不同体质人群的心脏变时功能研究

目的观察不同体质指数人群(正常人群和肥胖人群)在运动平板试验中的心脏变时功能的差异。方法根据BMI将受试人群分为正常体重组(BMI25)192例,肥胖组(BMI≥25)210例,观察对比两组人群在运动试验过程中达到运动峰值时间,心脏变时指数,休息后2分钟心率、收缩期血压下降百分比,心率、血压恢复至运动前水平的时间等指标。结果肥胖组人群运动峰值时间较正常组提前,肥胖组人群心脏变时性不良、肥胖组人群休息后2分钟心率及血压恢复百分比较正常组减小,肥胖组心率及血压恢复至运动前水平时间较与正常组人群延长,两组间比较有显著统计学意义。结论肥胖组人群心脏变时功能异常,提示体重超标人群的心脏自主神经功能较差。     

心脏变时功能与焦虑情绪的相关性

目的 探讨心脏变时功能和患者焦虑情绪的相关性。方法 随机选取2013年4月~2014年12月在我院行运动平板试验的患者101(男63，女38)例。记录静息时心电图、血压、运动中心率及血压变化、运动时间、运动量mets，监测血压、心率至运动后6 min。分别测量并计算运动后最大心率值、心脏变时性指数和运动结束后心率下降值。并对其进行焦虑自评量表（SAS）的问卷调查。所有数据采用SPSS17.0软件进行分析。结果 101例患者中焦虑39例，非焦虑62例。焦虑组与非焦虑组峰值心率/极量心率、心率储备和心脏变时性指数存在显著性差异；而焦虑相关因素的Logistic回归分析显示峰值心率/极量心率、心脏变时性指数、心率储备和代谢储备与焦虑并无显著性相关；焦虑评分与心脏变时功能相关性分析结果显示焦虑评分与运动时间呈显著性负相关，而与峰值心率/极量心率和心脏变时性指数呈显著性正相关。结论 焦虑情绪会通过影响自主神经而影响冠心病患者的心脏变时功能，从而导致心脏变时功能不良假阴性结果的出现。     

平板运动试验假阳性相关因素的分析

目的 探讨活动平板运动试验假阳性相关影响因素,调整观察参数,提高心电图活动平板运动试验评估冠脉病变的价值.方法 收集整理2012年1月至2014年6月因疑似冠心病在苏州九龙医院心脏中心接受活动平板运动试验、结果阳性的94例患者,所有患者均在平板运动试验后1w内行冠脉造影检查.根据造影结果将其分为真阳性组(A组)和假阳性组(B组),对比分析两组各项临床资料及活动平板试验数据.结果 真阳性组和假阳性组在性别、最大运动耐量(Mets)、运动峰值、心率收缩压乘积方面有显著差异(p＜0.05),A组平板运动试验中最大心率与运动终止后2 min心率的差值显著低于B组;A组平板运动试验终止后3 min收缩压与运动终止1 min收缩压的比值、包含2个以上冠心病危险因子的例数明显大于B组(p＜0.05).结论 活动平板试验参数结合相关的临床资料、血流动力学相关参数,能提高冠脉病变的诊断准确性,对临床诊断冠心病、评估治疗效果和预后等方面可提供有价值的参考.     

平板运动试验后心率恢复情况对冠心病的诊断价值

目的评价平板运动试验后心率恢复的意义及其对冠心病的诊断价值。方法76例拟诊冠心病患者行平板运动试验,根据冠状动脉造影结果分为冠心病组和非冠心病组。计算运动后1、2、3、4、5、7min心率恢复值并比较,利用运动后心率恢复异常作为诊断冠心病标准与传统的ST段压低法比较。结果冠心病组的患者运动后各时段心率恢复值均低于非冠心病组。以运动后1、2min心率恢复异常作为诊断冠心病的标准,与传统的ST段压低法相比,其敏感性无差别,特异性较高。结论冠心病组与非冠心病组比较表明,运动后心率恢复存在明显差异,且运动后心率恢复异常可以作为诊断冠心病的方法之一。     

平板运动试验心率恢复及心率变异性与冠心病的相关分析

目的 评价平板运动试验后心率恢复、心率变异性与冠心病的关系及临床意义.方法 对310例拟诊为冠心病的患者行活动平板运动试验,并对照其冠状动脉造影结果,将患者分为冠心病组106例和非冠心病组204例.比较两组患者的心率恢复值、达标时间、静息心率及运动最大心率,分析心率恢复异常与冠心病.同时评估短期心率变异性.结果 冠心病组运动后心率恢复值低于非冠心病组,差异有统计学意义;冠心病组心率变异性与非冠心病组相比,差异有统计学意义.结论 冠心病组与非冠心病组相比,心率恢复异常及心率变异性差异均有统计学意义,两者综合评价冠心病的准确率更高.     

正常人运动后心率恢复与性别的关系——单中心研究

目的 探讨正常人运动后心率恢复与性别的关系.方法 通过平板运动试验,收集439名正常人在运动后1、2、3、4、5、6、7 min的心率恢复值.将受试者分为男、女两组,分别计算两组在第5至第95百分位的心率恢复值.分析两组年龄与心率恢复的相关性,以及心率恢复在性别间的差异,并绘制男女运动结束后各时点心率恢复趋势图,分别比...     

病态窦房结综合征患者心脏变时功能不全的临床研究

目的探讨病态窦房结综合征患者心脏的变时功能。方法对60例病态窦房结综合征患者（观察组）和40例正常窦性心律者（对照组）作运动平板试验，测定静息心率、运动时的最大心率、运动时间、代谢当量；计算2级运动时的心率变时性指数（CRI）、运动后1min心率恢复值。结果观察组静息心率、最大心率、CRI明显低于对照组，差异有显著统计学意义（P〈0．01），观察组心率上升幅度、运动时间、代谢当量、运动后1min心率恢复值均低于对照组，差异有统计学意义（P〈O．05）；观察组心脏变时功能不全31例（517％），明显多于对照组4例（10％），差异有显著统计学意义（P〈0．01）。结论病态窦房结综合征患者常发生心脏变时功能不全。     

平板运动试验心脏变时功能不全对冠心病的诊断价值

目的探讨平板运动试验心脏变时功能不全对冠心病的诊断价值。方法将240例临床拟诊冠心病患者先后行平板运动试验及冠状动脉造影检查，并按冠状动脉造影结果分为冠心病组和非冠心病组，分析比较两组间心脏变时性指标。运动后最大心率〈预测最大心率的85％和变时性指数（CRI）〈0．8为心脏变时功能不全。结果冠心病组运动后最大心率、变时性指数两种变时功能不全的指标均低于非冠心病组（P〈0．01），与传统的ST段标准相比，变时功能不全诊断冠心病的敏感性、特异性、准确性无明显差异（P〉0．05），ST段标准伴变时功能不全诊断冠心病的特异性、准确性均较ST段标准明显增高，差异具有统计学意义（P〈0．05）。结论平板运动试验心脏变时功能不全是诊断冠心病的有用指标，与传统的ST段标准联合应用可提高对冠心病的诊断价值。     

非杓型高血压患者运动时的心血管反应

目的 探讨非杓型高血压患者运动时的心血管反应.方法 根据动态血压监测95例原发性高血压(EH)患者有无昼夜节律分为:A组为非杓型组52例和B组为杓型组43例,进行活动平板运动试验,比较分析两组患者运动中心率、血压、运动耐量及运动时间变化.计算分析心率变时性反应指数(CRI2),最大心率收缩压双乘积(RPP);心肌耗氧量...     

高尿酸人群平板运动试验中心脏变时功能改变

目的研究高尿酸人群在平板运动试验中心脏变时功能的变化。方法将受试人群分为对照组127例、高尿酸组121例,观察对比两组人群在运动试验过程中达到运动峰值时间,心脏变时指数(CRI),休息2 min后心率、收缩期血压下降百分比,心率、血压恢复至运动前水平的时间等指标。结果高尿酸组运动峰值时间较对照组提前,且心脏变时功能不良,休息2 min后心率、收缩期血压下降百分比较对照组低,心率及血压恢复至运动前水平时间比对照组长,两组比较差异均有统计学意义。结论高尿酸人群易出现心脏变时功能不良,提示其心脏自主神经功能容易受损,心血管事件的危险性增加,预后不良,临床上要给予足够的重视。     

High-sensitivity C-reactive protein levels and treadmill exercise test responses in men and women without overt heart disease

BACKGROUND:

C-reactive protein (CRP) is a marker of systemic inflammatory activity and may be modulated by physical fitness. Treadmill exercise testing is used to evaluate cardiovascular health through different variables including exercise capacity, heart rate and blood pressure responses. It was hypothesized that CRP levels are associated with these variables in men and women without overt heart disease.

METHODS:

A total of 584 asymptomatic subjects (317 [54.3%] women and 267 [45.7%] men) were enrolled in the present study and underwent clinical evaluation. CRP levels in men and women were examined relative to clinical characteristics and to variables of treadmill exercise testing: peak heart rate, exercise systolic blood pressure, exercise time, chronotropic reserve and heart rate recovery at the first and second minutes after exercise. Multivariate analysis was performed using a log-linear regression model.

RESULTS:

In women, exercise time on the treadmill exercise test (P=0.009) and high-density lipoprotein cholesterol levels (P=0.002) were inversely associated with CRP levels. Body mass index (P<0.001) and total cholesterol levels (P=0.005) were positively associated with CRP levels. In men, exercise time on the treadmill exercise test was inversely associated with CRP levels (P=0.015). Body mass index (P=0.001) and leukocyte count (P=0.002) were positively associated with CRP levels. CRP levels were not associated with peak heart rate, chronotropic reserve, heart rate recovery at the first and second minutes, or exercise systolic blood pressure.

CONCLUSIONS:

These findings contribute to the evidence that CRP is lower in individuals with better exercise capacity and demonstrate that this relationship is also apparent in individuals without overt heart disease undergoing cardiovascular evaluation through the treadmill exercise test. Lowering inflammatory markers may be an additional reason to stimulate sedentary individuals with low exercise capacity in the treadmill exercise test to improve physical conditioning through regular exercise.     

Relation between C-reactive protein, treadmill exercise testing, and inducible myocardial ischemia

This study examined the relation between high-sensitivity C-reactive protein (CRP), exercise-induced myocardial ischemia, and exercise tolerance in 288 stable patients who underwent maximal treadmill stress testing. CRP was correlated with peak exercise workload, which was consistent with the long-term predictive value of peak workload and CRP for outcome events. There was no correlation of high-sensitivity CRP with stress-induced ischemia, which is consistent with a lack of correlation between CRP and the degree of chronic luminal coronary arterial narrowing.     

运动试验时心脏变时功能不全影响因素的研究

目的分析平板运动试验中心脏变时功能不全的影响因素。方法回顾分析2008年1月至2011年10月于北京大学人民医院行平板运动试验并通过冠状动脉造影明确或排除冠心病的112例患者资料,根据平板运动试验中是否发生心脏变时功能不全(平板运动试验中实测最大心率<85%年龄预测最大心率)将患者分为变时功能正常组(65例)及变时性功能不全组(47例)。收集各项临床观察指标进行Logistic多因素回归分析,探寻平板运动中发生心脏变时功能不全的影响因素。结果单因素分析发现男性(p=0.016)、吸烟(p<0.001)、冠心病(p=0.004)、BM(Ip=0.047)在心脏变时功能不全组间和心脏变时功能正常组两组间存在显著性差异。二分类非条件Logistic多因素回归分析表明,吸烟(OR=3.473;95%CI1.510-7.988;p=0.003)是平板运动试验中心脏变时功能不全的独立危险因素。结论吸烟影响心脏变时功能,是平板运动试验中心脏变时功能不全发生的独立危险因素。     

Exercise response after cardiac transplantation: correlation with sympathetic reinnervation.

OBJECTIVE--To investigate the relation between sympathetic efferent reinnervation and chronotropic competence during exercise testing after cardiac transplantation. PATIENTS--Twenty five long-term cardiac transplant recipients and 11 normal controls. SETTING--Regional cardiothoracic centre. METHODS--Intracoronary tyramine was given to the transplant recipients and the per cent heart rate change measured. Exercise tests were performed in patients and controls according to the chronotropic assessment exercise protocol, and the per cent heart rate reserve measured at peak exercise and 6 min afterwards to estimate the recovery rate. RESULTS--The mean (SD) percentage heart rate change after intracoronary tyramine was 15.7 (15.4). Heart rate reserve achieved at peak exercise was 68.3 (20.6)% compared with 102.7 (9.3)% in the controls (P < 0.001). Heart rate recovery at 6 min was 41.7 (20.1)% compared with 79.5 (9.0)% in the controls (P < 0.001). Total workload was 69.0 (33.0) METS.min compared with 117.2 (41.9) METS.min in the controls (P < 0.01). There was a positive correlation between heart rate reserve achieved at peak exercise and response to tyramine (r = 0.66, P < 0.01), between heart rate recovery and response to tyramine (r = 0.69, P < 0.001), and between total workload and response to tyramine (r = 0.63, P = 0.04). CONCLUSION--Functional sympathetic efferent reinnervation of the sinus node occurred in some patients after transplantation, and was associated with improved heart rate response during and recovery after exercise, as well as with increased total workload.     

Comparison of the chronotropic response to exercise and heart rate recovery in predicting cardiovascular mortality.

BACKGROUND: Both an impaired capacity to increase heart rate during exercise testing (chronotropic incompetence), and a slowed rate of recovery following exercise (heart rate recovery) have been shown to be associated with all-cause mortality. It is, however, unknown which of these responses more powerfully predicts risk, and few data are available on their association with cardiovascular mortality or how they are influenced by beta-blockade. METHODS: Routine symptom-limited exercise treadmill tests performed on 1910 male veterans at the Palo Alto Veterans Affairs Medical Center from 1992 to 2002 were analyzed. Heart rate was determined each minute during exercise and recovery. Chronotropic incompetence was defined as the inability to achieve > or =80% of heart rate reserve, using a population-specific equation for age-predicted maximal heart rate. An abnormal heart rate recovery was considered to be a decrease of <22 beats/min at 2 min in recovery. Cox proportional hazards analyses including pretest clinical data, chronotropic incompetence, heart rate recovery, the Duke Treadmill Score (abnormal defined as <4), and other exercise test responses were performed to determine their association with cardiovascular mortality. RESULTS: Over a mean follow-up of 5.1+/-2.1 years, there were 70 deaths from cardiovascular causes. Both abnormal heart rate recovery and chronotropic incompetence were associated with higher cardiovascular mortality, a lower exercise capacity, and more frequent occurrence of angina during exercise. Both heart rate recovery and chronotropic incompetence were stronger predictors of risk than pretest clinical data and traditional risk markers. Multivariately, chronotropic incompetence was similar to the Duke Treadmill Score for predicting cardiovascular mortality, and was a stronger predictor than heart rate recovery [hazard ratios 3.0 (95% confidence interval 1.9-4.9), 2.8 (95% confidence interval 1.7-4.8), and 2.0 (95% confidence interval 1.1-3.5) for abnormal Duke Treadmill Score, chronotropic incompetence, and abnormal heart rate recovery, respectively]. Having both chronotropic incompetence and abnormal heart rate recovery strongly predicted cardiovascular death, resulting in a relative risk of 4.2 compared with both responses being normal. Beta-blockade had minimal impact on the prognostic power of chronotropic incompetence and heart rate recovery. CONCLUSION: Both chronotropic incompetence and heart rate recovery predict cardiovascular mortality in patients referred for exercise testing for clinical reasons. Chronotropic incompetence was a stronger predictor of cardiovascular mortality than heart rate recovery, but risk was most powerfully stratified by these two responses together. The simple application of heart rate provides powerful risk stratification for cardiovascular mortality from the exercise test, and should be routinely included in the test report.     

The reproducibility of heart rate recovery after treadmill exercise test

Background: Although predictive value of heart rate recovery (HRR) has been tested in large populations, the reproducibility of HRR in treadmill exercise test has not been assessed prospectively. This prospective study examined whether HRR index has test–retest stability in the short term. Methods: A total of 52 healthy volunteers without cardiovascular risk factors (mean age, 30 ± 10 years, 30 females) underwent standardized graded treadmill exercise test, and the test was repeated on the 7th and the 30th days. The subjects’ maximal heart rates and the decrease of heart rate from the peak exercise level to the level of 1, 2, 3, 4, and 5 minutes after the termination of the exercise were examined on each test, and heart rates for each minute from the first, second, and third tests were compared for each individual. Results: The maximal heart rates on the 1st, 7th, and the 30th days were 179 ± 11, 177 ± 10, 178 ± 10 beats/min, respectively [P = 0.07, intraclass correlation coefficient (ICC) = 0.92], and the 1st minute HRR indices after peak exercise were 33 ± 10, 33 ± 10, 33 ± 11, respectively (P = 0.66, ICC = 0.88). There was no statistical difference in the 2nd, 3rd, 4th, and 5th minute heart rates of the recovery phase among the 1st, 7th, and 30th day treadmill exercise tests, either. Conclusion: Maximal heart rates and the decline of heart rate to the 5th minute on recovery phase after treadmill exercise test have short‐term reproducibility. Ann Noninvasive Electrocardiol 2011;16(4):365–372     

Abnormal heart rate recovery after exercise: a comparison with known indicators of increased mortality.

BACKGROUND: Abnormal heart rate (HR) recovery at 1 min after exercise (< or =12 beats) was recently suggested to be a predictor of all cause and cardiac mortality. AIM: This study aimed to (1) correlate HR recovery at 1 min after exercise with known exercise and myocardial perfusion markers of increased cardiac mortality, and (2) compare the known exercise and myocardial perfusion markers of increased cardiac mortality between patients with a normal and abnormal HR recovery at 1 min after exercise. METHODS: One hundred patients with known or suspected coronary artery disease referred for exercise stress testing (ETT) were prospectively enrolled. Percent, ETT time peak HR, HR reserve, summed stress score (SSS), extent of stress (SE%) and reversible perfusion abnormalities (RE%) were recorded in every patient. RESULTS: There was poor correlation with markers of myocardial ischemia or infarction [SSS (r = 0.15), SE% (r = 0.05), RE% (r = 0.12), all p = n.s.] but highly significant correlation between HR recovery at 1 min after exercise and chronotropic variables [ETT time (r = 0.56), peak HR (r = 0.65), HR reserve % (r = 0.64), all p < 0.001]. Patients on beta-blockers had significantly more incidence of an abnormal HR recovery at 1 min after exercise, compared to patients not on beta-blockers (88 vs. 56%, p < 0.01). CONCLUSION: Abnormal HR recovery at 1 min after exercise has no correlation with known myocardial perfusion markers of increased cardiac mortality. Patients with an abnormal HR recovery do not appear to have an increased incidence or more severe myocardial infarction or ischemia. However, there is a strong correlation between HR recovery at 1 min after exercise and the chronotropic variables during exercise.     

A Mathematical Model of the Cardiac Chronotropic Response to Exercise

A mathematical model was developed from data collected from 410 normal subjects in order to describe the normal cardiac Chronotropic response to exercise. Subjects were examined by treadmill testing on either the Bruce protocol (189 patients) or the Chronotropic Assessment Exercise Protocol (CAEP) (221 patients), The CAEP, designed specifically for chronotropic assessment, is structured to collect heart rate data at submaximal as well as peak exercise intensities. Analysis of these subjects, without evidence of medical illness or cardiac medications, found the heart rate response to be a function of exercise intensity, age, resting heart rate, and maximal functional capacity. Heart rate reserve (HRR) was defined as the difference betii'een maximal predicted heart rate (MPHR) and resting heart (HR_rest). Metabolic reserve was defined as the difference between the maximally achieved workload (METS_peak) and the workload at rest (METS_rest). The Bruce and CAEP data provided a statistically linear and identical response of the form y = mx + b. The Bruce equation was %HRR = 0.95 ×%MR + 3.4 and the CAEP equation is %HRR = 0.94 ×%MR + 4.55. The following formula describes the normal predicted heart rate for an individual at some submaximal stage of exercise: HR_stage= [(220 - age -HR_rest) × (METS_stage - 1)/(METS_peak - 1)] + HR_rest. We conclude that the cardiac chronotropic response can be modeled as a simple linear mathematical function of exercise intensity, age, resting heart rate, and maximal functional capacity, and is independent of type of treadmill exercise protocol in normal subjects.