Cardiorespiratory Unit, Great Ormond Street Hospital for Children, London, United Kingdom.
Circulation. 2013 Sep 10;128(11 Suppl 1):S199-204. doi: 10.1161/CIRCULATIONAHA.112.000369.
A blunted heart rate recovery (HRR) from peak exercise is associated with adverse outcome in adults with ischemic heart disease. We assessed HRR after pediatric heart transplantation (HTx) and its prognostic use.
Between 2004 and 2010 we performed 360 maximal exercise tests (median, 2 tests/patient; range, 1-7) in 128 children (66 men; age at test, 14 ± 3 years) who received HTx (age, 8.5 ± 5.1 years) because of cardiomyopathy (66%) or congenital heart defects (34%). The change in heart rate from peak exercise to 1 minute of recovery was measured as HRR and was expressed as Z score calculated from reference data obtained in 160 healthy children. HRR was impaired soon after HTx (average in first 2 years Z=-1.9 ± 3.5) but improved afterward (Z=+0.52/y), such that HRR Z score normalized in most patients by 6 years after HTx (average, 0.6 ± 1.8). A subsequent decline in HRR Z score was noted from 6 years after HTx (rate of Z=-0.11/y). After 27 ± 15 months from the most recent exercise test, 19 patients died or were re-heart transplantation. For the follow-up after 6 years, HRR Z score was the only predictor of death/re-heart transplantation (P=0.003). Patients in the lowest quartile of HRR Z score had a much higher 5-year event rate (event-free rate, 29% versus 84%; hazard ratio, 7.0; P=0.0013).
HRR is blunted soon after HTx but normalizes at ≈ 6 years, potentially as a result of parasympathetic reinnervation of the graft, but then declines. This late decline in HRR Z score is associated with worse outcome.
运动后心率恢复（HRR）迟钝与成人缺血性心脏病不良预后相关。我们评估了儿科心脏移植（HTx）后的 HRR 及其预后作用。
2004 年至 2010 年，我们对 128 名接受 HTx（年龄 8.5±5.1 岁）的儿童（66 名男性；中位年龄 14±3 岁，年龄范围 1-7 岁）进行了 360 次最大运动测试（中位数，每位患者 2 次测试；范围，1-7 次），这些儿童患有心肌病（66%）或先天性心脏病（34%）。通过从 160 名健康儿童获得的参考数据计算 HRR 的 Z 分数，测量从峰值运动到恢复 1 分钟时的心率变化。HTx 后不久 HRR 受损（前 2 年平均 Z=-1.9±3.5），但随后改善（Z=+0.52/y），因此大多数患者在 HTx 后 6 年内 HRR Z 评分正常（平均，0.6±1.8）。从 HTx 后 6 年开始，HRR Z 评分下降。在最近一次运动测试后 27±15 个月，19 名患者死亡或再次接受心脏移植。对于 HTx 后 6 年的随访，HRR Z 评分是死亡/再次心脏移植的唯一预测因素（P=0.003）。HRR Z 评分最低四分位数的患者 5 年事件发生率显著更高（无事件生存率，29%对 84%；风险比，7.0；P=0.0013）。
HTx 后 HRR 减弱，但在 ≈6 年内恢复正常，可能是由于移植物的副交感神经再支配，但随后下降。HRR Z 评分的这种晚期下降与预后不良相关。
