Case-control study of heart rate abnormalities across the breast cancer survivorship continuum.
Case-control study of heart rate abnormalities across the breast cancer survivorship continuum.
复制标题
乳腺癌生存过程中心率异常的病例对照研究。
DOI：
10.1002/cam4.1916
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发表时间：
2019
期刊：
影响因子：
4
通讯作者：
Nohria,Anju
中科院分区：
文献类型：
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作者：
Groarke,JohnD;Mahmood,SyedS;Payne,David;Ganatra,Sarju;Hainer,Jon;Neilan,TomasG;Partridge,AnnH;DiCarli,MarceloF;Jones,LeeW;Mehra,MandeepR;Nohria,Anju
背景：在乳腺癌（BC）患者中观察到的运动能力受损和心血管死亡率增加的机制尚不清楚。乳腺癌（BC）中静息心率（HR）升高和心率恢复异常（HRR）的患病率、功能和预后意义需要评估。方法在一项单中心、回顾性、病例对照研究中，448例BC患者（62.6±10.0岁）与448例无癌、年龄匹配的对照组进行了比较。静息心率升高定义为静息时心率≥80bpm。运动后1分钟异常HRR定义为主动恢复≤12 bpm，被动恢复≤18 bpm。评估了这些参数与运动能力和全因死亡率的关系。结果BC组患者静息HR升高（23.7% vs 17.0%，P= 0.013）和HRR异常（25.9% vs 20.3%，P= 0.048）较对照组更为普遍。在调整分析中，BC患者静息HR升高(- 0.9 METs (SE 0.3)；P= 0.0003)或异常HRR (- 1.3 METs (SE 0.3)；P< 0.0001)在运动过程中代谢当量（METs）显著降低。静息心率升高与死亡率无关。在HRR异常的BC队列中，死亡率有增加的趋势（校正风险比2.06 (95% CI 0.95‐4.44，P= 0.07)）。结论：与无癌、年龄匹配的女性对照组相比，接受ETT治疗的BC患者的静息HR升高和异常HRR发生率增加。这些参数与运动能力下降有关。调节这些异常的策略可能有助于改善该队列的功能能力。
BackgroundMechanisms underlying impaired exercise capacity and increased cardiovascular mortality observed in breast cancer (BC) patients remain unclear. The prevalence, functional, and prognostic significance of elevated resting heart rate (HR) and abnormal heart rate recovery (HRR) in breast cancer (BC) requires evaluation.MethodsIn a single‐center, retrospective, case‐control study of women referred for exercise treadmill testing (ETT), 448 BC patients (62.6 ± 10.0 years) were compared to 448 cancer‐free, age‐matched controls. Elevated resting HR was defined as HR ≥80 bpm at rest. Abnormal HRR at 1‐minute following exercise was defined as ≤12 bpm if active recovery or ≤18 bpm if passive recovery. Association of these parameters with exercise capacity and all‐cause mortality was evaluated.ResultsElevated resting HR (23.7% vs 17.0%,P= 0.013) and abnormal HRR (25.9% vs 20.3%,P= 0.048) were more prevalent in BC cohort than controls. In adjusted analyses, BC patients with elevated resting HR (−0.9 METs (SE 0.3);P= 0.0003) or abnormal HRR (−1.3 METs (SE 0.3);P< 0.0001) had significant reductions in metabolic equivalents (METs) achieved during exercise. Elevated resting HR was not associated with mortality. There was a trend toward increased mortality in BC cohort with abnormal HRR (adjusted hazard ratio 2.06 (95% CI 0.95‐4.44,P= 0.07)).ConclusionsWomen across the BC survivorship continuum, referred for ETT, have an increased prevalence of elevated resting HR and abnormal HRR relative to cancer‐free, age‐matched female controls. These parameters were associated with decreased exercise capacity. Strategies to modulate these abnormalities may help improve functional capacity in this cohort.