武汉云克隆科技股份有限公司

Abstract

Objective: Psychological factors have been related to poor outcome in patients with heart failure. Pathophysiological mechanisms explaining this link may include the cardiovascular response to acute mental stress. The current study examined whether heart rate and blood pressure responses to acute mental stress predicted mortality in patients with chronic heart failure.

Methods: Patients with HF (N=100, 26% female, mean age 65±12 years) underwent a public speech task, during which heart rate (HR) and blood pressure (BP) were recorded. Their all cause mortality status was assessed 4.8 years thereafter. Heart rate reactivity was recoded into high, low, and negative responsiveness based on the 25th (bpm ≤0) and 75th (>6 bpm) percentile. Blood pressure reactivity was recoded in high (>12.1 mmHg), medium (2.3-12.1 mmHg) and low (<2.3 mmHg) responsiveness based on the 25th and 75th percentile. The following covariates were added to the Cox proportional hazards regression: gender, left ventricular ejection fraction, use of beta blocking agents (HR), use of ACEi/ARB medication (BP), and presence of implanted devices. A p value of <.10 was considered of interest, due to the limited sample size.

Results: At follow-up, 31 patients had died (31%), of whom 15 from cardiac causes. Results from the Cox proportional hazards regression showed that blunted HR reactivity (between 0.5-6 bpm; HR=2.3, 95% CI=0.9-6.2, p=.09) and low diastolic BP reactivity (HR=3.1, 95% CI=1.3-7.9, p=.02) were significantly associated with an increased risk of mortality in HF independent of included covariates (all ns, except ACEi/ARB use (HR=0.3, 95% CI=0.1-0.8, p=.02)). SBP reactivity was not significantly related to future mortality risk.

Conclusion: In this preliminary study, low heart rate and diastolic blood pressure reactivity to acute mental stress were independent associates of all cause mortality in patients with chronic heart failure. The observed blunted autonomic and hemodynamic response to mental stress is in accordance with physical stress reactivity. These findings call for replication by larger studies that also should examine whether mental stress reactivity is a mediator in the relation between psychological risk factors and adverse cardiac outcomes.

摘要

目的：心理因素与心力衰竭患者的预后不良有关。用病理生理学机制解释，这种联系可能包括心血管对急性精神压力的反应。目前的研究检测了心率和血压对急性精神压力的反应是否预示了慢性心力衰竭患者的死亡率。

方法：让心力衰竭患者（N=100，26%为女性，平均年龄为65±12岁）进行公开演讲，在此期间，记录了心率（HR）和血压（BP）。在那之后的4.8年，评估他们的所有死因。根据心率的第25（bpm ≤0）和第75（>6 bpm）百分比，分别将心率反应判为高、低和没有影响。基于第25和第75百分位数，判定血压的反应性为高（>12.1 mmHg）、中（2.3-12.1 mmHg）和低（<2.3 mmHg）反应性。在Cox比例风险回归模型中加入了以下协变量：性别、左心室射血分数、使用beta阻断剂（心率）、使用ACEi/ARB药物（血压）、以及存在植入设备。由于样本量有限，p值小于0.1就认为是有差异的。

结果：在随访中，31例患者死亡（31%），其中15例为心脏原因导致的。Cox比例风险回归结果显示，独立于包含的协变量（所有的都差异不显著，除了使用ACEi/ARB药物（HR=0.3，95%CI=0.1-0.8，p=0.02）），迟钝的心率反应（在0.5-6 bpm之间；HR=2.3，95%CI=0.9-6.2，p=0.09）和低心脏舒张血压反应性（HR=3.1，95%CI=1-7.9，p=0.02）与心力衰竭患者高风险的死亡率有显著的相关性。SBP的反应性与未来的死亡风险没有显著关系。

结论：根据我们的初步研究，低心率和舒张压对急性精神压力的反应与慢性心力衰竭患者的死因独立关联。观察到的对精神压力迟钝自主的和血流动力学的反应与身体的应激反应是一致的。这些发现需要更多的研究来进一步证明，这些研究也应该检测精神压力反应是否是心理风险因素与不良心脏预后之间的中介。