Lee Paul Y, Bello Juan, Patel Sarthak, Toro-Manotas Rafael, Biviano Angelo, Wan Elaine, Garan Hasan, Dizon Jose, Yuyun Matthew, Yarmohammadi Hirad
Rutgers New Jersey Medical School, Newark, New Jersey, USA.
Columbia University, New York, New York, USA.
Open Heart. 2025 Mar 28;12(1):e003133. doi: 10.1136/openhrt-2024-003133.
The significance of stress-test induced arrhythmias has been examined in prior studies, but there is no clear consensus regarding its significance.
To determine the significance of stress test-induced arrhythmias.
Relevant studies examining arrhythmia in both exercise and pharmacological stress testing were searched for in PubMed, Embase and Cochrane databases from inception to 14 June 2023. The primary outcomes of interest were mortality in ventricular and atrial arrhythmias, and later diagnosis of cardiac disease in atrial arrhythmias.
The presence of any ventricular arrhythmia during stress testing was significantly associated with mortality at all time points: OR 2.11 (95% CI 1.75, 2.54), p<0.00001. This association was still seen in the subgroup of healthy, asymptomatic patients: OR 2.22 (95% CI 1.45, 3.41), p=0.0003. Frequent premature ventricular complexes (PVCs) were associated with higher mortality compared with infrequent PVCs: OR 1.85 (95% CI 1.27, 2.69), p=0.001. The presence of atrial fibrillation (AF) during stress testing was not associated with mortality at all time points: OR 1.53 (95% CI 0.05, 50.19), p=0.81. However, it was associated with later diagnosis of AF: OR 4.60 (95% CI 1.59, 13.26), p=0.005. The presence of atrial arrhythmias during stress testing at all time points was also associated with later diagnosis of coronary artery disease or myocardial infarction: OR 1.82 (95% CI 1.09, 3.03), p=0.02.
Patients experiencing ventricular arrhythmia during stress testing face double the odds of mortality compared with those without such arrhythmias. Atrial arrhythmia during stress testing, on the other hand, shows no association with mortality. However, it is linked to subsequent diagnosis of AF, coronary artery disease and myocardial infarction.
既往研究已探讨了应激试验诱发心律失常的意义，但对于其意义尚无明确共识。
确定应激试验诱发心律失常的意义。
在PubMed、Embase和Cochrane数据库中检索从建库至2023年6月14日期间有关运动和药物应激试验中心律失常的相关研究。感兴趣的主要结局为室性和房性心律失常的死亡率，以及房性心律失常中后续的心脏病诊断情况。
应激试验期间出现任何室性心律失常在所有时间点均与死亡率显著相关：比值比（OR）为2.11（95%置信区间[CI]为1.75，2.54），p<0.00001。在健康无症状患者亚组中也可见这种关联：OR为2.22（95%CI为1.45，3.41），p=0.0003。频发室性早搏（PVC）与偶发PVC相比，与更高的死亡率相关：OR为1.85（95%CI为1.27，2.69），p=0.001。应激试验期间出现心房颤动（AF）在所有时间点均与死亡率无关：OR为1.53（95%CI为0.05，50.19），p=0.81。然而，它与AF的后续诊断相关：OR为4.60（95%CI为1.59，13.26），p=0.005。应激试验期间所有时间点出现房性心律失常也与冠状动脉疾病或心肌梗死的后续诊断相关：OR为1.82（95%CI为1.09，3.03），p=0.02。
应激试验期间出现室性心律失常的患者与未出现此类心律失常的患者相比，死亡几率高出一倍。另一方面，应激试验期间的房性心律失常与死亡率无关。然而，它与AF、冠状动脉疾病和心肌梗死的后续诊断有关。
