Physiotherapy:6分钟步行试验后心率恢复时间延长是心力衰竭心脏事件的独立危险因素

2022-06-14 xuyihan MedSci原创

心力衰竭(heart failure)简称心衰,是指由于心脏的收缩功能和(或)舒张功能发生障碍,不能将静脉回心血量充分排出心脏,导致静脉系统血液淤积,动脉系统血液灌注不足。

心力衰竭 (HF) 的患病率在世界范围内呈上升趋势。在美国,2007-2010 年的数据显示有超过 500万人患有心衰,九分之一的死亡与心衰有关。6 分钟步行测试 (6MWT) 是一种简单的用来测量心脏功能的试验,步行距离已被用作 HF 患者的预后标志物。此外,已发现源自 CPET 和 6MWT 的心率变量是 HF 患者发病率和死亡率的可靠预后指标,例如停止运动和恢复 1 分钟后的心率差异 (HRR1) ,以及在停止运动和恢复 2 分钟后 (HRR2)。在临床环境中,直观地,评估峰值运动心率和静息心率之间的时间(以分钟为单位)比确定峰值心率与 HRR1 和 HRR2 之间的差异更简单、更实用、更容易。据推测,运动停止后峰值运动心率恢复到静息心率的时间(以分钟为单位)将是预测 HF 患者心脏事件(住院和死亡)的潜在标志。因此,本项研究旨在探究6分钟步行试验(6MWT)后运动心率峰值恢复到静息心率的时间是否可以预测2年内心力衰竭(HF)患者的心脏事件。

为了完成本项研究,研究人员将76名存在HF,纽约心脏协会功能分类 II 和 III,左心室射血分数 <50%的患者纳入本项研究。患者使用心率监测器测量 6MWT 后峰值运动心率恢复到静息心率的时间。使用 Polar Pro-Trainer 5 软件(Kempele,芬兰)分析数据。对患者的心脏事件(住院和死亡)进行了超过 2 年的随访。

在 2 年的随访期间,34名患者发生了心脏事件。然而,有和无心脏事件组之间恢复静息心率的时间存在显着差异{有 3.6 (SD 1.1)  VS 没有 2.8 (SD 1.1) 分钟;平均差异为 0.79分钟(95% 置信区间 (CI) 为 0.28 至 1.28;P= 0.003}。在平均步行距离、1 分钟时的平均心率恢复和平均心率在2分钟时恢复。受试者工作曲线区分有无心脏事件的患者(曲线下面积 0.71,95% CI 0.61至0.81;P < 0.001)。使用逻辑回归分析,恢复静息心率的时间延长(≥3 分钟)独立地将心脏事件的风险增加了 6.9 倍(95% CI 2.34 至 20.12;P < 0.001)。Kaplan-Meier 曲线显示,恢复静息心率时间较长的患者心脏事件较多(P = 0.028)。

本项研究证实6MWT后恢复静息心率的时间延长(≥3分钟)是心衰患者心脏事件的独立预测因素。

原始出处:

G. N. Andrade. Et al. Prolonged heart rate recovery time after 6-minute walk test is an independent risk factor for cardiac events in heart failure: A prospective cohort study. Physiotherapy.2022.

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