摘要
目的探讨在射血分数保留性心力衰竭(HFpEF)患者中运动后心率恢复(HRR)与运动耐量的关系及对心血管事件的预测价值.方法纳入2016年8月至2018年8月就诊于云南省第一人民医院心内科,诊断为HFpEF且资料完整的患者120例,入组1周内完成心肺运动试验,计算运动后1 min心率恢复(HRR1),HRR1≤12次/min定义为异常,采用Pearson相关系数评价HRR1与运动试验参数的相关性,记录患者随访期间的心血管终点事件,以多变量Cox回归分析评价HRR1对心血管事件的预测价值.结果120例HFpEF患者纳入分析,其中HRR1≤12次/min患者49例.Pearson相关性分析显示,HRR1与峰值摄氧量(Peak VO2)无关(P>0.05).使用β受体阻滞剂对运动试验参数及HRR1异常的发生率没有影响(P均>0.05).平均随访(16.9±6.5)个月,26例(21.7%)发生终点事件.多变量Cox回归分析结果显示,HRR1≤12次/min患者发生心血管终点事件的风险是HRR1>12次/min患者的2.35倍(95%可信区间1.08~5.13,P<0.01).结论HRR1降低与HFpEF患者运动耐量的降低无相关性,HRR1降低是HFpEF患者预后不良的有力的独立预测指标.
Objective To investigate the relation of post-exercise heart rate recovery(HRR)with exercise capacity and the prognostic value on cardiovascular events in patients with ejection fraction preserved heart failure(HFpEF).Method Patients presented from August 2016 to August 2018 in the Department of Cardiology of the First People′s Hospital of Yunnan Province with the diagnosis of HFpEF and complete data were enrolled and performed cardiopulmonary exercise tests(CPET)within one week after being enrolled.Heart rate recovery at 1 minute(HRR1)post exercise was calculated which was defined as abnormal with HRR1≤12 bpms.Pearson correlation analysis was performed to evaluate correlations between HRR1 and other parameters in CPET.Cardiovascular endpoint events were recorded during follow-up and multivariate Cox regression analysis was used to evaluate the prognostic value of HRR1.Results A total of 120 patients with HFpEF were enrolled,of whom 49 with HRR1≤12 bpms.Pearson correlation analysis showed HRR1 was not associated with Peak VO2.Cardiovascular endpoint events occurred in 26 cases(21.7%)during a mean follow-up duration of(16.9±6.5)months.Multivariate analysis showed that in HFpEF patients with HRR1≤12 bpms had 2.35 times higher risk of cardiovascular events than those with HRR1>12 bpms(hazard ratio 2.35,95%confidence interval 1.08-5.13,P<0.01).Conclusions There was no correlation between the decrease of HRR1 and the decrease of exercise tolerance in patients with HFpEF.The decrease of HRR1 was a powerful independent predictor of poor prognosis in patients with HFpEF.
作者
壮可
赵燕
张云梅
胡华
梁莉雯
张宏
Zhuang Ke;Zhao Yan;Zhang Yunmei;Hu Hua;Liang Liwen;Zhang Hong(Department of Cardiology,The First People′s Hospital of Yunnan Province,Affiliated Hospital of Kunming University of Science and Technology,Kunming 650032,China)
关键词
心力衰竭
心率恢复
运动耐量
预后
Heart Failure
Heart rate recovery
Exercise capacity
Prognosis
作者简介
通信作者:赵燕,Email:13888195773@163.com
