心房颤动患者和非心房颤动患者的心肺健康与不良结局的关联：一项前瞻性队列研究。

IF 3.2 3区医学 Q1 MEDICINE, GENERAL & INTERNAL

International Journal of Medical Sciences Pub Date : 2025-06-09 eCollection Date: 2025-01-01 DOI:10.7150/ijms.110802

Yutong Wang, Tao Xu, Chenxi Xia, Xinyang Song, Yanwen Chen, Sixian Weng, Fang Wang

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In the AF group, outcomes included heart failure (HF), stroke, and all-cause mortality; in the non-AF group, incident AF, stroke, HF, and mortality were assessed. Associations between cardiorespiratory indices-RHR, HRmax, and VO₂max-and adverse cardiovascular events were evaluated using Cox proportional hazards models. Dose-response relationships were examined via restricted cubic spline (RCS) models with three knots. Results: In the non-AF population, higher resting heart rate was significantly associated with an increased risk of adverse cardiovascular outcomes, including heart failure (HF: HR = 1.008, 95% CI 1.001-1.014, P = 0.0182), stroke (HR = 1.010, 95% CI 1.004-1.016, P = 0.0018), atrial fibrillation (AF: HR = 1.011, 95% CI 1.007-1.015, P < 0.0001), and all-cause mortality (HR = 1.016, 95% CI 1.010-1.022, P < 0.0001). 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引用次数: 0

摘要

背景：心肺健康在心血管健康中起着至关重要的作用；然而，它对不同疾病的不良心血管结局的影响仍不明确。具体来说，心肺健康对心房颤动（AF）患者和非心房颤动患者的不同影响尚不完全清楚。本研究旨在探讨静息心率（RHR）、最大心率（HRmax）和最大摄氧量（vo2max）与不良心血管结果的关系，为运动处方和心脏康复实践提供有价值的见解。方法：将参与者分为两组：基线前诊断为房颤（AF组）和基线时无房颤（非房颤组）。在房颤组，结果包括心力衰竭（HF）、中风和全因死亡率；在非房颤组，评估房颤事件、卒中、心衰和死亡率。使用Cox比例风险模型评估心肺指数（rhr、HRmax和vo2max）与不良心血管事件之间的关系。剂量-反应关系通过三节限制三次样条（RCS）模型进行检验。结果：在非房颤人群中，较高的静息心率与心血管不良结局的风险增加显著相关，包括心力衰竭（HF: HR = 1.008, 95% CI 1.001-1.014, P = 0.0182）、中风（HR = 1.010, 95% CI 1.004-1.016, P = 0.0018）、房颤（AF: HR = 1.011, 95% CI 1.007-1.015, P < 0.0001）和全因死亡率（HR = 1.016, 95% CI 1.010-1.022, P < 0.0001）。相反，较高的HRmax与这些结果呈负相关(HF: HR = 0.993, 95% CI 0.991-0.995, P < 0.0001；卒中：HR = 0.993, 95% CI 0.990-0.995, P < 0.0001；Af: hr = 0.993, 95% ci 0.991 ~ 0.994, p < 0.0001；心血管死亡：HR = 0.994, 95% CI 0.990-0.997, P < 0.0001)。同样，较高的心肺适能（由vo2max测量）始终与不良结局风险降低相关（HR范围：0.930-0.961,P < 0.001）。在房颤人群中，较高的RHR与HF （HR = 1.007, 95% CI 1.002-1.012, P = 0.0047）和全因死亡率（HR = 1.009, 95% CI 1.004-1.014, P < 0.0001）的风险升高相关。相反，较大的VO₂max与不良结局风险降低相关，包括HF （HR = 0.934, 95% CI 0.899-0.972, P < 0.0001）、卒中（HR = 0.943, 95% CI 0.891-0.999, P = 0.0446）和全因死亡率（HR = 0.957, 95% CI 0.918-0.998, P = 0.038）。结论：在没有房颤的个体中，较高的静息心率与房颤、心衰、中风和全因死亡的风险增加显著相关，在RHR为每分钟61次时，房颤和心衰的风险最低。在房颤患者中，RHR升高与心衰和全因死亡风险升高显著相关。相反，在两组人群中，较高的vo2 max始终与不良后果风险降低相关。此外，vo2 max对有或无房颤的心血管不良预后风险具有很强的预测价值。

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Association of cardiorespiratory fitness with adverse outcomes in patients with and without atrial fibrillation: a prospective cohort study.

Background: Cardiorespiratory fitness plays a crucial role in cardiovascular health; however, its effects on adverse cardiovascular outcomes across different diseases remain poorly defined. Specifically, the differential impact of cardiorespiratory fitness on patients with and without atrial fibrillation (AF) is yet to be fully understood. This study aimed to explore the relationships between resting heart rate (RHR), maximal heart rate (HRmax), and maximal oxygen uptake (VO₂max) in relation to adverse cardiovascular outcomes, providing valuable insights to inform exercise prescriptions and cardiac rehabilitation practices. Methods: Participants were classified into two groups: those with AF diagnosed prior to baseline (AF group) and those without AF at baseline (non-AF group). In the AF group, outcomes included heart failure (HF), stroke, and all-cause mortality; in the non-AF group, incident AF, stroke, HF, and mortality were assessed. Associations between cardiorespiratory indices-RHR, HRmax, and VO₂max-and adverse cardiovascular events were evaluated using Cox proportional hazards models. Dose-response relationships were examined via restricted cubic spline (RCS) models with three knots. Results: In the non-AF population, higher resting heart rate was significantly associated with an increased risk of adverse cardiovascular outcomes, including heart failure (HF: HR = 1.008, 95% CI 1.001-1.014, P = 0.0182), stroke (HR = 1.010, 95% CI 1.004-1.016, P = 0.0018), atrial fibrillation (AF: HR = 1.011, 95% CI 1.007-1.015, P < 0.0001), and all-cause mortality (HR = 1.016, 95% CI 1.010-1.022, P < 0.0001). In contrast, higher HRmax was inversely associated with these outcomes (HF: HR = 0.993, 95% CI 0.991-0.995, P < 0.0001; stroke: HR = 0.993, 95% CI 0.990-0.995, P < 0.0001; AF: HR = 0.993, 95% CI 0.991-0.994, P < 0.0001; cardiovascular death: HR = 0.994, 95% CI 0.990-0.997, P < 0.0001). Similarly, higher cardiorespiratory fitness, measured by VO₂max, was consistently associated with reduced risks of adverse outcomes (HR range: 0.930-0.961, P < 0.001). In the AF population, higher RHR was associated with elevated risks of HF (HR = 1.007, 95% CI 1.002-1.012, P = 0.0047) and all-cause mortality (HR = 1.009, 95% CI 1.004-1.014, P < 0.0001). Conversely, greater VO₂max was linked to reduced risks of adverse outcomes, including HF (HR = 0.934, 95% CI 0.899-0.972, P < 0.0001), stroke (HR = 0.943, 95% CI 0.891-0.999, P = 0.0446), and all-cause mortality (HR = 0.957, 95% CI 0.918-0.998, P = 0.038). Conclusion: In individuals without AF, higher resting heart rate was significantly associated with increased risks of incident AF, HF, stroke, and all-cause mortality, with the lowest risks of AF and HF observed at an RHR of 61 beats per minute. Among patients with AF, elevated RHR was significantly linked to higher risks of HF and all-cause mortality. Conversely, higher VO₂max was consistently associated with reduced risks of adverse outcomes across both populations. Furthermore, VO₂max showed strong predictive value for adverse cardiovascular prognostic risks in individuals with and without AF.

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来源期刊

International Journal of Medical Sciences MEDICINE, GENERAL & INTERNAL-

CiteScore

7.20

自引率

0.00%

发文量

185

审稿时长

2.7 months

期刊介绍： Original research papers, reviews, and short research communications in any medical related area can be submitted to the Journal on the understanding that the work has not been published previously in whole or part and is not under consideration for publication elsewhere. Manuscripts in basic science and clinical medicine are both considered. There is no restriction on the length of research papers and reviews, although authors are encouraged to be concise. Short research communication is limited to be under 2500 words.