Chronotropic incompetence and myocardial injury after noncardiac surgery: planned secondary analysis of a prospective observational international cohort study
Chronotropic incompetence and myocardial injury after noncardiac surgery: planned secondary analysis of a prospective observational international cohort study
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DOI：
10.1016/j.bja.2019.03.022
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发表时间：
2019-07-01
影响因子：
9.8
通讯作者：
Ackland, Gareth L.
中科院分区：
文献类型：
--
作者：
Abbott, Tom E. F.;Pearse, Rupert M.;Ackland, Gareth L.
背景：心力衰竭的生理指标在外科手术患者中很常见，尽管缺乏诊断。运动期间心率（HR）的增加在心力衰竭（称为变时性功能不全）中经常变钝，这主要反映了β-肾上腺素受体功能障碍。我们研究了变时性功能不全是否与非心脏手术后心肌损伤有关。方法：这是一项国际队列研究的预定义分析，其中年龄≥ 40岁的参与者在非心脏手术前接受了限制性心肺运动试验。变时性功能不全定义为运动期间HR增加与HR第99百分位数年龄预测最大增加的比值。解释变量是心力衰竭的生物标志物（通气效率斜率[每分钟通气量/二氧化碳产生量] >= 34;峰值耗氧量
Background: Physiological measures of heart failure are common in surgical patients, despite the absence of a diagnosis. Heart rate (HR) increases during exercise are frequently blunted in heart failure (termed chronotropic incompetence), which primarily reflects beta-adrenoreceptor dysfunction. We examined whether chronotropic incompetence was associated with myocardial injury after noncardiac surgery.Methods: This was a predefined analysis of an international cohort study where participants aged >= 40 yr underwent symptom-limited cardiopulmonary exercise testing before noncardiac surgery. Chronotropic incompetence was defined as the ratio of increase in HR during exercise to age-predicted maximal increase in HR 99th centile. Explanatory variables were biomarkers for heart failure (ventilatory efficiency slope [minute ventilation/carbon dioxide production] >= 34; peak oxygen consumption