心肺运动试验后冠心病患者心率恢复与心肺功能及生活质量的关系

目的探讨心肺运动试验后2 min时冠心病患者心率恢复情况与心肺功能及生活质量的关系。方法 2014年12月至2015年12月就诊于该院的冠心病患者52例进行心肺运动试验,根据心肺运动试验心率峰值与试验结束后2 min即时心率的差值(HRR)是否≥42次/min进行分组,21例为正常组(HRR≥42次/min),31例为异常组(HRR42次/min)。比较两组患者心肺运动试验结果及生活质量指标。结果心肺储备功能指标:异常组静息心率、摄氧量峰值、无氧阈值均显著低于正常组(P0.05);生活质量:异常组生理职能、总体健康及活力维度评分明显低于正常组(P0.05)。结论 HRR与冠心病心脏呼吸储备功能及预后生活质量紧密相关,可作为一个辅助指标提示患者的心脏呼吸储备功能及生活质量。     

老年射血分数保留的心力衰竭患者心率变时功能研究及相关因素分析

目的探讨射血分数保留心力衰竭(HFpEF)患者心率变时功能及相关因素。方法选取住院治疗的老年HFpEF患者36例作为HFpEF组,另选32例性别、年龄匹配的无心力衰竭症状的体检者为对照组,两组分别进行运动负荷试验、心脏彩超检查,对比两组临床特征、生化指标、心脏彩超、运动负荷试验心率结果,分析心率变时功能指标心率储备分数的影响因素。结果 HFpEF组患者体重指数明显高于对照组,更多合并有高血压病、糖尿病、心房颤动,脑钠肽显著高于对照组(P均<0.05);HFpEF组左室重量指数,左房内径,舒张功能指标E/e′显著增高(P均<0.05);HFpEF组峰值心率[(127±15)次/分vs (145±11)次/分)],心率储备[(42±9)次/分vs (59±11)次/分)],及心率储备分数[(0.57±0.11)vs (0.75±0.24)]均显著低于对照组(P<0.05),运动后1、2、3 min心率恢复值也显著低于对照组(P<0.05)。老年HFpEF患者心率储备分数与E/e′间呈负相关(R=-0.617,P<0.05)。结论老年HFpEF患者存在心率变时功能不良,与左室舒张功能不全相关。     

静息心率与冠心病的临床探讨

用Holter监测已确诊的冠心病患者 2 5 6例 ,观察静息心率 (RHR)的变化与心肌缺血、心律失常及心率变异性(HRV)的相关性。结果 :冠心病组RHR显著高于正常对照组 (80 .14± 8.6 5次 /分vs 72 .0 6± 6 .82次 /分 ,P <0 .0 1) ;RHR≥ 80次 /分的患者心肌缺血总负荷与RHR 75～ 79次 /分及RHR <75次 /分的患者相比差异有显著意义 (84 8.5± 2 30 .1次 /分vs 385 .7± 14 4 .2次 /分、2 83.3± 96 .2次 /分 ,P <0 .0 1) ;RHR与心肌缺血及心律失常呈正相关 ;冠心病组的HRV显著低于正常对照组 (P <0 .0 1)。结论 :RHR与冠心病心肌缺血总负荷、心律失常及HRV发生、发展及预后有关。     

伊伐布雷定治疗慢性稳定性心绞痛的临床疗效观察

【】目的：观察盐酸伊伐布雷定对慢性稳定性心绞痛(SAP)的疗效及安全性。方法：前瞻性入选门诊就诊(2013年4月-2014年1月)的24例SAP患者,随机、双盲分为盐酸伊伐布雷定组和阿替洛尔组。每组各12例。观察治疗前后两组静息及最大运动量时心率水平、心绞痛发作次数、运动耐量的变化。结果：1.盐酸伊伐布雷定组的静息心率治疗前后分别为75.4±2.5次/分和63.7±3.3次/分(P＜0.05),最大运动量心率由治疗前122.8±4.6次/分降低至105.4±5.1次/分(P＜0.05)；阿替洛尔组治疗前后的静息心率由74.8±3.6次/分降低至64.5±4.1次/分(P＜0.05),最大运动量心率由127.5±5.3次/分降低至114.8±6.4次/分(P＜0.05)。静息心率两组间比较差异无统计学意义(P＞0.05),而盐酸伊伐布雷定降低最大运动量时心率优于阿替洛尔组(P＜0.05)。2.盐酸伊伐布雷定组治疗前后心绞痛发作次数由3.45±1.24次/周减少至1.87±1.31次/周(P＜0.05),心绞痛持续时间由7.55±3.88min缩短为2.13±4.11min(P＜0.05)；阿替洛尔组治疗前后心绞痛发作次数由 3.61±1.41次/周减少至2.11±1.53次/周(P＜0.05),心绞痛持续时间由8.01±3.24min缩短为2.75±3.37min(P＜0.05)。两组间比较差异无统计学意义(P＞0.05)。3.运动耐量方面,盐酸伊伐布雷定组从服药前的368.65±122.32s增加至服药12周后的501.39±131.63s(P＜0.05)；阿替洛尔组从服药前的371.35±113.45s增加至服药12周后的467.49±142.54s(P＜0.05),两组间差异有统计学意义(P＜0.05)。结论：伊伐布雷定同阿替洛尔一样可显著降低SAP患者心率、减少心绞痛发作,增加运动耐量,且具有良好的安全性及耐受性。     

心率恢复评估系统性红斑狼疮相关肺动脉高压女性患者疾病严重程度的价值

目的 探讨心率恢复评估系统性红斑狼疮相关肺动脉高压(SLE-PAH)女性患者疾病严重程度的价值.方法 回顾性纳入2009年11月到2015年9月在同济大学附属上海市肺科医院住院治疗的21例SLE-PAH女性患者,对所有患者进行右心导管检查、肺功能测试及心肺运动试验,并以同期年龄、性别、体质量指数上匹配的32名女性健康志愿者为正常对照组进行对比分析.结果 与正常组相比,SLE-PAH患者的峰值公斤摄氧量(Peak VO2/kg)、峰值摄氧量占预计值百分比(PeakVO2％ pred)、峰值心率(Peak HR)、摄氧效率平台(OUEP)及OUEP％ pred显著下降(t=-8.59～-2.49,P＜0.05),最低通气效率(Lowest VE/VCO2)及Lowest VE/VCO2％ pred明显升高(t=4.85、5.48,P＜0.01),2组间基础心率差异无统计学意义(t=0.34,P＞0.05),而SLE-PAH患者的HRR1、HRR2[(19.1±7.4)次/min、(34.7±11.1)次/min]却显著低于正常对照组[(28.0±6.3)次/min、(42.0±8.3)次/min](t=-4.73、-2.73,P＜0.05).Pearson相关性分析发现SLE-PAH患者HRR1及HRR2与Peak VO2％ pred、OUEP％ pred、心输出量(CO)、心指数(CI)均呈中度正相关(r =0.47～0.69,P＜0.05),与Lowest VE/VCO2％ pred呈中度负相关(r=-0.62、-0.55,P＜0.05),与mPAP无相关性(r=-0.35、-0.11,P＞0.05).此外,HRR1还与肺血管阻力(PVR)呈弱正相关(r=-0.45,P＜0.05),而PVR与HRR2无相关性(r=-0.31,P＞0.05).ROC曲线显示HRR1及HRR2曲线下面积分别为0.807(敏感度84.4％,特异度71.4％)及0.676(敏感度68.8％,特异度71.4％)(P＜0.05),HRR1及HRR2在ROC曲线上的分界点分别为23次/min及40次/min.结论 HRR1及HRR2均可以用来评估SLE-PAH女性患者疾病严重程度.因此,我们可以把HRR作为早期发现SLE-PAH的一个重要参数,并对疾病严重程度进行评估从而判断预后.     

心电图运动负荷试验阳性患者心肺运动试验分析

目的回顾性分析心电图运动负荷试验阳性患者心肺运动试验(CPET)的相关数据,探讨此类患者CPET的临床特点。方法入选2017年8月至2018年7月在北部战区总医院心内科住院诊断为冠心病并进行CPET测试的连续患者共2552例,同时进行心电图运动负荷试验,阳性患者215例作为阳性组,进行1︰1匹配选取与阳性患者同期进行CPET的心电图运动负荷试验阴性患者215例作为阴性组。全部受试者均使用瑞士Schiller CS-200CPET系统进行测试,在静息状态下测定人体的肺功能、心电图,继之连续动态监测记录进出气流、摄氧量(VO2)、二氧化碳排出量(VCO2)、十二导联心电图、血压和血氧饱和度的实时变化。结果两组患者年龄、体重指数、高血压病、糖尿病、高脂血症和陈旧性心肌梗死等方面比较,差异均无统计学意义(均P0.05)。阳性组男性比例(85.6%比74.4%,P=0.003)、吸烟比例(34.9%比26.0%, P=0.047)显著高于阴性组,但左心室射血分数(LVEF)[(51.9±3.8)%比(55.2±4.7)%,P=0.037]显著低于阴性组,差异均有统计学意义。两组患者在运动递增功率、峰值Borg评分、运动持续时间、峰值功率、峰值代谢当量、呼吸储备、每分通气量/每分二氧化碳排出量(VE/VCO2)、静息心率、静息血压、静息和峰值指脉血氧饱和度比较,差异均无统计学意义(均P0.05)。阳性组因疲劳终止比例(40.5%比62.8%,P0.001)和心率储备[(34.6±17.6)次/分比(38.8±21.0)次/分,P=0.026]显著低于阴性组。阳性组峰值心率达预计值比例[(87.1±11.8)%比(84.4±14.3)%,P=0.031]及峰值收缩压[(179.1±25.5)mm Hg比(173.6±26.6)mm Hg,P=0.029]显著高于阴性组,差异均有统计学意义。两组患者无氧阈(AT)摄氧量、AT对应心率、峰值摄氧量、峰值千克摄氧量、峰值负荷、峰值氧脉搏、最大呼吸频率、用力肺活量(FVC)、最大肺活量(VCmax)、第一秒用力呼气量(FEV1)、FEV1/FVC比较,差异均无统计学意义(均P0.05)。阳性组AT千克摄氧量[(11.9±2.4)ml/(kg·min)比(11.5±2.3)ml/(kg·min),P=0.040]、AT负荷[(3.4±0.7)Mets比(3.3±0.6)Mets,P=0.037]、最大通气量(MVV)[(113.9±30.1)L/min比(107.3±30.0)L/min,P=0.022]和MVV达预计值比例[(107±24)%比(102±24)%,P=0.030]显著高于阴性组,差异均有统计学意义。结论心电图运动负荷试验阳性患者可能因为男性比例较高,运动中峰值心率及峰值收缩压较高,AT负荷及MVV较高,表现出较强的心肺运动耐量。在进行CPET检查中,遵循症状限制性运动试验方法同时,建议根据患者的运动能力及状态,鼓励患者进行较强的或更接近靶心率的运动负荷测试,以得到更准确的测试结果。     

冠心病静息心率的变化及其临床意义研究

为探讨静息心率在冠心病中的变化及其临床意义。对 119例冠心病患者同时进行冠状动脉 (简称冠脉 )造影及静息心率的测定。结果 :冠心病组静息心率显著高于正常对照组 (79.11± 7.86vs 71.0 5± 6 .87次 /分 ,P <0 .0 5 ) ,在急性心肌梗死 (86 .77± 6 .76 )及不稳定型心绞痛组 (78.91± 8.30 )静息心率升高更明显 (P <0 .0 5 ) ,相关分析显示静息心率与冠脉的狭窄程度呈正相关 ,其中急性心肌梗死组静息心率与左前降支的狭窄程度呈显著正相关 ,P <0 .0 5。结论 :静息心率可能与动脉硬化的发生及冠心病的预后有关。     

增龄及冠心病对运动的反应和心率变异性的影响

目的　研究 70岁以上冠心病及非冠心病老人心血管系统对运动负荷的反应 ,探讨其运动负荷特征与心率变异各能谱范围的关系。方法　经活动平板运动试验、动态心电图心率变异能谱分析、并行冠状动脉造影患者 2 16例。 70岁以上老人 96例为老年组 (Ⅰ组 ) ,70岁以下 12 0例为对照组 (Ⅱ组 ) ,两组各分两个亚组 ,冠心病患者分别为Ⅰa、Ⅱa组、非冠心病患者各为Ⅰb组、Ⅱb组。比较各组患者运动前后各生理指标的变化。结果　 (1)Ⅰ组运动峰值心率低于次极量心率 (极量心率 85 % )或 <12 0次 min者多于Ⅱ组 (Ⅰa组 35 .14 %vsⅡa组 15 .5 5 % ,P <0 .0 1,Ⅰb组 16 .95 %vsⅡb组 5 .33% ,P <0 .0 5 ) ;ⅠaⅠb组运动后 1min心率恢复值均 <12次 min ;心率变异高能谱范围呈现增龄性改变 (Ⅰa组vsⅡa组 ,P <0 .0 5 ;Ⅰb组vsⅡb组 ,P <0 .0 5 )。 (2 )Ⅰa组心肌缺血多发生于较低运动负荷时 [ST压低 1mm时的代谢当量 (METs)Ⅰa组 4 .4 8vsⅡa组 5 .4 8,P <0 .0 5 ];Ⅰa组心率变异各能谱范围多呈有意义降低 ,心率变时性损害Ⅰa组高于其他 3个组。结论　 (1)老年人尤其老年冠心病患者存在运动后心血管系统反应迟钝现象 ,心率变异高能谱范围呈现增龄性改变。 (2 )老年冠心病患者心率变异各能谱均有异常。 (3)老年冠心病患?     

运动对高血压患者心脏变时性功能的影响

目的:通过对有运动习惯和无运动习惯的原发性高血压(Essential hypertension EHP)患者心脏变时性指标的对比,探讨运动对EHP患者心脏变时性和运动应激功能的影响。方法:对27例有运动习惯的EHP患者和33例无运动习惯的EHP患者进行活动平板运动试验,比较最大心率、达最大心率所用时间、心率上升和下降速率、2级末变时性指数(Chronotropic Index in grade 2 CRI2)值和心脏变时功能异常的百分数。结果:运动组最大心率、达最大心率所用时间均大于非运动组(154.27±12.05)次/minvs(148.75±11.81)次/min,P<0.05和(4.06±0.61)次/minvs(3.64±0.49)次/min,P<0.01,心率上升速率小于非运动组而下降速率增大(0.65±0.02)vs(0.75±021),P<0.01和(0.78±0.12)vs(0.84±0.15),P<0.05),心脏变时功能异常的比例降低(33%vs11%,P<0.05),CRI2值增大(1.07±0.11)vs(0.91±0.22),P<0.05;结论:运动可改善EHP患者心脏变时性,提高心血管系统对运动应激的适应性,因而可能改善自主神经的平衡和调节功能,提高患者抵御运动中不良应激反应的能力并有利于EHP患者预后的改善。     

高血压、糖尿病对老年患者心率恢复影响研究

目的本研究以60岁以上正常老年人、单纯高血压、糖尿病及二者合并存在者为研究对象,观察其平板运动试验后心率恢复(Heart rate recovery,HRR)变化情况,以期为临床评价其预后提供依据。方法选择160例2008年1月至2010年4月于我院心血管内科门诊行平板运动试验老年患者(≥60y),分为对照组、高血压组、糖尿病组及高血压合并糖尿病组,每组40例,采用改良Bruce方案行平板运动试验。结果由各组患者达到峰心率停止运动后不同时间心率恢复曲线发现,停止运动后第1、2、3 min各组患者心率迅速降低,HRR1、HRR2、HRR3显著增加,随停止运动时间延长,各组心率降低趋缓,逐渐形成一平台。对照组峰心率显著高于其他三组(P<0.01),停止运动后1分钟时心率恢复各组间无显著差异,2 min时仅对照组与高血压合并糖尿病组间心率恢复存在显著性差异[(38.25±7.88)次/min vs.(30.55±12.14)次/min,P<0.01]。3 min时对照组心率恢复显著高于高血压合并糖尿病组(51.95±6.90)次/min vs.(40.75±13.75)次/min,P<0.01)及高血压组(44.9±13.79)次/min,P<0.05),与糖尿病组相比未达统计学差异;4 min后对照组心率恢复与高血压、糖尿病、高血压合并糖尿病组相比均存在显著差异(P<0.01),但三组间无统计学差异。结论高血压、糖尿病老年患者心率恢复降低,且以二者合并存在时为显著,提示其全因死亡风险增加。     

Relation between postexercise abnormal heart rate recovery and myocardial damage evidenced by gated single-photon emission computed tomography

Abnormal heart rate recovery (HRR) after exercise has been associated with increased cardiac mortality. The ability of gated myocardial perfusion single-photon emission computed tomography (SPECT) to evaluate myocardial perfusion and function simultaneously might make it helpful in determining possible mechanisms that are involved in this finding. This study investigated the association between abnormal HRR and other indicators of risk for cardiovascular events. Patients (n = 1,296, 784 men; 57 +/- 11 years of age) who underwent exercise/technetium-99m sestamibi gated myocardial perfusion SPECT at rest were prospectively enrolled. Exercise treadmill testing was performed according to a symptom-limited Bruce's protocol. HRR was obtained from the subtraction of heart rate in the first minute of recovery after exercise treadmill testing from maximal heart rate during exercise. Myocardial perfusion SPECT was semi-quantitatively analyzed using a 17-segment left ventricular model. Left ventricular ejection fraction was automatically calculated using quantitative gated SPECT software. In our study, patients with abnormal HRR were older, more frequently diabetic, and hypertensive and had previous myocardial infarction and myocardial revascularization, higher heart rate at rest and perfusion defect quantification scores, lower left ventricular ejection fraction, and larger left ventricular volumes than did patients with normal HRR. In multivariable analysis, age (p <0.0001), heart rate at rest (p <0.0001), left ventricular ejection fraction (p <0.0001), and perfusion defect extent and severity at rest (p = 0.038) were independent predictors of abnormal HRR. In conclusion, abnormal HRR was significantly associated with lower left ventricular ejection fraction and with perfusion defect extent and severity at rest, but not with gated SPECT markers of myocardial ischemia. Therefore, abnormal HRR may reflect myocardial damage.     

Influence of the Maximum Heart Rate Attained during Exercise Testing on Subsequent Heart Rate Recovery

Background: Abnormal heart rate recovery (HRR) following exercise testing has been shown to be a predictor for adverse cardiovascular events. The actual maximum heart rate (MHR) attained during the exercise test does not however have a distinct significance in traditional HRR assessment. The objective of this study was to investigate the role of MHR in HRR. Methods: This prospective study consisted of 164 patients (62% male, mean age 53.7 ± 11.7 years) who were referred for a symptom‐limited standard Bruce Protocol treadmill exercise test, based on clinical indications. The patients were seated immediately at test completion and the heart rate (HR) recorded at one and two minutes postexercise. A normal HRR was defined as a HR drop of 18 beats per minute or more at the end of the first minute of recovery. The HRR profile of patients who reached ≥85% of their maximum predicted heart rate (MPHR) during peak exercise were then compared to HRR profile of those who could not. Results: One hundred twelve patients (Group A) achieved a MHR ≥ 85% of MPHR during peak exercise whereas 52 patients (Group B) did not. Chi‐square analysis showed a higher incidence of normal HRR in Group A compared to Group B (p = 0.029). Analysis of variance with repeated measures showed that group A had a greater HRR at the first minute F_1,162= 6.98, p = <0.01) but not the second minute (F_1,162=1.83, p = .18) postexercise. Conclusion: There is a relation between the peak heart rate attained during exercise and the subsequent HRR. A low peak heart rate increases the likelihood of a less than normal HRR. Assessment of the entire heart‐rate response seems warranted for more thorough risk‐stratification. Ann Noninvasive Electrocardiol 2010;15(1):43–48     

应用心率的恢复诊断PCI术后再狭窄

目的评价平板运动试验后心率恢复在PCI术后再狭窄诊断中的价值。方法成功行经皮冠状动脉介入治疗(PCI)的88例患者,术后6～9个月行平板运动试验及冠状动脉造影,以冠状动脉造影结果为参照,比较传统标准结合心率恢复异常与传统标准诊断再狭窄的敏感性、特异性、阳性预测值、阴性预测值。结果 88例患者中有22例经冠状动脉造影证实发生再狭窄。与传统标准相比,以运动后第一分钟心率恢复值(HRR1))异常诊断再狭窄的敏感性、特异性、阳性预测值和阴性预测值无明显差异(p>0.05)。在传统标准阳性的基础上结合HRR1异常诊断再狭窄的特异性(86.4%)较传统标准有显著提高(p<0.05)。结论运动后心率恢复异常可作为诊断再狭窄的无创方法之一,传统标准结合HRR1异常可提高平板运动试验对再狭窄的诊断价值。     

The effect of beta-blockade on heart rate recovery following exercise stress echocardiography

The purpose of this study was to determine the effects of beta-blockers (BBs) on heart rate recovery (HRR) following exercise stress testing. HRR is a predictor of mortality following exercise stress testing and is thought to be due to reinstitution of vagal tone. Exercise testing in the presence of BBs should have no effect on reinstitution of vagal tone and therefore no effect on HRR. One published study contradicts this understanding. The authors performed a retrospective analysis of the University of California, Davis, treadmill database and found 334 patients who underwent exercise stress echocardiography (ESE) with complete data. Patients undergoing ESE without a BB were compared with patients who were receiving a BB. HRR was not affected by BB use in patients without stress-induced echocardiographic abnormalities (negative ESE result). In patients with stress-induced echocardiographic abnormalities (positive ESE result), HRR was delayed compared with patients with negative ESE. BB use improved HRR in patients with positive ESE. BBs do not affect HRR in patients with a negative ESE result, and HRR can be used for mortality prediction. In patients with a positive ESE result, HRR is improved in the presence of a BB.     

One-minute heart rate recovery after cycloergometer exercise testing as a predictor of mortality in a large cohort of exercise test candidates: substantial differences with the treadmill-derived parameter.

BACKGROUND: Previous work showed a strong inverse association between 1-min heart rate recovery (HRR) after exercising on a treadmill and all-cause mortality. The aim of this study was to determine whether the results could be replicated in a wide population of real-world exercise ECG candidates in our center, using a standard bicycle exercise test. METHODS: Between 1991 and 1997, 1420 consecutive patients underwent ECG exercise testing performed according to our standard cycloergometer protocol. Three pre-specified cut-point values of 1-min HRR, derived from previous studies in the medical literature, were tested to see whether they could identify a higher-risk group for all-cause mortality; furthermore, we tested the possible association between 1-min HRR as a continuous variable and mortality using logistic regression. RESULTS: Both methods showed a lack of a statistically significant association between 1-min HRR and all-cause mortality. A weak trend toward an inverse association, although not statistically significant, could not be excluded. CONCLUSIONS: We could not validate the clear-cut results from some previous studies performed using the treadmill exercise test. The results in our study may only "not exclude" a mild inverse association between 1-min HRR measured after cycloergometer exercise testing and all-cause mortality. The 1-min HRR measured after cycloergometer exercise testing was not clinically useful as a prognostic marker.     

The importance of heart rate recovery in patients with heart failure or left ventricular systolic dysfunction

BACKGROUND: The ability to better predict outcome with exercise testing in patients with heart failure (HF) and left ventricular systolic dysfunction (LVSD) may prove extremely valuable in determining which patients are at increased risk. This study evaluated the ability of heart rate recovery (HRR) to predict outcome in patients with HF and validate previous findings in LVSD. METHODS AND RESULTS: HRR was measured at 1-, 2-, 3-, and 5-minute time points after treadmill testing in 2,193 males being evaluated for chest pain at the Palo Alto and Long Beach VA Hospitals. Left ventricular ejection fraction (LVEF) was calculated using biplane ventriculography and patients were considered to have LVSD if they had an LVEF <50%. Angiographic and clinical data was available for all patients. Of the 2,193 patients, 314 patients had LVSD and 109 had a history of HF. Both HF patients and patients with LVSD with a normal HRR at 2 minutes had improved survival compared with patients that had an abnormal HRR at 2 minutes when adjusted for age and beta-blocker use (HF adjusted odds ratio 0.25, 95% CI 0.10-0.66, P < .006; LVSD alone adjusted odds ratio 0.25, 95% CI 0.13-0.47, P < .0001). Stepwise proportional hazard regression analysis revealed that only 2-minute HRR, age, LVEF, and chronic obstructive pulmonary disorder were significant predictors of mortality in patients with LVSD and only HRR at 2 minutes and LV hypertrophy were significant predictors of mortality in patients with HF. CONCLUSION: HRR is a significant predictor of mortality in patients with HF and patients with LVSD and may be useful in better determining prognosis.     

Clinical Significance of Abnormal Heart Rate Recovery after Treadmill Exercise Test in Patients With Coronary Artery Disease

To evaluate the values of abnormal heart rate recovery （HRR） after treadmill exercise test in patients with coronary artery disease （CAD）. Methods One hundred and seventy-eight consecutive cases of suspected CAD who underwent symptom-limited treadmill exercise test （TET） and coronary angiography （CAG） were enrolled and divided into normal and abnormal HRR group based on the status of the values of HRR one or two minutes after TET. The clinical characteristics, TET parameters and CAG results of the two groups were compared attempted to assess the value of HRR on patients with CAD. Results （ 1 ） The cases of smoking, diabetes mellitus （DM） and ST segment deviation at rest in abnormal HRR group were more significantly than those in normal HRR group （ all P 〈 0. 05 ）. （2） The subjects of abnormal HRR usually had higher basal heart rate, more cases exhibited ST segment abnormality and or exercise-limited angina during or after TET（P 〈 0. 01 and P 〈 0. 05, respectively）, but lower level of peak heart rate attained （ P 〈 0. 05 ） than those in normal group. The values of metabolism equivalents and duration of TET between the two groups displayed phenomenal difference （ P 〈 0. 05 ）. There were more samples acquired moderate to high level of Duke test score and chronotropic incompetence in the group of abnormal HRR, compared to the normal HRR group （P 〈 0. 01 ）. （3） The cases of negative CAG results in the group of normal and abnormal HRR group were 73 （66. 97 % ） and 24 （34. 78 % ）. Cases of significant coronary lesions （ at least one major coronary vessel ≥ 50 % stenosis） amongst the subgroup of positive CAG were 36 （ 33.03 % ） and 45 （65.22 % ）, severe coronary lesions （ three-vessel, left main or the equivalents of left main） were 10 （9. 17 % ） and 17 （24. 64 % ） for normal and abnormal HRR respectively （P 〈 0. 01 ）. Accordingly, the Gensini scores in the subunit of abnormal HRR increased. （4）Linear correlation analysis indicate there was a negative correlation between the values of HRR in the first and second minutes and indices of severity of CAD （ all P 〈 0. 01 ）. The analysis of auxiliary diagnostic value of abnormal HRR indicated the annexed HRR standard had higher negative predictive value. Conclusions The status of HRR after TET are not only influenced by the clinical factors related to the cardiac autonomic function, but also associated with the extent of CAD. （ S Chin J Cardiol 2009 ; 10（1）：1-8）     

Abnormal heart rate recovery immediately after cardiopulmonary exercise testing in heart failure patients

An attenuated heart rate recovery (HRR) immediately after exercise has been shown to be predictive of mortality. It is not known whether HRR predicts mortality when measured in patients with heart failure. The present study was undertaken to evaluate the ability of HRR to predict mortality in patients with heart failure. We studied 84 NYHA class II or III chronic congestive heart failure patients who had a left ventricular ejection fraction < or = 40%. All patients underwent symptom limited cardiopulmonary exercise testing. The value for the HRR was defined as the difference in heart rate between peak exercise and one-minute later; a value < or = 18 beats per minute was considered abnormal. The patients were divided into 2 groups according to the value of HRR. Those with abnormal HRR were assigned to group I and those with normal HRR were assigned to group II. The 2 groups were compared with each other regarding baseline characteristics and exercise capacity assessed by peak VO2. There were 26 patients (31%) in group I and 58 patients (69%) in group II. Group II patients had better performance on treadmill exercise testing than group I patients. They had greater exercise duration (7.5 +/- 3.8 minutes versus 5 +/- 3.5 minutes, P = 0.006), better heart-rate reserve (79 +/- 25% versus 63 +/- 27%, P = 0.01), and higher values of maximal heart-rate (141 +/- 18 beats/min versus 132 +/- 17 beats/min, P = 0.04). Group II patients also had higher peak VO2 values (16.8 +/- 4.4 mL/kg/min versus 14.4 +/- 3.6 mL/kg/min, P = 0.01). When we separated the groups according to beta-blocker usage, beta-blockers had no prominent effect on HRR. In the follow-up period (mean 14.1 +/- 6.1 months), the presence of abnormal HRR and lower peak VO2 (< or = 14 mL/kg/min) were the only significant predictors of mortality in our patient population (adjusted hazard ratio [HR] 5.2, 95% CI, 1.3 to 24, P = 0.03 and adjusted HR 13, 95% CI, 2.1 to 25.6, P = 0.005, respectively). It seems that the attenuated HRR value one minute after peak exercise appears to be a reliable index of the severity of exercise intolerance in heart failure patients and this study supports the value of HRR as a prognostic marker among heart failure patients referred for cardiopulmonary exercise testing for prediction of prognosis.     

Correlation of Modification of Heart Rate Recovery with Adaptation to Myocardial Ischemia in a Model of Sequential Exercise Testings

Background: Heart rate recovery (HRR) has been identified as a reliable predictor of cardiac mortality, correlated with autonomic tone. In a model of sequential exercise testings, we investigated the reproducibility of HRR and the association between HRR modification and myocardial adaptation to ischemia. Methods: We studied 128 patients (mean age 62 ± 9 years, 83% males) with angiographically documented coronary artery disease (CAD) and a first positive exercise testing, who agreed to undergo a second exercise testing after 24 hours. Results: HRR was increased from 25 ± 10 beats/min at the first exercise testing to 30 ± 13 beats/min at the second exercise testing (P < 0.001). Thereafter, participants were divided into two groups: Group I comprised 88 patients who presented augmentation of the HRR in the first compared to the second exercise testing, while group II comprised 40 patients who presented unchanged or reduced HRR. The rate‐pressure product (RPP) at 1 mm ST‐segment depression (ischemic threshold) at the second compared to the first exercise testing were significantly improved in group I patients (2345 ± 3429 mmHg/min), while it was worsened in group II patients (?630 ± 2510 mmHg/min) (P < 0.001). Conclusions: In a model of sequential exercise testings, myocardial adaptation to exercise‐induced ischemia was associated with favorable modification of HRR.     

Usefulness of two-dimensional echocardiography during low-level exercise testing early after uncomplicated acute myocardial infarction

To determine whether 2-dimensional (2-D) echocardiographic measures of segmental and global left ventricular (LV) function immediately on recovery of low-level, symptom-limited treadmill exercise are as sensitive as the same variables measured at peak bicycle exercise, 21 patients were studied after acute myocardial infarction (AMI). The recovery treadmill ejection fraction analysis was predictive of the peak bicycle results in 18 of the 21 patients (86%) and recovery treadmill wall motion abnormalities were predictive of the peak bicycle analysis in 17 (81%) (p less than 0.01). These data indicate that 2-D echocardiography during the immediate recovery phase of low-level postinfarction treadmill testing was as sensitive as the peak exercise assessment of segmental and global LV function. Accordingly, the predictive value of rest and recovery exercise measures were prospectively assessed in 67 patients during a mean follow-up interval of 11 months (range 3 to 24). Clinical characteristics and treadmill electrocardiographic findings did not identify the 16 of 67 patients (24%) who had new cardiac events (3 cardiac deaths, 8 recurrent AMIs and 6 coronary artery bypass graft operations). However, a decrease in recovery ejection fraction units of more than 10% was seen in 7 of these 16 patients (44%) with events, compared with only 4 of the 51 (13%) without events (p less than 0.002), and new or worsening wall motion abnormalities on exercise recovery were seen in 10 of the 16 patients (63%) with events, but in only 10 of the 51 (20%) without (p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)