Coulibaly Iklo, Boka Bénédicte, Yao Hermann, Ekou Arnaud, Tro Gabin, Toure Camille, Kouassi Désirée
Service Médecine, Institut de cardiologie d'Abidjan, 01 BP V 206 Abidjan, Côte d'Ivoire.
Service d'hémodynamique, Institut de cardiologie d'Abidjan, Côte d'Ivoire.
Med Trop Sante Int. 2023 May 11;3(2). doi: 10.48327/mtsi.v3i2.2023.200. eCollection 2023 Jun 30.
Heart rate recovery (HRR) measured during stress tests, assesses the vago-sympathetic balance. It is a known prognostic and predictive parameter of cardiovascular mortality that is believed to be correlated with the presence and severity of coronary artery disease. The aim of this work was to assess the predictive value of heart rate recovery in the diagnostic and severity of coronary lesions in a major metropolis of sub-Saharan Africa where access to specialist care is unevenly distributed.
We conducted a retrospective observational study from January 2010 to February 2020 at the Abidjan Cardiology Institute, including patients who performed a diagnostic coronary angiography after a positive exercise test. Clinical, angiographic and exercise parameters were analyzed and compared in patients with abnormal heart rate recovery (HRR) and those with normal one.
The main study limitation is small sampling due to the cost of the angiographic procedure which limits its realization. We recorded 41 subjects whose mean age was 53.4 ± 9.6 years with a male predominance (sex ratio of 3.6). The predominant age group was between 50 and 60 years. Males were older than females with no significant difference. The predominant cardiovascular risk factors were overweight/obesity (68.29%) and hypertension (61%). Eight patients (19.5%) presenting an abnormal HRR (≤12 bpm) had more significant coronary disease (p=0.02) and more severe ones (p=0.003). Patients with abnormal HRR tended to be older without statistical significance (p=0.081), and had lower chronotropic reserve and maximum heart rate (p=0.008 and p=0.042, respectively). The positive predictive value of HHR was 87.5% and its negative predictive value was 60.6%.
Abnormal HRR can predict the presence of coronary artery disease and its severity. Evaluating HRR during stress tests could help in the detection, evaluation, and monitoring of ischemic heart disease in our resource-limited countries.
在压力测试期间测量的心率恢复（HRR）可评估迷走神经 - 交感神经平衡。它是心血管死亡率的一个已知的预后和预测参数，被认为与冠状动脉疾病的存在和严重程度相关。这项研究的目的是在撒哈拉以南非洲的一个主要大都市评估心率恢复对冠状动脉病变的诊断和严重程度的预测价值，在该地区获得专科护理的机会分布不均。
我们于2010年1月至2020年2月在阿比让心脏病学研究所进行了一项回顾性观察研究，纳入了运动试验阳性后进行诊断性冠状动脉造影的患者。对心率恢复（HRR）异常和正常的患者的临床、血管造影和运动参数进行了分析和比较。
主要研究局限性是由于血管造影程序的成本导致样本量小，这限制了研究的开展。我们记录了41名受试者，平均年龄为53.4±9.6岁，男性占主导（性别比为3.6）。主要年龄组在50至60岁之间。男性比女性年龄大，但无显著差异。主要的心血管危险因素是超重/肥胖（68.29%）和高血压（61%）。8名心率恢复异常（≤12次/分钟）的患者有更严重的冠状动脉疾病（p = 0.02）和更严重的病变（p = 0.003）。心率恢复异常的患者往往年龄较大，但无统计学意义（p = 0.081），且变时性储备和最大心率较低（分别为p = 0.008和p = 0.042）。HHR的阳性预测值为87.5%，阴性预测值为60.6%。
异常的HRR可预测冠状动脉疾病的存在及其严重程度。在压力测试期间评估HRR有助于在我们资源有限的国家检测、评估和监测缺血性心脏病。
