Department of Medicine I, LMU University Hospital, LMU Munich, Marchioninistraße 15, 81377 Munich, Germany.
DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Pettenkoferstraße 8a/9, 80336 Munich, Germany.
Europace. 2024 Oct 3;26(10). doi: 10.1093/europace/euae236.
Sports-related physical activity is associated with an increased risk of ventricular dysfunction and arrhythmias in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC). However, there are currently no standardized strategies for activity assessment. Thresholds for harmful levels of physical activity suggested by previous studies vary substantially and neither lifetime activity burden nor continuous modelling approaches were considered.
For this single-centre retrospective study, ARVC patients were interviewed to assess sports-related and non-sports-related physical activity between the age of 10 years and the last follow-up. Activity data were aggregated to the median metabolic equivalent of task-hours (METh) per week for each year. The association between cumulative physical activity burden and clinical study endpoints was investigated using Cox regression models. A total of 124 patients (median age: 39.5 years, 48% male) were included in the analysis, of whom 93 had been diagnosed with definite ARVC. Study participants reported a median overall activity of 202.3 METh/week, with 38.7 METh/week attributed to sports-related activity. In the continuous model, cumulative overall activity burden was associated with the occurrence of symptomatic heart failure [hazard ratio (HR) per 100 METh/week: 1.017, 95% CI (1.003, 1.032), P = 0.015], sustained ventricular tachycardia [HR: 1.021, 95% CI (1.006, 1.037), P = 0.007], and implantable cardioverter defibrillator interventions [HR: 1.017, 95%CI (1.000, 1.034), P = 0.048]. This finding was consistent when considering sports-related activity separately as a predictor variable, whereas the resulting hazard ratios did not show a significant association for non-sports-related physical activity.
This study demonstrates for the first time that cumulative physical activity as a continuous predictor variable is associated with symptomatic heart failure and arrhythmic risk in ARVC patients. Collaborative research is required in larger cohorts to investigate the influence of potential confounders on event occurrence and to develop threshold recommendations for clinical practice.
运动相关的体力活动与致心律失常性右室心肌病（ARVC）患者的心室功能障碍和心律失常风险增加相关。然而，目前尚无评估活动的标准化策略。之前的研究中建议的有害体力活动水平的阈值差异很大，而且既没有考虑终生活动负担，也没有考虑连续建模方法。
这项单中心回顾性研究对 ARVC 患者进行了访谈，以评估 10 岁至最后一次随访期间的运动相关和非运动相关体力活动。将活动数据汇总到每周每代谢当量任务小时（METh）的中位数。使用 Cox 回归模型研究累积体力活动负担与临床研究终点之间的关系。共纳入 124 名患者（中位年龄：39.5 岁，48%为男性）进行分析，其中 93 名被诊断为明确的 ARVC。研究参与者报告的总体活动中位数为 202.3 METh/周，其中 38.7 METh/周归因于运动相关活动。在连续模型中，累积总体活动负担与症状性心力衰竭的发生相关[每 100 METh/周的危险比（HR）：1.017，95%置信区间（CI）（1.003，1.032），P = 0.015]，持续性室性心动过速[HR：1.021，95%CI（1.006，1.037），P = 0.007]和植入式心脏复律除颤器干预[HR：1.017，95%CI（1.000，1.034），P = 0.048]。当分别将运动相关活动视为预测变量时，这一发现是一致的，而由此产生的危险比对于非运动相关体力活动没有显示出显著的相关性。
这项研究首次表明，作为连续预测变量的累积体力活动与 ARVC 患者的症状性心力衰竭和心律失常风险相关。需要在更大的队列中进行协作研究，以调查潜在混杂因素对事件发生的影响，并为临床实践制定阈值建议。
