Frequent ventricular ectopy after exercise as a predictor of death
Frequent ventricular ectopy after exercise as a predictor of death
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DOI：
10.1056/nejmoa022353
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发表时间：
2003-02-27
影响因子：
158.5
通讯作者：
Lauer, MS
中科院分区：
文献类型：
--
作者：
Frolkis, JP;Pothier, CE;Lauer, MS
基础：在人群队列中，心脏手术诱发的心室异位预测死亡风险增加。我们试图在一个临床队列中研究运动后心室异位的预后重要性，当副交感神经活动重新激活时。我们假设运动后心室异位（即，在恢复阶段）将预测死亡风险的增加比运动期间心室异位更好。METHODS我们研究了29，244例患者（平均[+/-SD]年龄，56+/-11岁; 70%男性），这些患者被转诊进行无心力衰竭、瓣膜疾病或心律失常病史的限制性运动试验。频发室性早搏的定义为每分钟室性早搏≥ 7次、室性二联律或三联律、室性联律或三联律、室性心动过速、室扑、尖端扭转型室性心动过速或室颤。945例患者仅在运动时发生频发室性早搏（3%），589（2%）只在恢复期间，491（2%）在运动和恢复期间。在平均5.3年的随访期间，有1862例死亡。运动时频繁发生心室异位预示着死亡风险增加（5年死亡率为9%，而运动时无心室异位的患者为5%;风险比为1.8; 95%置信区间为1.5 - 2.1; P
BACKGROUNDExercise-induced ventricular ectopy predicts an increased risk of death in population-based cohorts. We sought to examine in a clinical cohort the prognostic importance of ventricular ectopy immediately after exercise, when reactivation of parasympathetic activity occurs. We hypothesized that ventricular ectopy after exercise (i.e., during the recovery phase) would predict an increased risk of death better than ventricular ectopy during exercise.METHODSWe studied 29,244 patients (mean [+/-SD] age, 56+/-11 years; 70 percent men) who had been referred for symptom-limited exercise testing without a history of heart failure, valve disease, or arrhythmia. Frequent ventricular ectopy was defined by the presence of seven or more ventricular premature beats per minute, ventricular bigeminy or trigeminy, ventricular couplets or triplets, ventricular tachycardia, ventricular flutter, torsade de pointes, or ventricular fibrillation.RESULTSFrequent ventricular ectopy occurred only during exercise in 945 patients (3 percent), only during recovery in 589 (2 percent), and during both exercise and recovery in 491 (2 percent). There were 1862 deaths during a mean of 5.3 years of follow-up. Frequent ventricular ectopy during exercise predicted an increased risk of death (five-year death rate, 9 percent, vs. 5 percent among patients without frequent ventricular ectopy during exercise; hazard ratio, 1.8; 95 percent confidence interval, 1.5 to 2.1; P