白瑾,赵威,刘燕娥,徐昕晔,徐维,祖凌云,徐顺霖,高炜

• 1:北京大学第三医院心内科卫生部心血管分子生物学与调节肽重点实验室分子心血管学教育部重点实验室心血管受体研究北京市重点实验室

摘要(Abstract)：

目的探讨接受直接经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)的急性ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)患者运动后心率恢复与运动耐量的相关性以及其对患者远期预后的预测价值。方法纳入2011年7月至2014年12月就诊于北京大学第三医院心内科,直接PCI治疗成功、符合入组标准、资料完整的STEMI患者260例,均于发病后30 d内行心肺运动试验(cardiopulmonary exercise testing,CPET),并计算运动试验终止后1 min心率恢复(heart rate recovery at 1 min,HRR_1),将HRR_1与运动耐量进行相关性分析;记录上述患者随访期间的心血管终点事件。结果所有患者均完成CPET,HRR_1为(26.0±12.2)次。(1)HRR_1与峰值摄氧量(peak oxygen uptake,VO_(2peak))呈正相关(r=0.129,P<0.001)。进一步多重线性回归显示VO_(2peak)仍与HRR_1呈正相关。(2)随访期间[中位随访时间为55(42,72)个月]共发生心血管终点事件60例(23.1%)。经过Cox回归模型单因素筛选,HRR_1减低(HRR_1≤12次)与STEMI患者发生心血管终点事件呈显著相关性(P=0.010)。Cox多因素回归分析显示HRR_1≤12次的患者发生心血管终点事件的风险是HRR_1>12次者的2.671倍。结论 HRR_1减低与直接PCI成功的STEMI患者心肌梗死恢复期运动耐量降低相关,是STEMI患者远期预后不良的重要预测指标。

关键词(KeyWords)： 急性心肌梗死;自主神经功能;运动后心率恢复;运动耐量;预后

Abstract:

Keywords:

基金项目(Foundation): 首都临床特色应用研究与成果推广基金资助(Z151100004015047);; 第三方心脏康复服务平台关键技术研究(17V121xzjs)

作者(Author): 白瑾,赵威,刘燕娥,徐昕晔,徐维,祖凌云,徐顺霖,高炜

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