Jou Jordi, Zhou Xingwu, Lindow Thomas, Brudin Lars, Hedman Kristofer, Ekström Magnus, Malinovschi Andrei
Department of Medical Sciences, Clinical Physiology, Uppsala University, Uppsala, Sweden.
Department of Medical Sciences, Respiratory Medicine, Sleep and Allergy, Uppsala University, Uppsala, Sweden.
Eur J Prev Cardiol. 2025 Jan 6;32(1):32-42. doi: 10.1093/eurjpc/zwae308.
Chronotropic incompetence and impaired heart rate (HR) recovery are related to mortality. Guidelines lack specific reference values for HR recovery. We defined normal values and studied blunted HR response and recovery and mortality risk.
We included 9917 subjects (45% females) aged 18-85 years who performed a cycle exercise test. We defined normal values for peak HR, HR reserve, and HR recovery at 1 and 2 min (HRR1 and HRR2) based on individuals apparently healthy (N = 2242). Associations between blunted HR indices (<5th percentile) and mortality over a median follow-up of 8.6 years were analysed using Cox regression and competing risk analysis. All HR indices were age-dependent and independent predictors of all-cause and cardiovascular (CV) mortality. The 5th percentiles of HR reserve, HRR1, and HRR2 correlated weakly with existing reference values. Heart rate recovery variables were the strongest predictors of all-cause mortality in both the overall population [HRR1, hazard ratio 1.70 (95% confidence interval, 1.49-1.94), and HRR2, 1.57 (1.37-1.79)] and in subjects with normal exercise capacity [HRR1, 1.96 (1.61-2.39), and HRR2, 1.76 (1.46-2.12)]. Combining HR indices appeared to increase the risk of all-cause [HRR1 and HRR2, 1.96 (1.68-2.29), and peak HR and HRR1, 1.87 (1.56-2.23)] and CV mortality, although no specific combination was superior for predicting CV mortality.
All HR indices were age-dependent and associated with all-cause and CV mortality. Blunted HR recovery variables were the strongest predictors of all-cause mortality, even in subjects with normal exercise capacity. Combined blunted HR indices appeared to add prognostic value.
变时性功能不全和心率（HR）恢复受损与死亡率相关。指南缺乏心率恢复的具体参考值。我们定义了正常值，并研究了心率反应和恢复迟钝与死亡风险的关系。
我们纳入了9917名年龄在18 - 85岁之间进行了自行车运动试验的受试者（45%为女性）。我们根据明显健康的个体（N = 2242）定义了峰值心率、心率储备以及1分钟和2分钟时的心率恢复（HRR1和HRR2）的正常值。使用Cox回归和竞争风险分析，分析了心率指标迟钝（<第5百分位数）与中位随访8.6年期间死亡率之间的关联。所有心率指标都是全因死亡率和心血管（CV）死亡率的年龄依赖性独立预测因素。心率储备、HRR1和HRR2的第5百分位数与现有参考值的相关性较弱。心率恢复变量是总体人群[HRR1，风险比1.70（95%置信区间，1.49 - 1.94），HRR2，1.57（1.37 - 1.79）]以及运动能力正常的受试者[HRR1，1.96（1.61 - 2.39），HRR2，1.76（1.46 - 2.12）]中全因死亡率的最强预测因素。合并心率指标似乎会增加全因死亡率[HRR1和HRR2，1.96（1.68 - 2.29），峰值心率和HRR1，1.87（1.56 - 2.23）]和心血管死亡率的风险，尽管没有特定的组合在预测心血管死亡率方面更具优势。
所有心率指标都是年龄依赖性的，并且与全因死亡率和心血管死亡率相关。心率恢复变量迟钝是全因死亡率的最强预测因素，即使在运动能力正常的受试者中也是如此。合并的心率指标迟钝似乎增加了预后价值。
