Heart Rate Response to Exercise Stress Testing in Asymptomatic Women The St. James Women Take Heart Project
Heart Rate Response to Exercise Stress Testing in Asymptomatic Women The St. James Women Take Heart Project
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DOI：
10.1161/circulationaha.110.939249
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发表时间：
2010-07-13
期刊：
影响因子：
37.8
通讯作者：
Arnsdorf, Morton F.
中科院分区：
文献类型：
--
作者：
Gulati, Martha;Shaw, Leslee J.;Arnsdorf, Morton F.
背景-女性对运动负荷测试的正常心率(HR)反应的定义知之甚少，因为大多数描述正常反应的研究主要基于男性数据。心率反应减弱(变时性功能不全)和年龄预测心率的测量方法尚未在无症状女性中得到验证。我们调查了5437名无症状女性对运动试验的心率反应和年龄与预后的关系。方法和结果：受试者在1992年接受了症状受限的最大负荷试验。计算HR储备(HR从安静到高峰的变化)、变时性指数和年龄预测的HR峰值。截至2008年12月31日，已确认死亡人数。基线的平均年龄为52+/-11岁，15.9+/-2.2岁期间有549例死亡(10%)。平均峰值心率与年龄呈负相关，平均峰值心率=206~0.88(年龄)。在调整了运动量和传统的心脏风险因素后，峰值心率每增加1次/分钟，死亡风险降低3%，人力资源储备每增加1次，死亡风险降低2%(P<；0.001)。不能达到85%的年龄预测心率不是死亡率的独立预测因素，但低于预测心率平均值或变时性指数0.80是死亡率的独立预测因素(P<；0.001和P=0.023)。结论--在无症状女性中，变时性功能不全与死亡风险增加有关；然而，传统的基于男性的计算高估了女性的年龄最大心率。不同性别的生理心率对运动的反应参数应纳入临床实践。(发行量。2010；122：130-137。)
Background-The definition of a normal heart rate (HR) response to exercise stress testing in women is poorly understood, given that most studies describing a normative response were predominately based on male data. Measures of an attenuated HR response (chronotropic incompetence) and age-predicted HR have not been validated in asymptomatic women. We investigated the association between HR response to exercise testing and age with prognosis in 5437 asymptomatic women.Methods and Results-Participants underwent a symptom-limited maximal stress test in 1992. HR reserve (change in HR from rest to peak), chronotropic index, and age-predicted peak HR were calculated. Deaths were identified to December 31, 2008. Mean age at baseline was 52 +/- 11 years, with 549 deaths (10%) over 15.9 +/- 2.2 years. Mean peak HR was inversely associated with age; mean peak HR = 206-0.88(age). After adjusting for exercise capacity and traditional cardiac risk factors, risk of death was reduced by 3% for every 1-beat-per-minute increase in peak HR, and by 2% for every 1-beat-per-minute increase in HR reserve (P < 0.001). Inability to achieve 85% age-predicted HR was not an independent predictor of mortality, but being >= 1 SD below the mean predicted HR or a chronotropic index < 0.80 based on the prediction model established by this cohort were independent predictors of mortality (P < 0.001 and P = 0.023, respectively).Conclusions-Chronotropic incompetence is associated with an increased risk of death in asymptomatic women; however, the traditional male-based calculation overestimates the maximum HR for age in women. Sex-specific parameters of physiological HR response to exercise should be incorporated into clinical practice. (Circulation. 2010; 122: 130-137.)