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首页> 外文期刊>The American Journal of Cardiology >Effect of Beta-Blocker Use on Exercise Heart Rate Gradient and Reclassification of Mortality Risk in Patients Referred for Exercise Testing
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Effect of Beta-Blocker Use on Exercise Heart Rate Gradient and Reclassification of Mortality Risk in Patients Referred for Exercise Testing

机译：β-ressers对运动测试患者的运动心率梯度和重新分类的影响

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摘要

Impairments in heart rate (HR) reserve and HR recovery are associated with mortality, and the combination of these two, termed exercise HR gradient (EHRG), is a better predictor than either alone. However, the confounding effect of beta-blockade on chronotropic impairment to exercise has not been fully explored; the aim of the present study was to evaluate the effect of beta blockade on EHRG. Participants were 2769 Veterans (58.7 +/- 11.6 years) who underwent a maximal exercise test for clinical reasons. HR reserve and HR recovery were acquired and divided into quintiles and summed to provide an EHRG score. Net reclassification improvement (NRI) was performed to evaluate the impact of HR reserve, HR recovery and EHRG on all-cause mortality for patients with and without beta-blocker use. During a mean follow up of 10.9 +/- 4.1 years, 657 patients died. Among patients without beta-blocker therapy, adding EHRG score to an established model including multiple baseline risk factors and exercise capacity resulted in an NRI of 14.3% (p < 0.001). Adding HR recovery instead of EHRG score yielded an NRI of 11.5% (p <0.001), whereas HR reserve had no significant NRI among patients without beta-blocker therapy. In contrast, among participants on beta-blocker therapy, the addition of HR reserve, HR recovery, or EHRG score did not result in any significant reclassification. In conclusion, EHRG was superior to both HR reserve and HR recovery in predicting mortality and provides significant reclassification of risk but only among patients not taking beta-blockers. (C) 2020 Elsevier Inc. All rights reserved.
机译：心率储备（HR）和HR恢复的损伤与死亡率相关，两者的结合称为运动HR梯度（EHRG），是比单独两者更好的预测指标。然而，β受体阻滞剂对运动变时性损害的混杂效应尚未得到充分探讨；本研究的目的是评估β受体阻滞剂对EHRG的影响。参与者为2769名退伍军人（58.7+/-11.6岁），他们因临床原因接受了最大限度的运动测试。获取HR储备和HR恢复，并将其划分为五分位数，并求和以提供EHRG分数。对使用和不使用β受体阻滞剂的患者进行净再分类改善（NRI），以评估HR储备、HR恢复和EHRG对全因死亡率的影响。平均随访10.9+/-4.1年，657名患者死亡。在未接受β受体阻滞剂治疗的患者中，将EHRG评分添加到包括多个基线风险因素和运动能力的已建立模型中，NRI为14.3%（p<0.001）。加上HR恢复而非EHRG评分，NRI为11.5%（p<0.001），而在未接受β受体阻滞剂治疗的患者中，HR储备没有显著的NRI。相比之下，在接受β受体阻滞剂治疗的参与者中，增加HR储备、HR恢复或EHRG评分并没有导致任何显著的重新分类。总之，EHRG在预测死亡率方面优于HR储备和HR恢复，并提供了显著的风险重新分类，但仅适用于未服用β受体阻滞剂的患者。（C） 2020爱思唯尔公司版权所有。

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