Minai Omar A, Nguyen Quyen, Mummadi Srinivas, Walker Esteban, McCarthy Kevin, Dweik Raed A
Department of Pulmonary, Allergy, and Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio, USA.
Department of Medicine, Medicine Institute, Cleveland Clinic, Cleveland, Ohio, USA.
Pulm Circ. 2015 Sep;5(3):565-76. doi: 10.1086/682432.
Reduced heart rate recovery (HRR) after exercise is associated with increased mortality in cardiac and pulmonary diseases. We sought to evaluate the association between HRR after the 6-minute walk test (6MWT) and outcomes in patients with connective tissue disease-associated pulmonary hypertension (CTD-PH). Data were obtained by review of the medical records. HRR was defined as the difference in heart rate at the end of the 6MWT and after 1 minute (HRR1), 2 minutes (HRR2), and 3 minutes (HRR3) of rest. All patients with pulmonary hypertension and a diagnosis of systemic sclerosis, systemic lupus erythematosus, or mixed connective tissue disease who underwent the 6MWT between August 1, 2009, and October 30, 2011, were included (n = 66). By Kaplan-Meier analysis, HRR1, HRR2, and HRR3 at different cutoff points were all good predictors, with HRR1 of <16 being the best predictor of time to clinical worsening (log-rank P < 0.0001), hospitalization (log-rank P = 0.0001), and survival (log-rank P < 0.003). By proportional hazards regression, patients with HRR1 of <16 were at increased risk of clinical worsening (hazard ratio [HR]: 6.4 [95% confidence interval (CI): 2.6-19.2]; P < 0.0001], hospitalization (HR: 6.6 [95% CI: 2.4-23]; P < 0.0001), and death (HR: 4.5 [95% CI: 1.6-15.7]; P = 0.003). Patients in the highest tercile (HRR1 of ≥19) were unlikely to have a clinical worsening event (HR: 0.1 [95% CI: 0.04-0.5]; P = 0.001], to be hospitalized (HR: 0.1 [95% CI: 0.02-0.5]; P = 0.001), or to die (HR: 0.3 [95% CI: 0.07-0.9]; P = 0.04]. In conclusion, in patients with CTD-PH, abnormal HRR1 (defined as HRR1 of <16) after the 6MWT is a strong predictor of clinical worsening, time to clinical worsening, survival, and hospitalization.
运动后心率恢复（HRR）降低与心肺疾病死亡率增加相关。我们旨在评估6分钟步行试验（6MWT）后的HRR与结缔组织病相关肺动脉高压（CTD-PH）患者预后之间的关联。通过查阅病历获取数据。HRR定义为6MWT结束时与休息1分钟（HRR1）、2分钟（HRR2）和3分钟（HRR3）后的心率差值。纳入2009年8月1日至2011年10月30日期间接受6MWT的所有肺动脉高压且诊断为系统性硬化症、系统性红斑狼疮或混合性结缔组织病的患者（n = 66）。通过Kaplan-Meier分析，不同截断点的HRR1、HRR2和HRR3均为良好的预测指标，HRR1<16是临床恶化时间（对数秩检验P<0.0001）、住院（对数秩检验P = 0.0001）和生存（对数秩检验P<0.003）的最佳预测指标。通过比例风险回归分析，HRR1<16的患者临床恶化风险增加（风险比[HR]：6.4[95%置信区间（CI）：2.6 - 19.2]；P<0.0001），住院风险增加（HR：6.6[95%CI：2.4 - 23]；P<0.0001），死亡风险增加（HR：4.5[95%CI：1.6 - 15.7]；P = 0.003）。处于最高三分位数（HRR1≥19）的患者发生临床恶化事件的可能性较小（HR：0.1[95%CI：0.04 - 0.5]；P = 0.
