Relationship between cardiac chronotropic incompetence, exercise capacity and prognosis in patients with ejection fraction preserved heart failure
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摘要: 目的：探讨射血分数保留的心力衰竭（ejection fraction preserved heart failure，HFpEF）患者心脏变时功能不全（chronotropic incompetence，CI）与运动耐量的关系及其对远期心血管事件的预测价值。方法：纳入2016-08-2018-08就诊于云南省第一人民医院心内科，且资料完整、诊断为HFpEF的患者120例，均完成心肺运动试验（cardiopulmonary exercise tests，CPET），计算心率储备分数（percentage heart rate reserve，% HRRer），将% HRRer与运动试验参数进行相关性分析，记录患者随访期间的心血管终点事件。结果：Pearson相关性分析及多重线性回归均显示，% HRRer与峰值摄氧量（peak oxygen uptake，peak VO2）呈正相关（r=0.98，P<0.01）。随访（16.9±6.5）个月期间，共发生终点事件26例（21.7%）。单因素分析显示，% HRRer<80%与HFpEF患者发生心血管终点事件有显著相关性（P<0.01）；多因素Cox回归模型分析结果显示，% HRRer<80%的患者发生心血管终点事件的风险是% HRRer≥80%患者的3.81倍。结论：HFpEF患者心脏CI与运动耐量的降低呈正相关，两者均是HFpEF患者预后不良的有力的独立预测指标。Abstract: Objective: To investigate the relationship of cardiac chronotropic incompetence (CI), exercise capacity, and long-term cardiovascular events in patients with ejection fraction preserved heart failure (HFpEF).Method: A total of 120 patients with HFpEF were recruited from August 2016 to August 2018 in the Frist People's Hospital of Yunnan Province.Cardiopulmonary exercise tests (CPETs) were performed and percentage heart rate reserve (%HRRer) were calculated in every patient.The correlation between%HRRer and the parameters of CPETs was analyzed.Cardiovascular endpoint events were recorded during the follow-up time.Result: Both Pearson and multiple linear regression analysis showed that%HRRer was related to peak VO2 (r=0.98, P<0.01).Moreover, cardiovasuclar endpoint events occurred in 26 cases (21.7%) during follow-up time (16.9±6.5 months).In addition, univariate analysis showed that%HRRer<80% was significantly related to cardiovascular events (P<0.01), while Cox proportional hazard ratio model showed that HFpEF patients with%HRR<80% had 3.81 times of risk of cardiovascular events as patients with%HRRer ≥ 80%.Conclusion: Cardiac CI is positively related with decreased exercise capacity in HFpEF patients, both are independent predictors of poor prognosis in such patient.
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Key words:
- heart failure /
- preserved ejection fraction /
- chronotropic incompetence /
- exercise capacity /
- prognosis
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