Duarte Carlos Vieira, Myers Jonathan, de Araújo Claudio Gil Soares
Gama Filho University, Rio de Janeiro, Brazil.
Stanford University, Palo Alto, USA.
Eur J Prev Cardiol. 2015 May;22(5):629-35. doi: 10.1177/2047487314520784. Epub 2014 Jan 27.
Although substantial evidence relates reduced exercise heart rate (HR) reserve and recovery to a higher risk of all-cause mortality, a combined indicator of these variables has not been explored. Our aim was to combine HR reserve and recovery into a single index and to assess its utility to predict all-cause mortality.
Retrospective cohort analysis.
Participants were 1476 subjects (937 males) aged between 41 and 79 years who completed a maximal cycle cardiopulmonary exercise test while not using medication with negative chronotropic effects or having an implantable cardiac pacemaker. HR reserve (HR maximum - HR resting) and recovery (HR maximum - HR at 1-min post exercise) were calculated and divided into quintiles. Quintile rankings were summed yielding an exercise HR gradient (EHRG) ranging from 2 to 10, reflecting the magnitude of on- and off-HR transients to exercise. Survival analyses were undertaken using EHRG scores and HR reserve and recovery in the lowest quintiles (Q1).
During a mean follow up of 7.3 years, 44 participants died (3.1%). There was an inverse trend for EHRG scores and death rate (p < 0.05) that increased from 1.2% to 13.5%, respectively, for scores 10 and 2. An EHRG score of 2 was a better predictor of all-cause mortality than either Q1 for HR reserve (<80 bpm) or HR recovery alone (<27 bpm): age-adjusted hazard ratios: 3.53 (p = 0.011), 2.52 (p < 0.05), and 2.57 (p < 0.05), respectively.
EHRG, a novel index combining HR reserve and HR recovery, is a better indicator of mortality risk than either response alone.
尽管大量证据表明运动心率（HR）储备和恢复能力降低与全因死亡率升高有关，但尚未对这些变量的综合指标进行探讨。我们的目的是将HR储备和恢复能力合并为一个单一指数，并评估其预测全因死亡率的效用。
回顾性队列分析。
参与者为1476名年龄在41至79岁之间的受试者（937名男性），他们在未使用具有负性变时作用的药物或未植入心脏起搏器的情况下完成了最大运动强度的心肺运动试验。计算HR储备（最大心率 - 静息心率）和恢复能力（最大心率 - 运动后1分钟心率），并将其分为五等分。将五等分排名相加，得出运动HR梯度（EHRG），范围为2至10，反映运动时HR瞬变的幅度。使用EHRG评分以及最低五分之一（Q1）的HR储备和恢复能力进行生存分析。
在平均7.3年的随访期间，44名参与者死亡（3.1%）。EHRG评分与死亡率呈负相关趋势（p < 0.05），评分10和2时的死亡率分别从1.2%增至13.5%。EHRG评分为2时，比单独的HR储备Q1（<80次/分钟）或单独的HR恢复能力（<27次/分钟）更能预测全因死亡率：年龄调整后的风险比分别为3.53（p = 0.011）、2.52（p < 0.05）和2.57（p < 0.05）。
EHRG是一种结合HR储备和HR恢复能力的新型指数，比单独的任何一项指标都更能反映死亡风险。
