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通讯作者:

王嫱,E-mail:jerrytortoise@163.com

中图分类号:R593.2

文献标识码:A

文章编号:1007-4368(2022)04-498-05

DOI:10.7655/NYDXBNS20220406

参考文献 1
FISCHER L,BENJAMIN N,BLANK N,et al.Right heart size and function significantly correlate in patients with pulmonary arterial hypertension ⁃ a cross ⁃ sectional study [J].Respir Res,2018,19(1):216
参考文献 2
KATO M,ATSUMI T.Pulmonary arterial hypertension as⁃ sociated with connective tissue diseases:a review focus⁃ ing on distinctive clinical aspects[J].Eur J Clin Invest,2018,48(2):1-9
参考文献 3
中华医学会呼吸病学分会肺栓塞与肺血管病学组,中国医师协会呼吸医师分会肺栓塞与肺血管病工作委员会,全国肺栓塞与肺血管病防治协作组,等.中国肺动脉高压诊断与治疗指南(2021版)[J].中华医学杂志,2021,101(1):11-51
参考文献 4
HUANG P H,LEU H B,CHEN J W,et al.Usefulness of attenuated heart rate recovery immediately after exercise to predict endothelial dysfunction in patients with suspect⁃ ed coronary artery disease[J].Am J Cardiol,2004,93(1):10-13
参考文献 5
LINDGREN M,ROBERTSON J,ADIELS M,et al.Elevat⁃ ed resting heart rate in adolescent men and risk of heart failure and cardiomyopathy[J].ESC Heart Fail,2020,7(3):1178-1185
参考文献 6
DZUDIE A,BARCHE B,MOULIOM S,et al.Resting heart rate predicts all⁃cause mortality in sub⁃Saharan Af⁃ rican patients with heart failure:a prospective analysis from the Douala Heart failure registry(Do⁃HF)[J].Car⁃ diovasc Diagn Ther,2021,11(1):111-119
参考文献 7
LAU K,MALIK A,FOROUTAN F,et al.Resting heart rate as an important predictor of mortality and morbidity in ambulatory patients with heart failure:a systematic re⁃ view and meta ⁃ analysis[J].J Card Fail,2021,27(3):349-363
参考文献 8
NWABUO C C,APPIAH D,MOREIRA H T,et al.Tem⁃ poral changes in resting heart rate,left ventricular dys⁃ function,heart failure and cardiovascular disease:CAR⁃ DIA study[J].Am J Med,2020,133(8):946-953
参考文献 9
BRUGADA J,KATRITSIS D G,ARBELO E,et al.2019 ESC Guidelines for the management of patients with su⁃ praventricular tachycardia[J].Eur Heart J,2020,41(5):655-720
参考文献 10
RAIN S,HANDOKO M L,TRIP P,et al.Right ventricu⁃ lar diastolic impairment in patients with pulmonary arteri⁃ al hypertension[J].Circulation,2013,128(18):2016-2025
参考文献 11
CHEMLA D,CASTELAIN V,HERVÉ P,et al.Haemody⁃ namic evaluation of pulmonary hypertension[J].Eur Respir J,2002,20(5):1314-1331
参考文献 12
HENKENS I R,VAN WOLFEREN S A,GAN C T,et al.Relation of resting heart rate to prognosis in patients with idiopathic pulmonary arterial hypertension[J].Am J Car⁃ diol,2009,103(10):1451-1456
参考文献 13
TONELLI A R,WANG X F,ALKUKHUN L,et al.Heart rate slopes during 6⁃ min walk test in pulmonary arterial hypertension,other lung diseases,and healthy controls [J].Physiol Rep,2014,2(6):1-11
参考文献 14
WITTE C,MEYER Z H G M,ANDRIÉ R,et al.Heart rate variability and arrhythmic burden in pulmonary hy⁃ pertension[J].Adv Exp Med Biol,2016,934:9-22
参考文献 15
WONG Y Y,WESTERHOF N,RUITER G,et al.Systolic pulmonary artery pressure and heart rate are main deter⁃ minants of oxygen consumption in the right ventricular myocardium of patients with idiopathic pulmonary arterial hypertension[J].Eur J Heart Fail,2011,13(12):1290-1295
参考文献 16
CIARKA A,DOAN V,VELEZ ⁃ROA S,et al.Prognostic significance of sympathetic nervous system activation in pulmonary arterial hypertension[J].Am J Respir Crit Care Med,2010,181(11):1269-1275
参考文献 17
SARNARI R,KAMAL R Y,FRIEDBERG M K,et al.Doppler assessment of the ratio of the systolic to diastolic duration in normal children:relation to heart rate,age and body surface area[J].J Am Soc Echocardiogr,2009,22(8):928-932
参考文献 18
GOMEZ O,OKUMURA K,HONJO O,et al.Heart rate re⁃ duction improves biventricular function and interactions in experimental pulmonary hypertension[J].Am J Physi⁃ ol Heart Circ Physiol,2018,314(3):H542-H551
参考文献 19
MINAI O A,GUDAVALLI R,MUMMADI S,et al.Heart rate recovery predicts clinical worsening in patients with pulmonary arterial hypertension[J].Am J Respir Crit Care Med,2012,185(4):400-408
参考文献 20
BERSOHN M M,TURNER M P,TRAIGER G L,et al.Systemic BP and heart rate as prognostic indicators in pulmonary arterial hypertension[J].Chest,2013,144(3):959-965
参考文献 21
ISHII R,OKUMURA K,AKAZAWA Y,et al.Heart rate reduction improves right ventricular function and fibrosis in pulmonary hypertension[J].Am J Respir Cell Mol Bi⁃ ol,2020,63(6):843-855
参考文献 22
CORREALE M,BRUNETTI N D,MONTRONE D,et al.Functional improvement in pulmonary arterial hyperten⁃ sion patients treated with ivabradine[J].J Card Fail,2014,20(5):373-375
参考文献 23
CHANG S M,LIN C C,HSIAO S H,et al.Pulmonary hy⁃ pertension and left heart function:insights from tissue Doppler imaging and myocardial performance index[J].Echocardiography,2007,24(4):366-373
参考文献 24
VAN WOLFEREN S A,MARCUS J T,WESTERHOF N,et al.Right coronary artery flow impairment in patients with pulmonary hypertension[J].Eur Heart J,2008,29(1):120-127
参考文献 25
GÓMEZ A,BIALOSTOZKY D,ZAJARIAS A,et al.Right ventricular ischemia in patients with primary pulmonary hypertension[J].J Am Coll Cardiol,2001,38(4):1137-1142
目录contents

    摘要

    目的:探索静息状态下测得心率对结缔组织疾病相关肺动脉高压(connective tissue disease⁃associated pulmonary arterial hypertension,CTD⁃PAH)患者远期预后的预测作用。方法:收集2009—2021年南京医科大学第一附属医院风湿免疫科收治的所有经右心导管确诊的CTD⁃PAH患者89 例。比较心率 < 100 次/min和心率≥100 次/min患者的临床特点、二维超声心动图参数、血流动力学参数及生存情况。采用Kaplan⁃Meier、Cox方法进行生存分析。结果:两组患者性别、年龄、WHO心功能分级、6 min 步行距离、末端脑钠肽前体、二维超声心动图及血流动力学参数的差异均无统计学意义(P > 0.05)。与静息心率 < 100 次/min 的 CTD⁃PAH 患者相比,静息心率≥100 次/min 的患者病死率更高(P < 0.01)。静息心率 < 100 次/min 和 ≥100 次/min的患者1年、3年及5年的总体生存率分别为98.6%、90.7%、87.6%和93.8%、66.8%、55.6%。校正年龄和性别后静息心率≥100 次/min仍是CTD⁃PAH预后的独立危险因素。结论:静息心率可能是预测CTD⁃PAH患者远期不良预后的指标之一,可反映右心室整体功能情况。

    Abstract

    Objective:To explore the relationship between resting heart rate and long ⁃term prognosis of patients with connective tissue disease⁃associated pulmonary arterial hypertension(CTD⁃PAH). Methods:A total of 89 patients with CTD⁃PAH diagnosed by right cardiac catheterization were collected from the Departments of Rheumatology,the First Affiliated Hospital of Nanjing Medical University from 2009 to 2021. The clinical characteristics,two ⁃dimensional echocardiographic parameters,hemodynamic parameters and survival of patients with heart rate < 100 beats/min and heart rate ≥100 beats/min were compared. Kaplan⁃Meier and Cox methods were used for survival analysis. Results:There was no significant difference in sex,age,WHO functional class,6 ⁃ minute walking distance,N⁃terminal pro⁃brain natriuretic peptide,two⁃dimensional echocardiographic and hemodynamic parameters between the two groups. The mortality of patients with resting heart rate ≥100 beats/min was higher than that of patients with resting heart rate <100 beats/min(P < 0.01). The overall1⁃,3⁃ and 5⁃year survival rates of patients with resting heart rate < 100 beats/min and ≥ 100 beats/ min were98.6%,90.7%,87.6% and 93.8%,66.8%,55.6% . After adjustment for age and sex,resting heart rate ≥100 beats/min remained an independent risk factor for prognosis of patients with CTD ⁃PAH. Conclusion:The resting heart rate may be one of the indexes to predict the long⁃term poor prognosis of patients with CTD⁃PAH and may reflect the overall function of the right ventricle.

  • 肺动脉高压(pulmonary arterial hypertension, PAH)是肺小动脉血管痉挛、血管重塑等病理改变导致肺血管阻力进行性增加,最终引起右心衰竭和死亡的一种临床综合征[1]。PAH是结缔组织病 (connective tissue disease,CTD)的严重并发症,也是患者死亡的主要原因之一[2]。因此早期筛查影响PAH预后的潜在危险因素并及时干预具有重要临床意义[3]

  • 心率增快是心血管疾病的独立危险因素,静息心率增快与冠心病、心力衰竭等心血管事件死亡率明显相关[4-5]。心力衰竭患者心率增快多与交感神经系统和肾素⁃血管紧张素⁃醛固酮系统激活相关,静息心率增高,进而引发心脏舒张期缩短,心肌耗氧量增加,组织器官血流灌注不足,使得病情进一步恶化[6-8]。静息心率是心力衰竭预后的重要预测指标,但在肺动脉高压中尚未得到重视。为研究静息心率对肺动脉高压患者预后的价值,我们对89例结缔组织病相关肺动脉高压(connective tissue disease associated with pulmonary hypertension,CTD ⁃ PAH) 患者进行了回顾性分析,评估静息心率对CTD⁃PAH患者远期预后的预测作用。

  • 1 对象和方法

  • 1.1 对象

  • 回顾性分析2009—2021年南京医科大学第一附属医院风湿免疫科收治的所有经右心导管(right heart catheterization,RHC)确诊的CTD⁃PAH患者。纳入标准:①确诊CTD;②RHC确诊PAH;③年龄 ≥18岁。排除标准:①严重的肺间质病变或慢性阻塞性肺疾病;②慢性血栓栓塞性肺高压;③有导致PAH的药物使用史;④人类免疫缺陷病毒感染;⑤肝硬化门静脉高压;⑥左心疾病或先天性心脏病导致的肺高压;⑦合并甲状腺功能亢进疾病。

  • PAH的诊断标准如下:海平面静息状态下,右心导管测量肺动脉平均压力(mean pulmonary arterial pressure,mPAP)≥25mmHg,肺毛细血管楔压 ≤ 15mmHg并且肺血管阻力(pulmonary vascular resis⁃ tance,PVR)≥3WU,心输出量可正常或者下降。 CTD的诊断标准如下:系统性红斑狼疮(systemic lupus erythematosus,SLE)的诊断沿用1997年美国风湿病学会的分类标准;原发性干燥综合征(primary Sjogren’s syndrome,PSS)的诊断沿用2002年国际分类标准;系统性硬化症(systemic sclerosis,SSc)的诊断沿用1980年美国风湿病学会的分类标准;混合性结缔组织病(mixed connective tissue disease,MCTD) 的诊断沿用Sharp标准。患者同时满足2个或2个以上CTD的诊断标准则定义为重叠综合征。若患者有系统性自身免疫疾病的临床和血清学表现,但不能满足任何一个已知的结缔组织病分类标准的则定义为未分化结缔组织病。

  • 本研究获得南京医科大学第一附属医院医学伦理委员会批准(编号2018⁃SR⁃333),所有入组患者均知情同意。

  • 1.2 方法

  • 1.2.1 临床资料收集

  • 回顾性记录患者就诊时的人口学信息、临床特征、WHO心功能分级、6min步行距离、实验室检测指标、二维超声心动图参数和右心导管参数。

  • 静息心率测量方法:患者取平卧位,安静状态下休息15min,行右心导管操作前由心电监护测得患者瞬时静息心率。

  • 1.2.2 临床结局评估

  • 研究终点是全因死亡,通过电话随访患者本人和/或其直系亲属获得患者生存状态。生存期计算是从右心导管确诊PAH到本研究随访截止日期 (2021年10月1日)的时间间隔;若患者在研究截止期之前已经死亡,则计算至患者死亡的时间间隔。

  • 1.3 统计学方法

  • 使用的统计分析软件为SPSS 20.0和GraphPad prism 8.0。符合正态分布的连续变量用均数±标准差(x- ± s)表示,非正态分布的连续变量用中位数(四分位数)[MP25P75)]表示,分类变量用例数和百分率表示。独立样本t检验和Wilcoxon秩和检验分别用于比较正态分布和非正态分布连续变量的组间差异,使用卡方检验或Fisher精确检验比较分类变量的组间差异。Kaplan⁃Meier方法用于评估患者总体生存率,Cox回归分析与预后相关的危险因素。双尾P< 0.05为差异有统计学意义。

  • 2 结果

  • 2.1 CTD⁃PAH患者基线资料

  • 本研究共纳入89例由RHC诊断的CTD⁃PAH患者,其中SLE⁃PAH最常见,占48.3%,其次为PSS⁃PAH (23.6%)、SSc⁃PAH(10.1%)、MCTD⁃PAH(7.9%),类风湿关节炎、多发性肌炎或皮肌炎相关PAH相对少见。

  • 本研究中将静息心率≥100次/min定义为心率增快[9],89例CTD⁃PAH患者亚组临床特征见表1,所有患者均未使用降低心率的药物。两组患者性别、年龄、WHO心功能分级、6min步行距离、末端脑钠肽前体(NT⁃pro BNP)、右心房内径、右心室内径、左心室射血分数、肺动脉收缩压、mPAP、心指数(cardiac index,CI)、PVR、右房压、经皮血氧饱和度比较差异均无统计学意义(P> 0.05)。与静息心率< 100次/min的CTD⁃PAH患者相比,静息心率≥ 100次/min的患者病死率更高(P< 0.01)。

  • 2.2 CTD⁃PAH患者总体生存率

  • CTD⁃PAH患者平均随访时间为(42.3±31.3)个月,12例患者死亡。1年、3年及5年总体生存率分别为97.6%、86.3%及81.9%(图1)。

  • 2.3 静息心率对CTD⁃PAH患者预后的影响

  • 静息心率< 100次/min的CTD⁃PAH患者5年生存率明显高于心率≥100次/min的患者(P< 0.01)。静息心率< 100次/min的CTD⁃PAH患者,1年、3年及5年总体生存率分别为98.6%、90.7%及87.6%;静息心率≥100次/min的CTD⁃PAH患者1年、3年及5年总体生存率分别为93.8%、66.8%及55.6%(图2)。校正年龄和性别因素后,静息心率≥100次/min仍是CTD⁃PAH患者预后不良的独立危险因素(表2)。

  • 表1 CTD⁃PAH患者临床基线资料

  • Table1 Clinical data of CTD⁃PAH patients at baseline

  • 图1 89例CTD⁃PAH患者生存曲线

  • Fig.1 Survival curve of 89CTD⁃PAH patients

  • 图2 静息心率<100次/min与≥100次/min的CTD⁃PAH患者总体生存率比较

  • Fig.2 Comparison of overall survival rates between CTD⁃PAH patients with resting heart rate< 100beats/min and ≥100beats/min

  • 表2 CTD⁃PAH患者预后危险因素分析

  • Table2 Analysis of prognostic risk factors in CTD⁃PAH patients

  • 3 讨论

  • 本研究发现,静息心率≥100次/min的CTD ⁃ PAH患者病死率较高;Kaplan⁃Meier曲线提示静息心率≥100次/min的患者远期生存率显著低于静息心率< 100次/min的患者,校正年龄和性别后的Cox回归分析显示静息心率≥100次/min是CTD⁃PAH预后的独立危险因素,表明静息心率可能是预测CTD⁃ PAH患者远期不良预后的一个潜在指标。

  • 在PAH患者中,右心室舒张功能障碍与疾病严重程度和预后不良密切相关[10]。随着肺血管阻力的增加,右心室每搏做功指数不断增加,进而导致右心室心肌肥厚和心肌耗氧量增加,每搏输出量减少,此时心输出量的维持依赖于心率代偿性的增加,而心率增加反映了交感神经张力的增加,主要依靠去甲肾上腺素能驱动。长期去甲肾上腺素能过度驱动导致右心室β⁃肾上腺素能受体下调,右心室功能受损,右心室舒张末期压力升高,舒张期充盈时间缩短,心肌供养不足,进一步损害冠脉系统灌注,最终导致右心室心肌缺血,右心室后负荷增加,右心室功能进一步恶化[11-12],进而导致PAH预后不良。

  • PAH患者基础交感神经活性增加,导致静息心率增加[13]。有研究表明PAH患者平均心率高于健康对照组[14],交感神经系统激活是PAH患者发生临床恶化的独立预测因子[15-16]。研究表明随着心率的增加,右心室舒张期缩短,右心室收缩期与舒张期比值(S/D)呈指数增加,反映了室间隔向左移位及左心室充盈减少,最终左心室及右心室功能受损[17-18]。 Wong等[15] 同样证明心率增加是PAH患者右室心肌肥厚和心肌耗氧量增加的主要决定因素之一。降低心率后,通过减少肌动蛋白⁃肌球蛋白交叉桥以改善右心室的早期舒张,从而使收缩末期心肌顺应性增加,进而改善右心室收缩和舒张功能,改善心输出量和血流动力学指标[17-18]。Minai等[19] 认为运动实验后心率恢复异常与充血性心力衰竭患者、PAH患者临床恶化事件、生存率及住院率密切相关,可能与内皮细胞功能失调、运动后交感神经的持续兴奋及副交感神经再激活障碍相关[4]。值得注意的是,Bersohn等[20] 研究表明在任何时候出现较高的心率都可能提示预后不良。

  • 本研究发现静息心率可能是预测CTD⁃PAH远期不良预后的指标,心率较低的患者往往远期预后更好。近期一项动物模型研究表明,尽管存在持续性肺动脉高压和右心室压力负荷,伊伐布雷定降低大鼠心率的同时还能减少右心室TGF⁃β促纤维化信号和胶原纤维化,从而改善心肌细胞肥大,进而改善心肌收缩和舒张功能[21]。同样另一项临床研究也表明,对于服用伊伐布雷定3个月的10例心率> 100次/min的PAH患者,随着心率的显著降低,其运动耐量和心功能分级得到显著改善[22]

  • 因此,静息时心率的降低可能改善右心室整体功能,进而改善PAH患者预后。主要表现为以下两点:第一,心率降低可能通过延长右心室舒张期充盈时间而改善PAH患者右室舒张功能;第二,延长舒张期充盈时间可以增加冠状动脉的灌注,提高右心室心肌供氧,进而改善右心室收缩功能[12]

  • 本研究存在一定局限性:①为回顾性单中心研究,研究样本量较少,可能存在部分研究偏倚。②本研究中静息心率为瞬时静息心率,可能存在测量偏倚,未来将进行24h平均心率、住院期间心率监测及分层的进一步研究。

  • 综上所述,静息心率可能是预测CTD⁃PAH患者远期不良预后的指标之一。本研究数据显示静息心率≥100次/min的CTD⁃PAH患者远期生存率显著低于静息心率< 100次/min的患者。静息心率可能反映右心室整体功能情况。因此,与降低静息心率相关的治疗可能会改善右心室功能,进而改善PAH患者预后,提高生存率[1122]。然而截至目前对于在PAH患者中使用降低心率药物的效果尚未得到充分研究,未来还需更多大样本、高质量的研究加以证实,从而改善PAH患者的预后。

  • 参考文献

    • [1] FISCHER L,BENJAMIN N,BLANK N,et al.Right heart size and function significantly correlate in patients with pulmonary arterial hypertension ⁃ a cross ⁃ sectional study [J].Respir Res,2018,19(1):216

    • [2] KATO M,ATSUMI T.Pulmonary arterial hypertension as⁃ sociated with connective tissue diseases:a review focus⁃ ing on distinctive clinical aspects[J].Eur J Clin Invest,2018,48(2):1-9

    • [3] 中华医学会呼吸病学分会肺栓塞与肺血管病学组,中国医师协会呼吸医师分会肺栓塞与肺血管病工作委员会,全国肺栓塞与肺血管病防治协作组,等.中国肺动脉高压诊断与治疗指南(2021版)[J].中华医学杂志,2021,101(1):11-51

    • [4] HUANG P H,LEU H B,CHEN J W,et al.Usefulness of attenuated heart rate recovery immediately after exercise to predict endothelial dysfunction in patients with suspect⁃ ed coronary artery disease[J].Am J Cardiol,2004,93(1):10-13

    • [5] LINDGREN M,ROBERTSON J,ADIELS M,et al.Elevat⁃ ed resting heart rate in adolescent men and risk of heart failure and cardiomyopathy[J].ESC Heart Fail,2020,7(3):1178-1185

    • [6] DZUDIE A,BARCHE B,MOULIOM S,et al.Resting heart rate predicts all⁃cause mortality in sub⁃Saharan Af⁃ rican patients with heart failure:a prospective analysis from the Douala Heart failure registry(Do⁃HF)[J].Car⁃ diovasc Diagn Ther,2021,11(1):111-119

    • [7] LAU K,MALIK A,FOROUTAN F,et al.Resting heart rate as an important predictor of mortality and morbidity in ambulatory patients with heart failure:a systematic re⁃ view and meta ⁃ analysis[J].J Card Fail,2021,27(3):349-363

    • [8] NWABUO C C,APPIAH D,MOREIRA H T,et al.Tem⁃ poral changes in resting heart rate,left ventricular dys⁃ function,heart failure and cardiovascular disease:CAR⁃ DIA study[J].Am J Med,2020,133(8):946-953

    • [9] BRUGADA J,KATRITSIS D G,ARBELO E,et al.2019 ESC Guidelines for the management of patients with su⁃ praventricular tachycardia[J].Eur Heart J,2020,41(5):655-720

    • [10] RAIN S,HANDOKO M L,TRIP P,et al.Right ventricu⁃ lar diastolic impairment in patients with pulmonary arteri⁃ al hypertension[J].Circulation,2013,128(18):2016-2025

    • [11] CHEMLA D,CASTELAIN V,HERVÉ P,et al.Haemody⁃ namic evaluation of pulmonary hypertension[J].Eur Respir J,2002,20(5):1314-1331

    • [12] HENKENS I R,VAN WOLFEREN S A,GAN C T,et al.Relation of resting heart rate to prognosis in patients with idiopathic pulmonary arterial hypertension[J].Am J Car⁃ diol,2009,103(10):1451-1456

    • [13] TONELLI A R,WANG X F,ALKUKHUN L,et al.Heart rate slopes during 6⁃ min walk test in pulmonary arterial hypertension,other lung diseases,and healthy controls [J].Physiol Rep,2014,2(6):1-11

    • [14] WITTE C,MEYER Z H G M,ANDRIÉ R,et al.Heart rate variability and arrhythmic burden in pulmonary hy⁃ pertension[J].Adv Exp Med Biol,2016,934:9-22

    • [15] WONG Y Y,WESTERHOF N,RUITER G,et al.Systolic pulmonary artery pressure and heart rate are main deter⁃ minants of oxygen consumption in the right ventricular myocardium of patients with idiopathic pulmonary arterial hypertension[J].Eur J Heart Fail,2011,13(12):1290-1295

    • [16] CIARKA A,DOAN V,VELEZ ⁃ROA S,et al.Prognostic significance of sympathetic nervous system activation in pulmonary arterial hypertension[J].Am J Respir Crit Care Med,2010,181(11):1269-1275

    • [17] SARNARI R,KAMAL R Y,FRIEDBERG M K,et al.Doppler assessment of the ratio of the systolic to diastolic duration in normal children:relation to heart rate,age and body surface area[J].J Am Soc Echocardiogr,2009,22(8):928-932

    • [18] GOMEZ O,OKUMURA K,HONJO O,et al.Heart rate re⁃ duction improves biventricular function and interactions in experimental pulmonary hypertension[J].Am J Physi⁃ ol Heart Circ Physiol,2018,314(3):H542-H551

    • [19] MINAI O A,GUDAVALLI R,MUMMADI S,et al.Heart rate recovery predicts clinical worsening in patients with pulmonary arterial hypertension[J].Am J Respir Crit Care Med,2012,185(4):400-408

    • [20] BERSOHN M M,TURNER M P,TRAIGER G L,et al.Systemic BP and heart rate as prognostic indicators in pulmonary arterial hypertension[J].Chest,2013,144(3):959-965

    • [21] ISHII R,OKUMURA K,AKAZAWA Y,et al.Heart rate reduction improves right ventricular function and fibrosis in pulmonary hypertension[J].Am J Respir Cell Mol Bi⁃ ol,2020,63(6):843-855

    • [22] CORREALE M,BRUNETTI N D,MONTRONE D,et al.Functional improvement in pulmonary arterial hyperten⁃ sion patients treated with ivabradine[J].J Card Fail,2014,20(5):373-375

    • [23] CHANG S M,LIN C C,HSIAO S H,et al.Pulmonary hy⁃ pertension and left heart function:insights from tissue Doppler imaging and myocardial performance index[J].Echocardiography,2007,24(4):366-373

    • [24] VAN WOLFEREN S A,MARCUS J T,WESTERHOF N,et al.Right coronary artery flow impairment in patients with pulmonary hypertension[J].Eur Heart J,2008,29(1):120-127

    • [25] GÓMEZ A,BIALOSTOZKY D,ZAJARIAS A,et al.Right ventricular ischemia in patients with primary pulmonary hypertension[J].J Am Coll Cardiol,2001,38(4):1137-1142

  • 参考文献

    • [1] FISCHER L,BENJAMIN N,BLANK N,et al.Right heart size and function significantly correlate in patients with pulmonary arterial hypertension ⁃ a cross ⁃ sectional study [J].Respir Res,2018,19(1):216

    • [2] KATO M,ATSUMI T.Pulmonary arterial hypertension as⁃ sociated with connective tissue diseases:a review focus⁃ ing on distinctive clinical aspects[J].Eur J Clin Invest,2018,48(2):1-9

    • [3] 中华医学会呼吸病学分会肺栓塞与肺血管病学组,中国医师协会呼吸医师分会肺栓塞与肺血管病工作委员会,全国肺栓塞与肺血管病防治协作组,等.中国肺动脉高压诊断与治疗指南(2021版)[J].中华医学杂志,2021,101(1):11-51

    • [4] HUANG P H,LEU H B,CHEN J W,et al.Usefulness of attenuated heart rate recovery immediately after exercise to predict endothelial dysfunction in patients with suspect⁃ ed coronary artery disease[J].Am J Cardiol,2004,93(1):10-13

    • [5] LINDGREN M,ROBERTSON J,ADIELS M,et al.Elevat⁃ ed resting heart rate in adolescent men and risk of heart failure and cardiomyopathy[J].ESC Heart Fail,2020,7(3):1178-1185

    • [6] DZUDIE A,BARCHE B,MOULIOM S,et al.Resting heart rate predicts all⁃cause mortality in sub⁃Saharan Af⁃ rican patients with heart failure:a prospective analysis from the Douala Heart failure registry(Do⁃HF)[J].Car⁃ diovasc Diagn Ther,2021,11(1):111-119

    • [7] LAU K,MALIK A,FOROUTAN F,et al.Resting heart rate as an important predictor of mortality and morbidity in ambulatory patients with heart failure:a systematic re⁃ view and meta ⁃ analysis[J].J Card Fail,2021,27(3):349-363

    • [8] NWABUO C C,APPIAH D,MOREIRA H T,et al.Tem⁃ poral changes in resting heart rate,left ventricular dys⁃ function,heart failure and cardiovascular disease:CAR⁃ DIA study[J].Am J Med,2020,133(8):946-953

    • [9] BRUGADA J,KATRITSIS D G,ARBELO E,et al.2019 ESC Guidelines for the management of patients with su⁃ praventricular tachycardia[J].Eur Heart J,2020,41(5):655-720

    • [10] RAIN S,HANDOKO M L,TRIP P,et al.Right ventricu⁃ lar diastolic impairment in patients with pulmonary arteri⁃ al hypertension[J].Circulation,2013,128(18):2016-2025

    • [11] CHEMLA D,CASTELAIN V,HERVÉ P,et al.Haemody⁃ namic evaluation of pulmonary hypertension[J].Eur Respir J,2002,20(5):1314-1331

    • [12] HENKENS I R,VAN WOLFEREN S A,GAN C T,et al.Relation of resting heart rate to prognosis in patients with idiopathic pulmonary arterial hypertension[J].Am J Car⁃ diol,2009,103(10):1451-1456

    • [13] TONELLI A R,WANG X F,ALKUKHUN L,et al.Heart rate slopes during 6⁃ min walk test in pulmonary arterial hypertension,other lung diseases,and healthy controls [J].Physiol Rep,2014,2(6):1-11

    • [14] WITTE C,MEYER Z H G M,ANDRIÉ R,et al.Heart rate variability and arrhythmic burden in pulmonary hy⁃ pertension[J].Adv Exp Med Biol,2016,934:9-22

    • [15] WONG Y Y,WESTERHOF N,RUITER G,et al.Systolic pulmonary artery pressure and heart rate are main deter⁃ minants of oxygen consumption in the right ventricular myocardium of patients with idiopathic pulmonary arterial hypertension[J].Eur J Heart Fail,2011,13(12):1290-1295

    • [16] CIARKA A,DOAN V,VELEZ ⁃ROA S,et al.Prognostic significance of sympathetic nervous system activation in pulmonary arterial hypertension[J].Am J Respir Crit Care Med,2010,181(11):1269-1275

    • [17] SARNARI R,KAMAL R Y,FRIEDBERG M K,et al.Doppler assessment of the ratio of the systolic to diastolic duration in normal children:relation to heart rate,age and body surface area[J].J Am Soc Echocardiogr,2009,22(8):928-932

    • [18] GOMEZ O,OKUMURA K,HONJO O,et al.Heart rate re⁃ duction improves biventricular function and interactions in experimental pulmonary hypertension[J].Am J Physi⁃ ol Heart Circ Physiol,2018,314(3):H542-H551

    • [19] MINAI O A,GUDAVALLI R,MUMMADI S,et al.Heart rate recovery predicts clinical worsening in patients with pulmonary arterial hypertension[J].Am J Respir Crit Care Med,2012,185(4):400-408

    • [20] BERSOHN M M,TURNER M P,TRAIGER G L,et al.Systemic BP and heart rate as prognostic indicators in pulmonary arterial hypertension[J].Chest,2013,144(3):959-965

    • [21] ISHII R,OKUMURA K,AKAZAWA Y,et al.Heart rate reduction improves right ventricular function and fibrosis in pulmonary hypertension[J].Am J Respir Cell Mol Bi⁃ ol,2020,63(6):843-855

    • [22] CORREALE M,BRUNETTI N D,MONTRONE D,et al.Functional improvement in pulmonary arterial hyperten⁃ sion patients treated with ivabradine[J].J Card Fail,2014,20(5):373-375

    • [23] CHANG S M,LIN C C,HSIAO S H,et al.Pulmonary hy⁃ pertension and left heart function:insights from tissue Doppler imaging and myocardial performance index[J].Echocardiography,2007,24(4):366-373

    • [24] VAN WOLFEREN S A,MARCUS J T,WESTERHOF N,et al.Right coronary artery flow impairment in patients with pulmonary hypertension[J].Eur Heart J,2008,29(1):120-127

    • [25] GÓMEZ A,BIALOSTOZKY D,ZAJARIAS A,et al.Right ventricular ischemia in patients with primary pulmonary hypertension[J].J Am Coll Cardiol,2001,38(4):1137-1142

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