Department of Cardiology, Antwerp University Hospital, Edegem, Belgium.
Circ Heart Fail. 2014 Mar 1;7(2):279-87. doi: 10.1161/CIRCHEARTFAILURE.113.000883. Epub 2014 Feb 11.
Physical activity (PA) predicts cardiovascular mortality in the population at large. Less is known about its prognostic value in patients with chronic heart failure (HF).
Data from 836 patients with implantable cardioverter defibrillator without or with cardiac resynchronization therapy enrolled in the Sensitivity of the InSync Sentry OptiVol feature for the prediction of Heart Failure (SENSE-HF)(1) study and the Diagnostic Outcome Trial in Heart Failure (DOT-HF) were pooled. The devices continuously measured and stored total daily active time (single-axis accelerometer). Early PA (average daily activity over the earliest 30-day study period) was studied as a predictor of time to death or HF-related hospital admission (primary end point). Data from 781 patients were analyzed (65±10 years; 85% men; left ventricular ejection fraction, 26±7%). Older age, shorter height, ischemic cause, peripheral artery disease, atrial fibrillation, diabetes mellitus, rales, peripheral edema, higher New York Heart Association class, lower diastolic blood pressure, and no angiotensin II receptor blocker/angiotensin-converting enzyme inhibitor use were associated with reduced early PA. The primary end point occurred in 135 patients (15±7 months of follow-up). In multivariable analysis including baseline variables, early PA predicted death or HF hospitalization, with a 4% reduction in risk for each 10 minutes per day additional activity (hazard ratio [HR], 0.96; confidence interval [CI], 0.94-0.98; P=0.0002 compared with a model with the same baseline variables but without PA). PA also predicted death (HR, 0.93; CI, 0.90-0.96; P<0.0001) and HF hospitalization (HR, 0.97; CI, 0.95-0.99; P=0.011).
Early PA, averaged over a 30-day window early after defibrillator implantation or cardiac resynchronization therapy in patients with chronic HF, predicted death or HF hospitalization, as well as mortality and HF hospitalization separately, accounting for baseline HF severity. Clinical Trial Registration Information- URL: http://www.clinicaltrials.gov. Unique identifiers: NCT00400985, NCT00480077.
体力活动（PA）可预测普通人群的心血管死亡率。在慢性心力衰竭（HF）患者中，其预后价值知之甚少。
来自 Sensitivity of the InSync Sentry OptiVol feature for the prediction of Heart Failure（SENSE-HF）（1）研究和 Diagnostic Outcome Trial in Heart Failure（DOT-HF）的 836 例植入式心脏复律除颤器患者的数据被汇总，这些患者没有或接受了心脏再同步治疗。设备连续测量和存储总日常活动时间（单轴加速度计）。早期 PA（最早 30 天研究期间的平均每日活动）作为死亡或 HF 相关住院的预测因素进行研究（主要终点）。对 781 例患者的数据进行了分析（65±10 岁；85%为男性；左心室射血分数，26±7%）。较年长、身高较矮、缺血性病因、外周动脉疾病、房颤、糖尿病、啰音、外周水肿、较高的纽约心脏协会分级、较低的舒张压以及未使用血管紧张素 II 受体阻滞剂/血管紧张素转换酶抑制剂与早期 PA 减少相关。主要终点发生在 135 例患者中（15±7 个月的随访）。在包括基线变量的多变量分析中，早期 PA 预测死亡或 HF 住院，每天增加 10 分钟活动可降低 4%的风险（风险比[HR]，0.96；置信区间[CI]，0.94-0.98；与没有 PA 的相同基线变量但没有 PA 的模型相比，P=0.0002）。PA 还预测死亡（HR，0.93；CI，0.90-0.96；P<0.0001）和 HF 住院（HR，0.97；CI，0.95-0.99；P=0.011）。
在慢性 HF 患者植入除颤器或心脏再同步治疗后早期的 30 天窗口内，早期 PA 平均水平可预测死亡或 HF 住院，以及单独的死亡率和 HF 住院率，反映了基线 HF 的严重程度。
临床试验注册信息-网址：http://www.clinicaltrials.gov。唯一标识符：NCT00400985，NCT00480077。
