Ahmed Haitham M, Al-Mallah Mouaz H, Keteyian Steven J, Brawner Clinton A, Ehrman Jonathan K, Zhao D I, Guallar Eliseo, Blaha Michael J, Michos Erin D
1Preventive Cardiology and Rehabilitation, Cleveland Clinic, Cleveland, OH; 2Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, MD; 3Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, MI; 4King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, King Abdulaziz Cardiac Center, Ministry of National Guard, Health Affairs, Riyadh, SAUDI ARABIA; and 5Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
Med Sci Sports Exerc. 2017 Aug;49(8):1704-1710. doi: 10.1249/MSS.0000000000001285.
Maximum predicted heart rate (MPHR) is traditionally calculated by (220 - age). However, this formula's validity has been questioned in women. The purpose of this study was to derive sex-specific formulas for MPHR in a clinical population and compare their prognostic significance with the traditional formula.
This was a retrospective cohort of adults referred for exercise treadmill testing between 1991 and 2009. Peak heart rate versus age was plotted by sex, and linear regression analysis was used to derive sex-specific MPHR formulas. Cox models were used to calculate risk of death and myocardial infarction (MI) based on attainment of 85% MPHR using both formulas.
Of 31,090 patients (mean ± SD, age = 55 ± 10 yr), there were 2824 deaths over 11 ± 5 yr. MPHR was best estimated by 197 - 0.8 × age for women and 204 - 0.9 × age for men (P interaction < 0.001). Compared with the sex-specific formulas, the traditional formula overestimated peak heart rate by 12 ± 2 bpm in women and 11 ± 1 bpm in men. There were 1868 patients (6%) who achieved the target heart rate using the sex-specific formulas but not with the traditional formula. Achievement of ≥85% MPHR was similarly associated with lower risk of death (adjusted hazard ratio = 0.76 [95% confidence interval = 0.60-0.97] vs 0.75 [0.62-0.90]) and MI (0.71 [0.47-1.06] vs 0.79 [0.57-1.10]) for the sex-specific versus traditional formula.
In patients referred for exercise treadmill testing, sex-specific formulas more accurately estimated peak heart rate than the traditional MPHR formula, reclassified 6% of stress tests from inadequate to adequate, and were similarly associated with risk of MI and death.
最大预测心率（MPHR）传统上通过（220 - 年龄）来计算。然而，该公式在女性中的有效性受到质疑。本研究的目的是在临床人群中推导针对不同性别的MPHR公式，并将其预后意义与传统公式进行比较。
这是一项对1991年至2009年间接受运动平板试验的成年人进行的回顾性队列研究。按性别绘制峰值心率与年龄的关系图，并使用线性回归分析推导针对不同性别的MPHR公式。使用Cox模型基于两种公式达到85% MPHR的情况来计算死亡和心肌梗死（MI）风险。
在31090例患者（平均±标准差，年龄 = 55 ± 10岁）中，在11 ± 5年期间有2824例死亡。女性的MPHR最佳估计公式为197 - 0.8×年龄，男性为204 - 0.9×年龄（P交互作用 < 0.001）。与针对不同性别的公式相比，传统公式在女性中高估峰值心率12 ± 2次/分钟，在男性中高估11 ± 1次/分钟。有1868例患者（6%）使用针对不同性别的公式达到了目标心率，但使用传统公式未达到。对于针对不同性别的公式与传统公式，达到≥85% MPHR同样与较低的死亡风险（调整后风险比 = 0.76 [95%置信区间 = 0.60 - 0.97] 对 0.75 [0.62 - 0.90]）和MI风险（0.71 [0.47 - 1.06] 对 0.79 [0.57 - 1.10]）相关。
在接受运动平板试验的患者中，针对不同性别的公式比传统MPHR公式更准确地估计峰值心率，将6%的压力测试从不足重新分类为充足，并且与MI和死亡风险同样相关。
