Heart rate response and recovery during exercise predict future delirium risk-A prospective cohort study in middle- to older-aged adults.
Heart rate response and recovery during exercise predict future delirium risk-A prospective cohort study in middle- to older-aged adults.
复制标题
DOI：
10.1016/j.jshs.2021.12.002
复制
发表时间：
2023-05
影响因子：
11.7
通讯作者：
Hu, Kun
中科院分区：
文献类型：
--
作者：
Gao, Lei;Gaba, Arlen;Li, Peng;Saxena, Richa;Scheer, Frank A. J. L.;Akeju, Oluwaseun;Rutter, Martin K.;Hu, Kun
次极量运动的心率反应/恢复（HRR）可预测住院期间未来谵妄的风险。HRR指数的最低四分位数相当于比最高四分位数的患者年龄大6岁，目前吸烟，或有3个或更多额外的心血管风险。在年龄、性别、体力活动水平、心率控制药物的亚组中，结果是可靠的，但在基线认知较好的患者中，低HRR的风险似乎更大。仅考虑术后谵妄和排除痴呆相关病例的结果也一致。谵妄是一种神经认知障碍，其特征是在手术/疾病引起的大脑压力后注意力、意识和认知突然下降。现在人们越来越关注心血管健康如何与神经认知障碍相互作用，因为它们具有重叠的风险因素，并与随后的痴呆症和死亡率有关。心血管健康的一个常见指标是运动的心率反应/恢复（HRR），但这与未来谵妄的关系尚不清楚。对38，740名中老年英国生物库参与者（平均年龄= 58.1岁，范围：40-72岁; 47.3%男性）的心电图数据进行了检查，这些参与者完成了标准化次极量运动负荷测试（15秒基线，6分钟运动，1分钟恢复）并在随访期间需要住院。HRR指数推导为运动期间（峰值/静息HR）和恢复期间（峰值/恢复HR）的心率（HR）反应的乘积，并分为低/平均/高组，分别为底部四分位数/中间2个四分位数/顶部四分位数。使用考克斯比例风险模型和2年里程碑分析研究3个HRR组与新发谵妄之间的关联，以尽量减少反向因果关系。社会人口学因素、生活方式因素/体力活动、心血管风险、合并症、认知和达到的最大工作负荷作为协变量。在11年的中位随访期间，348名参与者（9/1000）新发谵妄。与高HRR组（16/1000）相比，低HRR组（风险比= 1.90，95%置信区间（95%CI）：1.30-2.79，p = 0.001）和平均HRR组（风险比= 1.54，95%CI：1.07-2.22，p = 0.020）的谵妄风险几乎加倍。低HRR相当于年龄大于6岁、目前吸烟或有≥3种额外心血管疾病风险。敏感性分析的结果是可靠的，但在认知能力较好的患者中，仅考虑术后谵妄时，风险似乎更大（n = 147;风险比= 2.66，95%CI：1.46-4.85，p = 0.001）。次极量运动时HRR与未来谵妄风险相关。鉴于HRR是潜在的可修改的，它可能被证明是有用的神经系统风险分层与传统的心血管危险因素。
Heart rate response/recovery (HRR) to submaximal exercise predicted future delirium risk during hospitalization. Lowest quartile for a HRR index was equivalent to being 6 years older, a current smoker, or having 3 or more additional cardiovascular risks compared to those in the highest quartile. Findings were robust in subsets by age, sex, physical activity level, rate-control medications, but the risk from low HRR appeared greater in those with better baseline cognition. Results were also consistent when only postoperative delirium was considered, and when dementia related cases were excluded. Delirium is a neurocognitive disorder characterized by an abrupt decline in attention, awareness, and cognition after surgical/illness-induced stressors on the brain. There is now an increasing focus on how cardiovascular health interacts with neurocognitive disorders given their overlapping risk factors and links to subsequent dementia and mortality. One common indicator for cardiovascular health is the heart rate response/recovery (HRR) to exercise, but how this relates to future delirium is unknown. Electrocardiogram data were examined in 38,740 middle- to older-aged UK Biobank participants (mean age = 58.1 years, range: 40–72 years; 47.3% males) who completed a standardized submaximal exercise stress test (15-s baseline, 6-min exercise, and 1-min recovery) and required hospitalization during follow-up. An HRR index was derived as the product of the heart rate (HR) responses during exercise (peak/resting HRs) and recovery (peak/recovery HRs) and categorized into low/average/high groups as the bottom quartile/middle 2 quartiles/top quartile, respectively. Associations between 3 HRR groups and new-onset delirium were investigated using Cox proportional hazards models and a 2-year landmark analysis to minimize reverse causation. Sociodemographic factors, lifestyle factors/physical activity, cardiovascular risk, comorbidities, cognition, and maximal workload achieved were included as covariates. During a median follow-up period of 11 years, 348 participants (9/1000) newly developed delirium. Compared with the high HRR group (16/1000), the risk for delirium was almost doubled in those with low HRR (hazard ratio = 1.90, 95% confidence interval (95%CI): 1.30–2.79, p = 0.001) and average HRR (hazard ratio = 1.54, 95%CI: 1.07–2.22, p = 0.020)). Low HRR was equivalent to being 6 years older, a current smoker, or ≥3 additional cardiovascular disease risks. Results were robust in sensitivity analysis, but the risk appeared larger in those with better cognition and when only postoperative delirium was considered (n = 147; hazard ratio = 2.66, 95%CI: 1.46–4.85, p = 0.001). HRR during submaximal exercise is associated with future risk for delirium. Given that HRR is potentially modifiable, it may prove useful for neurological risk stratification alongside traditional cardiovascular risk factors.
登录
查看更多内容
术前心率变异性分析是预测食管手术围手术期谵妄的一种潜在的简单易行的方法。
DOI：
10.1016/j.amsu.2021.102856
发表时间：
2021-10
期刊：
Annals of medicine and surgery (2012)
影响因子：
--
作者：
Echizen M;Satomoto M;Miyajima M;Adachi Y;Matsushima E
通讯作者：
Matsushima E
影响因子：
4.7
作者：
Bherer L;Erickson KI;Liu-Ambrose T
通讯作者：
Liu-Ambrose T
影响因子：
4
作者：
Berglund, Ida J.;Soras, Sara E.;Moholdta, Trine
通讯作者：
Moholdta, Trine
影响因子：
9.8
作者：
Abbott, Tom E. F.;Pearse, Rupert M.;Ackland, Gareth L.
通讯作者：
Ackland, Gareth L.
影响因子：
--
作者：
ARAI, Y;SAUL, JP;COLUCCI, WS
通讯作者：
COLUCCI, WS