Relationship between diastolic function and heart rate recovery after symptom-limited exercise.
Relationship between diastolic function and heart rate recovery after symptom-limited exercise.
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DOI：
10.1016/j.cardfail.2011.09.010
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发表时间：
2012-01
影响因子：
6
通讯作者：
Pellikka, Patricia A.
中科院分区：
文献类型：
--
作者：
Gharacholou, S. Michael;Scott, Christopher G.;Borlaug, Barry A.;Kane, Garvan C.;McCully, Robert B.;Oh, Jae K.;Pellikka, Patricia A.
自主神经异常与舒张期功能障碍和心率异常恢复有关；然而，很少有研究评估舒张期功能障碍是否与心率恢复异常有关，以及两者是否影响运动能力。对2826例症状受限运动试验室壁运动反应正常的患者进行了运动超声心动图和舒张期评价。HR恢复定义为运动高峰至恢复1min时HR的差值；HR异常恢复定义为最低四分位数。心率恢复为(32±14)次/min。有舒张期功能障碍或心率恢复异常的患者运动能力较低，且两者兼有的患者的运动能力最低(P<；与正常反应相比P<；0.0001)。舒张期功能异常指标与心率恢复异常相关。在多变量分析中，年龄后，舒张期功能障碍(参照：正常的舒张期功能)是心率恢复异常(调整后的OR1.47；95%可信区间1.20~1.80)和变时性功能不全(调整后的OR1.42；95%可信区间1.16~1.74)的最强预测因子。舒张期功能障碍与症状受限运动后心率恢复异常独立相关。需要进一步的研究来确定在心率恢复异常的患者中，舒张期功能是否会改变观察到的不良结局。
Autonomic abnormalities have been implicated in both diastolic dysfunction and abnormal heart rate (HR) recovery; however, few studies have assessed whether diastolic dysfunction is associated with abnormal HR recovery, and whether both modify exercise capacity. Exercise echocardiography with diastolic assessment was performed in 2826 patients with normal wall motion responses to symptom-limited exercise testing. HR recovery was defined as the difference in HR from peak exercise to 1 minute in recovery; abnormal HR recovery was defined as the lowest quartile. Mean HR recovery was 32±14 beats per minute. Patients with diastolic dysfunction or abnormal HR recovery had lower exercise capacity, and those with both had the lowest exercise capacity (p<0.0001 for comparison to normal responses). Indices of abnormal diastolic function were correlated with abnormal HR recovery. In multivariable analysis, after age, diastolic dysfunction (referent: normal diastolic function) was the strongest predictor of abnormal HR recovery (adjusted OR 1.47; 95% CI 1.20-1.80) and incrementally predictive of chronotropic incompetence (adjusted OR 1.42; 95% CI 1.16-1.74). Diastolic dysfunction is independently associated with abnormal HR recovery after symptom-limited exercise. Further studies are needed to determine if diastolic function modifies the adverse outcomes observed in those with abnormal HR recovery.
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