[特发性扩张型心肌病中血压与心率的改良相互作用]

Leder U, Baumert M, Liehr M, Schirdewan A, Figulla H R, Voss A

Klinik für Innere Medizin III, Klinikum der Universität Jena.

Biomed Tech (Berl). 2002 Jun;47(6):151-4. doi: 10.1515/bmte.2002.47.6.151.

BACKGROUND

Neurovegetative and haemodynamic changes impact on the regulation pattern of blood pressure and heart rate in patients with heart failure. We studied these patterns and their interactions in patients with idiopathic dilated cardiomyopathy (IDC) and in healthy subjects (REF).

METHODS

We continually measured the heart rate and blood pressure (Portapres device) in twenty-five supine IDC patients (age: 51 +/- 13 y; left ventricular end-diastolic diameter 67 +/- 11 mm; ejection fraction 30 +/- 11%) and in twenty-seven REF (age: 50 +/- 11 y) Recording time was 30 minutes. The heart rate (HR) of each beat and the systolic blood pressure (SYS) of the subsequent beat were measured. Code numbers (symbols) were assigned to the beat-to-beat changes in HR and SYS (increase: 1; decrease: 0). The frequencies of the symbols sequences of three successive beats were counted. In this way we obtained a matrix consisting of eight (two to the power of three) HR and SYS combinations: 000, 100, 010, 001, 111, 110, 011 and 101. We then counted the frequencies of the different combinations of the symbol sequences in HR and SYS (2(3) x 2(3) = 64 combinations). The relative frequencies of symbol patterns appearing in HR, SYS and in the combined analysis of HR and SYS, were compared for IDC and REF using the T-test for independent samples.

RESULTS

Significant differences were seen between IDC and REF. The HR patterns 101 and 010 were more frequent in IDC than in REF patients (11.1 +/- 4.7 vs. 7.7 +/- 2.9%, p = 0.003, and 16.1 +/- 6.3 vs. 11.7 +/- 4.9%, p = 0.008). This finding was even more marked in the analysis of the SYS patterns 101 and 010 (11.0 +/- 7.4 vs. 8.2 +/- 2.9%, p < 0.001, and 11.6 +/- 7.4 vs. 5.4 +/- 2.7%, p < 0.001). Non-alternating patterns were more frequent in REF (e.g. 000HR & 111SYS: 4.6 +/- 3.3 vs. 2.9 +/- 2.4%, p = 0.03).

CONCLUSIONS

We demonstrated significant interaction of the regulation patterns of blood pressure and heart rate, as also their interactions in IDC. Opposed changes in HR and SYS mediated by the baroreflex, became superimposed by alternans phenomena in IDC. The pattern analysis of changes in HR and SYS detects these disturbances of neurovegetative short-term control.

背景

神经植物性和血流动力学变化影响心力衰竭患者的血压和心率调节模式。我们研究了特发性扩张型心肌病（IDC）患者和健康受试者（REF）的这些模式及其相互作用。

方法

我们连续测量了25例仰卧位IDC患者（年龄：51±13岁；左心室舒张末期直径67±11mm；射血分数30±11%）和27例REF（年龄：50±11岁）的心率和血压（Portapres设备）。记录时间为30分钟。测量每搏的心率（HR）和随后搏动的收缩压（SYS）。为HR和SYS的逐搏变化分配代码编号（符号）（增加：1；减少：0）。计算三个连续搏动的符号序列的频率。通过这种方式，我们获得了一个由八个（2的三次幂）HR和SYS组合组成的矩阵：000、100、010、001、111、110、011和101。然后我们计算了HR和SYS中符号序列的不同组合的频率（2³×2³ = 64种组合）。使用独立样本t检验比较IDC和REF中HR、SYS以及HR和SYS联合分析中出现的符号模式的相对频率。

结果

IDC和REF之间存在显著差异。IDC患者中HR模式101和010比REF患者更频繁（11.1±4.7对7.7±2.9%，p = 0.003，以及16.1±6.3对11.7±4.9%，p = 0.008）。在SYS模式101和010的分析中这一发现更为明显（11.0±7.4对8.2±2.9%，p < 0.001，以及11.6±7.4对5.4±2.7%，p < 0.001）。REF中无交替模式更频繁（例如000HR & 111SYS：4.6±3.3对2.9±2.4%，p = 0.03）。