平板运动试验后心率恢复和恢复期室性期前收缩的临床意义

Clinical significance of heart rate recovery and the presence of premature ventricular complexes during recovery of patients who had undergone treadmill test

目的:观察平板运动试验后患者心率恢复情况及恢复期室性期前收缩的数量,探讨其在心力衰竭(心衰)和冠心病方面可能的临床意义。方法:入选完成平板运动试验的342例住院患者,根据平板结果和氨基末端B型利钠肽前体水平分别分为阳性组(184例)和阴性对照组(158例),心衰组(48例)和正常对照组(294例)。比较各组患者在试验后0s、30s、1min、2min、4min、6min、10min的心率,计算1min、2min、4min、6min、10min5个时间点的心率恢复速率值,并计算恢复期10min内室性期前收缩总数。结果:阳性组和心衰组患者的心率恢复速率均低于各自的对照组。在试验后2min内,心率恢复速率曲线分离较大,差异具有统计学意义。2min后各组差异减小,无统计学意义。阳性组、心衰组运动后室性期前收缩的数量均比相应的对照组增多(37.6±3.7:19.2±2.4;32.3±3.1:11.8±1.9),均P<0.05。结论:平板运动试验后2min内心率恢复的减慢和恢复期室性期前收缩的增多可能是一个预测心血管事件简单而实用指标。

Objective：Slow recovery of heart rate （HR） in response to exercise is an independent predictor of the mortality of patients with congestive heart failure and coronary artery disease.Our study investigated the HR recovery and the presence of premature ventricular complexes （PVCs） during recovery of patients who had undergone treadmill test.Method：A total of 342 inpatients had undergone treadmill test,and were further divided into positive group （n=184） and negative group （n=158） according to test results,as well as into heart failure group （n=48） and non-heart failure group （n=294）,respectively.Post-treadmill HRs at 0 s,30 s,1 min,2 min,4 min,6 min,10 min were recorded and HR recovery rate at 1 min,2 min,4 min,6 min and 10 min were calculated.The presence and number of PVCs during 10 minutes of recovery time were also recorded.Between-group comparisons were made thereafter.During the first two minitues after exercise,the HR recovery curves reached greater divergence between both positive and negative groups,and heart failure and non-heart failure groups.Result：The difference between groups become smaller after that.There were significantly more PVCs in positive group （37.6±3.7 vs 19.2±2.4;P0.05） and heart failure group （32.3±3.1 vs 11.8±1.9;P0.05） each compared to its corresponding control group.Conclusion：Post-treadmill test HR recovery and the presence and number of PVCs within 2 minutes could probably be served as an easy and cost-effective predictor of cardiovascular events.