高血压患者不同类型心脏重塑中心率变异性的功率谱成分

Power spectral components of heart rate variability in different types of cardiac remodelling in hypertensive patients.

作者信息

Konrady A O, Rudomanov O G, Yacovleva O I, Shlyakhto E V

机构信息

Department of Faculty Therapy, St. Petersburg Pavlov State Medical University, 6/8 Lev Tolstoy st., St. Petersburg 197089, Russia.

出版信息

Med Sci Monit. 2001 Jan-Feb;7(1):58-63.

PMID:11208494

Abstract

BACKGROUND

The aim of the study was to evaluate whether there are any significant differences in cardiac autonomic regulation in distinct types of hypertensive cardiac remodelling.

MATERIAL AND METHODS

We examined 86 patients with mild to moderate essential hypertension (EH). The parameters of left ventricle (LV) were measured by echocardiography: the diastolic mass normalized for body surface area (LVMI) and relative wall thickness (RWT). All patients were divided into three groups: normal LV geometry (23), concentric left ventricular hypertrophy (LVH) (29) and eccentric LVH (34). The control group included 30 age and sex-matched healthy volunteers. For calculation of heart rate variability (HRV) 512 RR intervals in supine rest and passive tilt were measured. Power spectral analysis with fast Furrier transform was used to obtain the total power, low frequency (LF) power (from 0.003 to 0.14 Hz), high frequency (HF) power (from 0.15 to 0.40 Hz) and sympathovagal index (SVI) as LF:HF ratio.

RESULTS

The parameters of HRV did not differ significantly among the groups studied. In the group with normal LV geometry there was observed a good response to tilt test resulting in an increase of SVI in three times (from 2.4 +/- 0.3 to 7.2 +/- 0.4), while in patients with both types of LVH there were no significant changes in SVI or even an inverse reaction to passive tilt. In the group with normal geometry patients with higher meanings of RWT had higher LF power (r = 0.52, p < 0.01), while in patients with LVH the increasement of LVMI and RWT was associated with reduction of HRV (rr = -0.43, -0.36, p < 0.05, respectively).

CONCLUSIONS

Heart rate variability is significantly reduced in essential hypertension and is also closely connected with cardiac structure and function. Patients with normal LV geometry are characterized by a preserved response to tilt test. LVH produce significant disturbances of autonomic regulation possibly due to lower sensitivity of cardiac adrenoreceptors independently of the LVH pattern.

摘要

背景

本研究旨在评估不同类型高血压性心脏重塑患者的心脏自主神经调节是否存在显著差异。

材料与方法

我们检查了86例轻度至中度原发性高血压（EH）患者。通过超声心动图测量左心室（LV）参数：体表面积标准化的舒张期质量（LVMI）和相对壁厚度（RWT）。所有患者分为三组：正常左心室几何形态组（23例）、同心性左心室肥厚（LVH）组（29例）和偏心性LVH组（34例）。对照组包括30名年龄和性别匹配的健康志愿者。在仰卧休息和被动倾斜时测量512个RR间期以计算心率变异性（HRV）。采用快速傅里叶变换进行功率谱分析，以获取总功率、低频（LF）功率（0.003至0.14Hz）、高频（HF）功率（0.15至0.40Hz）以及交感迷走神经指数（SVI，即LF:HF比值）。

结果

所研究的各组之间HRV参数无显著差异。在左心室几何形态正常的组中，观察到对倾斜试验有良好反应，导致SVI增加了三倍（从2.4±0.3增至7.2±0.4），而在两种类型LVH的患者中，SVI无显著变化，甚至对被动倾斜有反向反应。在几何形态正常的组中，RWT值较高的患者LF功率较高（r = 0.52，p < 0.01），而在LVH患者中，LVMI和RWT的增加与HRV降低相关（分别为rr = -0.43，-0.36，p < 0.05）。