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静息心率与房颤发生的关系(来自亨利福特医院运动测试项目)

Relation of Resting Heart Rate to Incident Atrial Fibrillation (from the Henry Ford Hospital Exercise Testing Project).

作者信息

Aladin Amer I, Al Rifai Mahmoud, Rasool Shereen H, Keteyian Steven J, Brawner Clinton A, Blumenthal Roger S, Blaha Michael J, Al-Mallah Mouaz H, McEvoy John W

机构信息

Department of Medicine, Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins School of Medicine, Baltimore, Maryland.

Department of Medicine, Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins School of Medicine, Baltimore, Maryland; Department of Medicine, University of Kansas School of Medicine, Wichita, Kansas.

出版信息

Am J Cardiol. 2017 Jan 15;119(2):262-267. doi: 10.1016/j.amjcard.2016.09.047. Epub 2016 Oct 8.

Abstract

Autonomic nervous system (ANS) dysfunction plays a role in atrial fibrillation (AF) initiation. Cardiorespiratory fitness modulates ANS function and is inversely associated with resting heart rate (RHR) and risk of AF. Thus, we sought to study the association between RHR, as a surrogate for ANS function, and incident AF independent of exercise capacity (EC). We analyzed 51,436 subjects without previous AF who underwent a clinically indicated exercise stress test. Incident AF was ascertained through claims files. RHR was measured before stress testing, and EC was estimated by peak metabolic equivalents of task. We studied the association between RHR categories (<70, 70 to 85 [reference], and >85 beats/min) and incident AF using Cox models adjusted for risk factors and for EC. We tested for interaction between RHR and age, gender, smoking, and EC. Mean (SD) age was 53 (13) years, 53% were men, and 28% were black. Participants with RHR <70 beats/min were older, more likely to be men, have higher EC, and more likely to smoke but less likely to have diabetes and hypertension. Over a median of 5.5 years, RHR <70 beats/min was associated with 14% increased risk of AF (95 CI 6% to 25%) in fully adjusted models, whereas RHR >85 beats/min was not associated with AF risk after adjusting for EC. Results for RHR analyzed continuously and by quartile were similar. No interaction was seen. In conclusion, subjects with low RHR at all levels of EC are at increased risk of AF and may benefit from heart rhythm surveillance, particularly in the presence of other AF risk factors.

摘要

自主神经系统(ANS)功能障碍在房颤(AF)的起始过程中起作用。心肺适能调节自主神经系统功能,且与静息心率(RHR)及房颤风险呈负相关。因此,我们试图研究作为自主神经系统功能替代指标的RHR与独立于运动能力(EC)的新发房颤之间的关联。我们分析了51436名既往无房颤且接受了临床指征运动应激试验的受试者。通过理赔档案确定新发房颤情况。在应激试验前测量RHR,并通过任务的峰值代谢当量估算EC。我们使用针对风险因素和EC进行调整的Cox模型研究了RHR类别(<70、70至85[参考值]以及>85次/分钟)与新发房颤之间的关联。我们测试了RHR与年龄、性别、吸烟及EC之间的相互作用。平均(标准差)年龄为53(13)岁,53%为男性,28%为黑人。RHR<70次/分钟的参与者年龄更大,更可能为男性,具有更高的EC,且更可能吸烟,但患糖尿病和高血压的可能性较小。在中位5.5年的时间里,在完全调整模型中,RHR<70次/分钟与房颤风险增加14%相关(95%置信区间为6%至25%),而在调整EC后,RHR>85次/分钟与房颤风险无关。连续分析及按四分位数分析RHR的结果相似。未发现相互作用。总之,在所有EC水平下,RHR较低的受试者房颤风险增加,可能受益于心律监测,尤其是在存在其他房颤风险因素的情况下。

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