老年人站立挑战和心肺运动试验后心率恢复:前瞻性多中心观察队列研究

BJA open Pub Date : 2023-11-03 DOI:10.1016/j.bjao.2023.100238

Aaron James , David Bruce , Nicholas Tetlow , Amour B.U. Patel , Ethel Black , Nicole Whitehead , Anna Ratcliff , Alice Jamie Humphreys , Neil MacDonald , Gayle McDonnell , Ravishankar Raobaikady , Jeeveththaa Thirugnanasambanthar , Jeuela I. Ravindran , Nicole Whitehead , Gary Minto , Tom E.F. Abbott , Shaman Jhanji , Don Milliken , Gareth L. Ackland

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引用次数: 0

摘要

背景:老年人迷走神经功能受损，通过“黄金标准”最大运动后延迟心率恢复(hrexercise)来量化，是心肺功能和死亡率的独立预测因子(特别是当HRR≤12次min - 1时)。站立挑战(hrreorthostatic)后心率也经常下降，但其机制尚不清楚。我们测试了hrreorthostatic是否反映了与hrexercise相似的迷走神经自主神经特征。方法前瞻性多中心队列研究，受试者计划进行心肺运动试验(CPET)作为常规护理的一部分。在接受CPET之前，参与者坐着3分钟，然后站立3分钟(hrreorthostatic)，测量心率。记录CPET结束后1分钟hrexercise情况。主要结果是每位参与者在站立和运动后达到心率峰值后每10秒1分钟的平均心率变化之间的相关性。次要结果是hrreexercise组和hrreexercise组的hrreorthostatic和峰值VO2比较。结果共87例受试者，平均年龄64岁[95%CI: 61 ~ 66];48名(55%)女性完成了两项测试。站立和运动后峰值心率后每10 s平均心率变化1 min显著相关(R2=0.81;术中,0.0001)。hrexercise≤12次/ min - 1时，hrreorthostatic不变(n=27)，但当hrexercise≤12次/ min - 1时，hrreorthostatic较低(n=60;平均差值:3次min - 1[95%置信区间1 - 5次min - 1];术中,0.0001)。hrreorthostatic较慢与较低的峰值VO2相关(平均差值:3.7 ml kg-1 min -1[95%置信区间0.7-6.8 ml kg-1 min -1];P = 0.039)。结论穷竭运动后心率恢复具有预后意义，其特征是直立挑战后心率恢复的定量差异。这些数据表明，直立挑战是一个有效的，简单的测试表明迷走神经损伤。临床试验注册:researchregistry6550。

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Heart rate recovery after orthostatic challenge and cardiopulmonary exercise testing in older individuals: prospective multicentre observational cohort study

Background

Impaired vagal function in older individuals, quantified by the ‘gold standard’ delayed heart rate recovery after maximal exercise (HRR^exercise), is an independent predictor of cardiorespiratory capacity and mortality (particularly when HRR ≤12 beats min⁻¹). Heart rate also often declines after orthostatic challenge (HRR^orthostatic), but the mechanism remains unclear. We tested whether HRR^orthostatic reflects similar vagal autonomic characteristics as HRR^exercise.

Methods

Prospective multicentre cohort study of subjects scheduled for cardiopulmonary exercise testing (CPET) as part of routine care. Before undergoing CPET, heart rate was measured with participants seated for 3 min, before standing for 3 min (HRR^orthostatic). HRR^exercise 1 min after the end of CPET was recorded. The primary outcome was the correlation between mean heart rate change every 10 s for 1 min after peak heart rate was attained on standing and after exercise for each participant. Secondary outcomes were HRR^orthostatic and peak VO₂ compared between individuals with HRR^exercise <12 beats min⁻¹.

Results

A total of 87 participants (mean age: 64 yr [95%CI: 61–66]; 48 (55%) females) completed both tests. Mean heart rate change every 10 s for 1 min after peak heart rate after standing and exercise was significantly correlated (R²=0.81; P<0.0001). HRR^orthostatic was unchanged in individuals with HRR^exercise ≤12 beats min⁻¹ (n=27), but was lower when HRR^exercise >12 beats min⁻¹ (n=60; mean difference: 3 beats min⁻¹ [95% confidence interval 1–5 beats min⁻¹]; P<0.0001). Slower HRR^orthostatic was associated with lower peak VO₂ (mean difference: 3.7 ml kg^-1 min⁻¹ [95% confidence interval 0.7–6.8 ml kg^-1 min⁻¹]; P=0.039).

Conclusion

Prognostically significant heart rate recovery after exhaustive exercise is characterised by quantitative differences in heart rate recovery after orthostatic challenge. These data suggest that orthostatic challenge is a valid, simple test indicating vagal impairment.