Cardiorespiratory Fitness Is Related to the Risk of Sudden Cardiac Death A Population-Based Follow-Up Study
Cardiorespiratory Fitness Is Related to the Risk of Sudden Cardiac Death A Population-Based Follow-Up Study
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DOI：
10.1016/j.jacc.2010.05.043
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发表时间：
2010-10-26
影响因子：
24
通讯作者：
Kurl, Sudhir
中科院分区：
文献类型：
--
作者：
Laukkanen, Jari A.;Makikallio, Timo H.;Kurl, Sudhir
目的探讨心肺功能与心源性猝死(SCD)的关系。背景：心肺功能对心源性猝死(SCD)的预测作用有限。采用呼吸气体交换分析仪和单车功率运动试验中的最大负荷来确定心肺功能的适合度。作为一个连续变量，心肺健康的1代谢当量(MET)增加与SCD风险降低22%相关(相对风险：0.78，95%可信区间：0.71至0.84，p<；0.001)。除了心肺功能、运动试验中的缺血性ST段压低、吸烟、收缩压、常见的冠心病、冠心病家族史和2型糖尿病外，SCD的风险也与吸烟、收缩压、冠心病家族史和2型糖尿病有关。总体模型判别的哈雷尔C指数为0.767，而心肺健康在风险预测方面提供了适度的改善(从0.760到0.767)，与所有其他风险因素相结合。在模型中加入心肺适合度后，综合辨别能力提高了0.0087(p=0.018，相对综合辨别能力提高0.11)。但净重分类指数(-0.018)无统计学意义的改善(p=0.703)。结论除常规危险因素预测外，心肺功能状况也是SCD的预测因子。区别程度略有改善，尽管在使用具有常规风险因素的心肺健康时，净重分类指数没有变化。(J Am Coll心脏ol 2010；56：1476-83)(C)2010，美国心脏病学会基金会
Objectives Our aim was to examine the relation of cardiorespiratory fitness with sudden cardiac death (SCD) in a population-based sample of men.Background Very limited information is available about the role of cardiorespiratory fitness in the prediction of SCD.Methods This population study was based on 2,368 men 42 to 60 years of age. Cardiorespiratory fitness was defined by using respiratory gas exchange analyzer and maximal workload during cycle ergometer exercise test.Results During the 17-year follow-up, there were 146 SCDs. As a continuous variable, 1 metabolic equivalent (MET) increment in cardiorespiratory fitness was related to a decrease of 22% in the risk of SCD (relative risk: 0.78, 95% confidence interval: 0.71 to 0.84, p < 0.001). In addition to cardiorespiratory fitness, ischemic ST-segment depression during exercise testing, smoking, systolic blood pressure, prevalent coronary heart disease, family history of coronary heart disease, and type 2 diabetes mellitus were related to the risk of SCD. The Harrell C-index for the total model discrimination was 0.767, while cardiorespiratory fitness provides modest improvement (from 0.760 to 0.767) in the risk prediction when added with all other risk factors. The integrated discrimination improvement was 0.0087 (p = 0.018, relative integrated discrimination improvement 0.11) when cardiorespiratory fitness was added in the model. However, the net reclassification index (-0.018) was not statistically significantly improved (p = 0.703).Conclusions Cardiorespiratory fitness is a predictor of SCD in addition to that predicted by conventional risk factors. There was a slight improvement in the level of discrimination, although the net reclassification index did not change while using cardiorespiratory fitness with conventional risk factors. (J Am Coll Cardiol 2010;56:1476-83) (C) 2010 by the American College of Cardiology Foundation