Zafrir Barak, Azencot Mali, Dobrecky-Mery Idit, Lewis Basil S, Flugelman Moshe Y, Halon David A
Department of Cardiovascular Medicine, Lady Davis Carmel Medical Center, Haifa, Israel; the Ruth and Bruce Rappaport School of Medicine, New York, USA
Department of Cardiovascular Medicine, Lady Davis Carmel Medical Center, Haifa, Israel; the Ruth and Bruce Rappaport School of Medicine, New York, USA.
Eur J Prev Cardiol. 2016 Aug;23(12):1298-306. doi: 10.1177/2047487315624747. Epub 2015 Dec 23.
Autonomic control of the cardiovascular system may be impaired in type 2 diabetes and is associated with increased morbidity and mortality. Parameters obtained during stress testing may reflect early stages of cardiac autonomic dysfunction and provide prognostic information in asymptomatic type 2 diabetes.
We performed maximal exercise treadmill testing in 594 patients with type 2 diabetes without known coronary heart disease. The prognostic significance of physiological parameters associated with autonomic dysfunction was assessed, including chronotropic incompetence (<80% heart rate reserve), abnormal heart rate recovery at 1 minute <18 beats/minute, and resting tachycardia >100 beats/minute. Cox proportional hazards analysis was used to determine the association of exercise parameters with a composite outcome of all-cause mortality, myocardial infarction or stroke.
Resting heart rate >100 beats/minute was observed in 18% of patients, chronotropic incompetence in 30% and heart rate recovery at 1 minute <18 beats/minute in 35%. Over 79 ± 16 months, there were 72 (12%) events. Each parameter was significantly associated with event risk in an adjusted multivariate analysis: chronotropic incompetence (hazard ratio 1.89, 95% confidence interval 1.18-3.01; P = 0.008), resting heart rate ≥100 beats/minute (hazard ratio 1.97, 95% confidence interval 1.19-3.26; P = 0.008) and heart rate recovery at 1 minute <18 beats (hazard ratio 1.77, 95% confidence interval 1.12-2.81; P = 0.015). A progressive relationship between the number of abnormal parameters and event risk was observed (log rank P < 0.001).
Chronotropic incompetence, resting tachycardia and reduced heart rate recovery are independently and additively associated with long-term mortality, myocardial infarction or stroke in type 2 diabetes without known coronary heart disease.
2型糖尿病患者的心血管系统自主神经控制功能可能受损，且与发病率和死亡率增加相关。在压力测试期间获得的参数可能反映心脏自主神经功能障碍的早期阶段，并为无症状2型糖尿病患者提供预后信息。
我们对594例无已知冠心病的2型糖尿病患者进行了最大运动平板试验。评估了与自主神经功能障碍相关的生理参数的预后意义，包括变时性功能不全（心率储备<80%）、1分钟心率恢复异常<18次/分钟以及静息心动过速>100次/分钟。采用Cox比例风险分析来确定运动参数与全因死亡率、心肌梗死或中风的复合结局之间的关联。
18%的患者静息心率>100次/分钟，30%的患者有变时性功能不全，35%的患者1分钟心率恢复<18次/分钟。在79±16个月的时间里，发生了72例（12%）事件。在调整后的多变量分析中，每个参数均与事件风险显著相关：变时性功能不全（风险比1.89，95%置信区间1.18 - 3.01；P = 0.008）、静息心率≥100次/分钟（风险比1.97，95%置信区间1.19 - 3.26；P = 0.008）以及1分钟心率恢复<18次（风险比1.77，95%置信区间1.12 - 2.81；P = 0.015）。观察到异常参数数量与事件风险之间存在渐进关系（对数秩检验P < 0.001）。
在无已知冠心病的2型糖尿病患者中，变时性功能不全、静息心动过速和心率恢复降低与长期死亡率、心肌梗死或中风独立且累加相关。
