累积休息心率负荷和心血管风险在患者心力衰竭在鼻节律
Jun Hao1, Jingyang Wang2, Rui Shi3
1Clinical Trial Research Center, The First Affiliated Hospital of Nanchang University, Nanchang, China; Medical Research and Biometrics Center, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China; Institute for Global Health, University College London, London, United Kingdom.
Revista espanola de cardiologia (English ed.)
|August 15, 2025
概括
累积休息心率负荷,是一种随时间推移的心率的新测量方法,强烈预测慢性心力衰竭 (HF) 患者的不良结果. 这种指标比传统的心率指标提供了更好的风险预测.
科学领域:
- 心脏病学 心脏病学
- 临床研究 临床研究
- 心脏衰竭管理的管理
背景情况:
- 休息心率 (RHR) 是慢性心力衰竭 (HF) 中预后意义的重要标志.
- 传统的RHR测量不能捕捉心率升高的幅度和持续时间.
- 一个新的指标,累积静止心率负荷,可能会提供更好的预后洞察力.
研究的目的:
- 为了评估累积静止心率负荷和慢性HF在鼻腔节律患者的不良结果之间的关联.
- 为了比较累积静止心率负载与传统心率参数的预测值.
- 评估累积静止心率负荷在HF风险分层中的潜在临床实用性.
主要方法:
- 分析了来自5项大型随机对照试验 (BEST,GUIDE-IT,HF-ACTION,RELAX,TOPCAT) 的数据.
- 计算累积心率负荷为心率≥70次/分钟 (bpm) 的曲线下的面积 (AUC).
- 使用Cox比例风险回归模型来评估与重大心脏不良事件 (MACE) 和其他结果的关联.
主要成果:
- 更高的累积静止心率负载与MACE (HR,1.31),心血管死亡 (HR,1.17),心血管住院 (HR,1.34) 和全因死亡 (HR,1.20) 的风险增加显著相关.
- 与基线心率,平均心率和心率变化指标相比,累积的静止心率负载显示出所有评估结果的优异预测值.
- 这些发现在大量患者队列 (n=5428) 中是强有力的.
结论:
- 累积的静止心率负荷是慢性HF患者不良结果的强大独立预测因素.
- 与传统的心率评估相比,这种新型指标提供了增强的预后价值.
- 将累积静止心率负载纳入临床实践可能会改善风险分层并为高风险HF患者指导有针对性的干预措施.
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