Excessive heart rate increase during mild mental stress in preparation for exercise predicts sudden death in the general population
Excessive heart rate increase during mild mental stress in preparation for exercise predicts sudden death in the general population
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DOI：
10.1093/eurheartj/ehp160
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发表时间：
2009-07-01
影响因子：
39.3
通讯作者：
Ducimetiere, Pierre
中科院分区：
文献类型：
--
作者：
Jouven, Xavier;Schwartz, Peter J.;Ducimetiere, Pierre
本研究的目的是在表面健康的个体中早期识别出心脏性猝死的高危人群。我们检验了这样一个假设，即在准备运动测试时对轻度精神压力反应最大的心率增加的个体可能处于最高风险中。数据来自参与巴黎前瞻性研究I的7746名公务员，随访23年，允许比较休息和轻度精神压力之间的心率变化（运动试验前的准备）在患有心源性猝死（n = 81）、非猝死（n = 129）冠状动脉死亡或任何原因死亡（n = 1306）的受试者之间进行。轻度精神紧张时的平均心率增加为8.9 +/- 10.8 b. p.m.。精神紧张时心源性猝死的风险随着心率增加而逐渐增加，校正混杂因素后，第三个与第一个三分位数的相对风险为2.09（95%置信区间，1.13-3.86）。这种关系在非冠心病猝死中没有观察到，轻度精神紧张引起的重要心率增加预示着心源性猝死的长期风险。运动试验前的心率变化可能为危险分层提供一个简单的工具。
The aim of this study involves the early identification, among apparently healthy individuals, of those at high risk for sudden cardiac death. We tested the hypothesis that individuals who respond to mild mental stress in preparation for exercise test with the largest heart rate increases might be at highest risk.Data from 7746 civil servants participating in the Paris Prospective Study I, followed-up for 23 years, allowed to compare heart rate changes between rest and mild mental stress (preparation prior to an exercise test) between subjects who suffered sudden cardiac death (n = 81), non-sudden (n = 129) coronary death, or death from any cause (n = 1306). The mean heart rate increase during mild mental stress was 8.9 +/- 10.8 b.p.m. Risk of sudden cardiac death increased progressively with heart rate increase during mental stress and the relative risk of the third vs. the first tertile was 2.09 (95% confidence interval, 1.13-3.86) after adjustment for confounders. This relationship was not observed for non-sudden coronary death.An important heart rate increase produced by a mild mental stress predicts long-term risk for sudden cardiac death. Heart rate changes before an exercise test may provide a simple tool for risk stratification.