左室舒张功能不全患者运动试验后心率恢复分析

Anaysis of heart rate recovery after exercise treadmill testing in patients with left ventricular diastolic dysfunction

目的探讨左室舒张功能不全(LVDD)患者运动负荷试验后3 min内的心率恢复(HRR)变化及意义。方法选取83例LVDD患者及37例正常对照,均进行心电图运动负荷试验,记录静息心率、峰值心率及运动后3 min内的心率,计算运动后第1,2,3 min的HRR(HRR1,HRR2,HRR3)及HRR的校正值(HRR1%,HRR2%,HRR3%),比较两组间HRR指标的关系。结果两组间静息心率、预测储备心率、HRR1、HRR1%、HRR2%及反应运动能力的代谢当量(METs)、运动时间均无明显差异(P>0.05),而峰值心率(127±16次/分vs 140±14次/分)、心率储备(43±17次/分vs 53±14次/分)、HRR2(34±8次/分vs 42±14次/分)、HRR3(39±12 vs 49±13)及HRR3%(30±8 vs 35±8),LVDD组显著低于对照组(P<0.05)。结论 LVDD患者HRR较正常人减低,推测此类患者存在自主神经调节异常的早期改变。

Objective To investigate the changes in heart rate recovery （HRR） after maximal exercise treadmill testing in patients with left ventricular diastolic dysfunction（LVDD）. Methods Echocardiography and treadmill exercise testing were performed in 83 patients with LVDD and 37 health controls. Heart rate （HR） was measured at rest, at maximum exercise and at 1, 2, and 3 minutes into recovery, percent recovery of HRR at 1, 2, and 3 minute（ HRR1%, HRR2%, HRR3% ） were calculated. Results There was no significant difference in resting heart, predicted HR reserve, HRR1%, HRR2%, METs and exercise time（ P 〉 0.05 ）. While peak heart rate （127 ± 16 bpm vs 140 ± 14 bpm）, HR reserve （43 ± 17 bpm vs 53 ± 14 bpm）, HRR2（34 ±8 bpm vs 42 ± 14 bpm）, HRR3（39 ± 12 bpm vs 49 ± 13 bpm） and HRR3% （ 30 ± 8 vs 35 ± 8 ） were significantly lower in patients with LVDD than that in the healthy subjects （ P 〈 0.05 ）. Conclusions HRR is markedly attenuated in LVDD patients comared with healthy subjects and it is postulated that these patients could have early abnormal modulation of cardiac autonomic activity.