts long-term all-cause and CV mortality in patients with stable CAD. Measurement of HRR at 3 minutes during passive recovery can be used as a complementary tool to identify patients with a higher total and CV risk.
心率恢复（HRR）的长期预后价值在冠心病（CAD）患者中尚未完全记录。我们试图在一个患有稳定 CAD 的大队列中证实 HRR 的预后价值。
从冠状动脉手术研究登记处，一个 1974 年至 1979 年间接受心脏导管检查的 24958 例 CAD 患者的数据库中，我们确定了 4097 例基线运动应激测试数据的患者。在被动恢复期，在运动后 3 分钟测量 HRR。根据 HRR 的阈值和连续模型评估临床结局。
中位长期随访时间为 14.7 年（四分位间距，9.8-16.2）。HRR<46 次/分钟（bpm）最能区分非幸存者和幸存者（接收者操作特征曲线下面积=0.613），并且与全因死亡风险增加相关（调整后的危险比=1.15；P=0.011）。HRR 的增加与全因（调整后的危险比=每 10 bpm 0.94；95%置信区间，0.91-0.97；P=0.0005）和心血管（CV）死亡率（调整后的危险比=每 10 bpm 0.94；95%置信区间，0.90-0.98；P=0.003）的风险降低相关。
在患有稳定 CAD 的患者中，3 分钟时的 HRR 独立预测全因和 CV 死亡率的长期预后。在被动恢复期的 3 分钟时测量 HRR 可作为识别总风险和 CV 风险较高的患者的补充工具。
