Chen Tao, Zhu Huiying, Su Qingyuan
Department of Chronic Disease Management, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510120, Guangdong, China.
Department of Cardiac Function, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510120, Guangdong, China.
Cardiol Res Pract. 2022 Jul 15;2022:1647809. doi: 10.1155/2022/1647809. eCollection 2022.
A retrospective study was conducted on all patients with CHD who were admitted to CR and completed cardiopulmonary exercise tests (CPET) in Guangdong Hospital of traditional Chinese medicine. According to the risk stratification method of CHD, all participants were divided into three groups: low, moderate, and high risk. The training target heart rates (HRt) of each participant were calculated according to the formula of heart-rate-reserve (HRR), maximum-heart-rate (MHR), target-heart-rate (THR), and anaerobic threshold (AT) method provided in the guideline. Among them, the HRR method using the maximum-heart-rate obtained by the age formula was named "HRR method A," and that using the actual measured peak heart rate was named "HRR method B." For the three groups, the effectiveness and safety indexes at the target-heart-rate zone set by the different formulas above are counted and compared using CPET data.
A total of 324 patients were included in the analysis. There was no significant difference between the target-heart-rate set by the HRR method A and AT method among the three groups ( > 0.05). The mean value of HRt set by other methods was lower than the AT heart rate ( < 0.05). The HRt set by the THR method was close to the AT, while that set by the MHR method was the lowest. The frequency of patients whose HRt was set by the MHR method was lower than the AT one, which was the highest. None of the participants had serious adverse events. There were no risks of ECG abnormalities in the low- and moderate-risk groups. The HRR method A had the highest incidence of various risks of ECG abnormalities, while the MHR method had the lowest one, and the safety of the THR method is close to that of the AT method ( < 0.05).
The heart rate calculated by HRR method A is more consistent with the actual AT. All four techniques are safe in low- and moderate-risk patients. In high-risk patients, using HRR method A has certain risks. It is recommended to use the MHR method for safety reasons, but its effectiveness is low. If considering both effectiveness and safety, the THR method can be conservatively selected at the beginning of the CR program.
对广东省中医院收治的所有冠心病患者进行回顾性研究，这些患者均完成了心肺运动试验（CPET）。根据冠心病风险分层方法，将所有参与者分为三组：低风险、中风险和高风险。根据指南中提供的心率储备（HRR）、最大心率（MHR）、目标心率（THR）和无氧阈（AT）方法的公式，计算每个参与者的训练目标心率（HRt）。其中，使用年龄公式得出的最大心率的HRR方法称为“HRR方法A”，使用实际测量的峰值心率的HRR方法称为“HRR方法B”。对于这三组，使用CPET数据对上述不同公式设定的目标心率区域的有效性和安全性指标进行计数和比较。
共纳入324例患者进行分析。三组中HRR方法A和AT方法设定的目标心率之间无显著差异（>0.05）。其他方法设定的HRt平均值低于AT心率（<0.05）。THR方法设定的HRt接近AT，而MHR方法设定的HRt最低。MHR方法设定HRt的患者频率低于AT，而AT设定HRt的患者频率最高。所有参与者均未发生严重不良事件。低风险和中风险组无心电图异常风险。HRR方法A的各种心电图异常风险发生率最高，而MHR方法的发生率最低，THR方法的安全性接近AT方法（<0.05）。
HRR方法A计算的心率与实际AT更一致。所有四种技术在低风险和中风险患者中都是安全的。在高风险患者中，使用HRR方法A有一定风险。出于安全考虑，建议使用MHR方法，但其有效性较低。如果同时考虑有效性和安全性，在心脏康复计划开始时可保守选择THR方法。
