Zhao Shuang, Chen Keping, Su Yangang, Hua Wei, Chen Silin, Liang Zhaoguang, Xu Wei, Dai Yan, Liu Zhimin, Fan Xiaohan, Hou Cuihong, Zhang Shu
1 State Key Laboratory of Cardiovascular Disease, Arrhythmia Centre, Fuwai Hospital, National Centre for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
2 Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China.
Eur J Prev Cardiol. 2017 May;24(7):760-767. doi: 10.1177/2047487316688982. Epub 2017 Jan 24.
Background Patient activity (PA) has been demonstrated to predict all-cause mortality. However, the association between PA and cardiac death is unclear. Aims The aims of this study were to determine whether PA can predict cardiac death and what is the cut-off of PA to discriminate cardiac death, as well as the mechanism underlying the relationship between PA and survival in patients with home monitoring. Methods This study retrospectively analysed clinical and implantable cardioverter-defibrillator/cardiac resynchronization therapy defibrillator device data in 845 patients. Data regarding PA and PP variability during the first 30-60 days of home monitoring were collected, and mean values were calculated. The primary endpoint was cardiac death, and the secondary endpoint was all-cause mortality. Results The mean PA percentage was 11 ± 5.8%. Based on receiver operating characteristic curve analysis, we determined that a PA cut-off value of 7.84% (113 min) can predict cardiac death. During a mean follow-up period of 31.1 ± 12.9 months (ranging from three to 60 months), PA ≤ 7.84% was associated with increased risks of cardiac death in an unadjusted analysis; after adjusting in a multivariate Cox model, the relationship remained significant between PA≤7.84% and cardiac death (hazard ratio = 3.644, 95% confidence interval = 2.424-5.477, p < 0.001). Moreover, a significant correlation was observed between PA and PP variability ( r = 0.601, p < 0.001). Conclusions A baseline PA ≤ 7.84% was associated with a higher risk of cardiac death in patients who have survived more than three months after implantable cardioverter-defibrillator/cardiac resynchronization therapy defibrillator implantation. PA had a sizable effect on heart rate variability, reflecting autonomic function.
背景 患者活动（PA）已被证明可预测全因死亡率。然而，PA与心源性死亡之间的关联尚不清楚。目的 本研究旨在确定PA是否能预测心源性死亡，以及PA用于区分心源性死亡的临界值是多少，同时探究家庭监测患者中PA与生存之间关系的潜在机制。方法 本研究回顾性分析了845例患者的临床及植入式心脏复律除颤器/心脏再同步化治疗除颤器设备数据。收集家庭监测前30 - 60天内PA和PP变异性的数据，并计算平均值。主要终点为心源性死亡，次要终点为全因死亡率。结果 PA的平均百分比为11±5.8%。基于受试者工作特征曲线分析，我们确定PA临界值为7.84%（113分钟）可预测心源性死亡。在平均随访31.1±12.9个月（3至60个月）期间，未调整分析中PA≤7.84%与心源性死亡风险增加相关；在多变量Cox模型中进行调整后，PA≤7.84%与心源性死亡之间的关系仍然显著（风险比 = 3.644，95%置信区间 = 2.424 - 5.477，p < 0.001）。此外，观察到PA与PP变异性之间存在显著相关性（r = 0.601，p < 0.001）。结论 植入式心脏复律除颤器/心脏再同步化治疗除颤器植入后存活超过三个月的患者中，基线PA≤7.84%与较高的心源性死亡风险相关。PA对反映自主神经功能的心率变异性有显著影响。
