Department of Cardiology, Academic Medical Center, Amsterdam, the Netherlands.
Achieve Amsterdam University of Applied Sciences, Amsterdam, the Netherlands.
Am Heart J. 2018 May;199:163-169. doi: 10.1016/j.ahj.2018.02.008. Epub 2018 Feb 13.
Routine outpatient care of patients with coronary artery disease (CAD) lacks a simple measure of physical fitness and risk of mortality. Heart rate recovery (HRR) is noninvasive and easily obtainable in outpatient settings. Prior studies have suggested that delayed postexercise HRR in the first minutes is associated with mortality in several types of populations. However, a comprehensive overview of the prognostic value of delayed HRR for time to mortality specifically in CAD patients is not available. The purpose of the current meta-analysis is to evaluate the prognostic value of delayed HRR in CAD patients.
We conducted a systematic search in OVID MEDLINE and OVID EMBASE to identify studies reporting on HRR and risk of incident cardiovascular events or mortality in CAD patients. Hazard ratios for delayed versus nondelayed HRR were pooled using random-effects meta-analysis.
Four studies were included, comprising 2,428 CAD patients. The study quality of the included studies was rated moderate (n = 2) to high (n = 2). Delayed HRR was defined by ≤12 to ≤21 beat/min in the recovery period. During follow-up (range 2.0-9.8 years), 151 patients died (6.2% [range 2.5%-19.5%]). Only data on mortality could be pooled. Heterogeneity was limited (I = 32%; P = .23); pooled unadjusted hazard ratio for mortality, based on 3 studies, was 5.8 (95% CI 3.2-10.4).
In CAD patients, delayed HRR is significantly associated with all-cause mortality. As exercise testing is performed routinely in CAD patients, HRR can be considered in monitoring exercise; still, further research must investigate the addition of HRR in current risk scores.
冠心病（CAD）患者的常规门诊护理缺乏身体适应性和死亡率的简单衡量标准。心率恢复（HRR）是非侵入性的，在门诊环境中易于获得。先前的研究表明，运动后最初几分钟的 HRR 延迟与几种人群的死亡率有关。然而，专门针对 CAD 患者的死亡率，HRR 延迟的预后价值的综合概述尚不可用。本荟萃分析的目的是评估 HRR 延迟在 CAD 患者中的预后价值。
我们在 OVID MEDLINE 和 OVID EMBASE 中进行了系统检索，以确定报告 HRR 与 CAD 患者发生心血管事件或死亡率风险的研究。使用随机效应荟萃分析对延迟与非延迟 HRR 的风险比进行了汇总。
共纳入了 4 项研究，包括 2428 名 CAD 患者。纳入研究的质量被评为中等（n = 2）到高（n = 2）。在恢复期内，HRR 延迟定义为≤12 至≤21 次/分钟。在随访期间（范围 2.0-9.8 年），有 151 名患者死亡（6.2%[范围 2.5%-19.5%]）。仅可对死亡率数据进行汇总。异质性有限（I = 32%；P =.23）；基于 3 项研究，未调整的死亡率合并风险比为 5.8（95%CI 3.2-10.4）。
在 CAD 患者中，HRR 延迟与全因死亡率显著相关。由于 CAD 患者常规进行运动测试，因此可以考虑在监测运动时使用 HRR；然而，还需要进一步的研究来探讨在现有风险评分中添加 HRR。
