Heart rate recovery after the 6 min walk test rather than distance ambulated is a powerful prognostic indicator in heart failure with reduced and preserved ejection fraction: a comparison with cardiopulmonary exercise testing
Heart rate recovery after the 6 min walk test rather than distance ambulated is a powerful prognostic indicator in heart failure with reduced and preserved ejection fraction: a comparison with cardiopulmonary exercise testing
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DOI：
10.1093/eurjhf/hfs216
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发表时间：
2013-05-01
影响因子：
18.2
通讯作者：
Guazzi, Marco
中科院分区：
文献类型：
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作者：
Cahalin, Lawrence P.;Arena, Ross;Guazzi, Marco
心率恢复（HRR）似乎是心力衰竭（HF）的一个可靠的预后指标。当在HF中使用6分钟步行试验（6 MWT）时，步行距离通常是参考预后变量。我们假设6 MWT后的HRR比远距离步行更好，随机对258例HF患者[216例HF EF降低（HFrEF）和42例HF EF保留（HFpEF）]进行6 MWT和心肺运动试验（CPX），然后测量HRR。HRR定义为运动峰值时心率与试验终止后1分钟心率之间的差异。在平均随访22.8 - 22.1个月期间，对患者的主要心脏事件进行了评估。在跟踪期间发生了50起主要心脏事件。单变量考克斯回归分析结果表明，6 MWT和CPX后的HRR是不良事件的显著（P 0.001）预测因子。多因素考克斯回归分析显示，6 MWT和CPX后的二分HRR是最强的生存预测因子（2）分别为61.1和53.8; P 0.001），有左室射血分数（残差（2）6.1，P 0.05）增加了6 MWT模型的显著预后价值和治疗效率（VE/VCO 2斜率）（残差（2）6.6，P 0.05）为CPX模型增加了显著的预后价值。6 MWT后的HRR是一个强大的预测指标，其表现与最大运动后的HRR相似。如果在后续研究中得到证实，6 MWT HRR应取代6 MWT距离作为对HF患者心血管风险进行分级时考虑的参考标准6 MWT测量值。
Heart rate recovery (HRR) appears to be a robust prognostic marker in heart failure (HF). When using the 6 min walk test (6MWT) in HF, distance ambulated is generally the reference prognostic variable. We hypothesized that HRR after the 6MWT would be a better prognostic measure than distance ambulated.A 6MWT and cardiopulmonary exercise testing (CPX) were randomly performed in 258 HF patients [216 HF with reduced EF (HFrEF) and 42 HF preserved EF (HFpEF)], after which HRR was measured. HRR was defined as the difference between heart rate at peak exercise and 1 min following test termination. Patients were assessed for major cardiac events during a mean follow-up period of 22.8 22.1 months. There were 50 major cardiac events during the tracking period. Univariate Cox regression analysis results identified HRR after both the 6MWT and CPX as a significant (P 0.001) predictor of adverse events. Multivariate Cox regression analysis revealed that dichotomized HRR after the 6MWT and CPX was the strongest predictor of survival ((2) 61.1 and 53.8, respectively; P 0.001), with LVEF (residual (2) 6.1, P 0.05) adding significant prognostic value to the 6MWT model and ventilatory efficiency (the VE/VCO2 slope) (residual (2) 6.6, P 0 .05) adding significant prognostic value to the CPX model.HRR after the 6MWT is a powerful prognosticator that performs similarly to HRR after maximal exercise. If confirmed in subsequent studies, 6MWT HRR should replace 6MWT distance as the reference criterion 6MWT measure to consider when grading cardiovascular risk in HF patients.