Buchhorn Reiner, Hulpke-Wette Martin, Nothroff Jörg, Paul Thomas
Department of Pediatric Cardiology, Georg-August-University, Göttingen, Germany.
Med Sci Monit. 2002 Oct;8(10):CR661-6.
Analysis of heart rate variability (HRV) provides a noninvasive index of autonomic nervous system activity. HRV has shown to be reduced in congestive heart failure and in children with congenital heart disease (CHD). Beta-blockers improve HRV in adults with congestive heart failure, but this improvement remains to be demonstrated in children.
MATERIAL/METHODS: HRV was analysed in 14 infants with severe heart failure due to CHD who received a 'standard' therapy with digoxin and diuretics ('Digoxin/Diuretics' group) and in 9 of these patients with an additional propranolol therapy ('Propranolol' group) 17 days later on average and compared with HRV of 70 healthy infants ('Healthy Control').
Comparing the 'Digoxin/Diuretics' group versus 'Healthy Control', we found significantly reduced HRV in the time domain and the frequency domain, that could be abolished in the 'Propranolol' group. None of the HRV parameter were significantly related to age or any hemodynamic parameter but inversely related to ejection fractions within the normal range (pNN50: r= -0.58, p=0.004; rMSSD: r= -0.42; p=0.049). HRV measurements (SDNN, r= -0.48) and plasma norepinephrine levels (r=0.7) were significantly related to clinical symptoms of heart failure, measured by the Ross Score.
HRV represents a noninvasive parameter that is reduced in infants with congenital heart disease depending on the severity of heart failure but not on hemodynamic disturbances. Propranolol but not digoxin therapy effectively reduced the supposed autonomic imbalance in infants with severe heart failure due to CHD.
心率变异性（HRV）分析提供了一种自主神经系统活动的无创指标。已表明在充血性心力衰竭患者以及患有先天性心脏病（CHD）的儿童中HRV降低。β受体阻滞剂可改善充血性心力衰竭成人患者的HRV，但这种改善在儿童中仍有待证实。
材料/方法：对14例因CHD导致严重心力衰竭且接受地高辛和利尿剂“标准”治疗的婴儿（“地高辛/利尿剂”组）以及其中9例在平均17天后额外接受普萘洛尔治疗的患者（“普萘洛尔”组）的HRV进行分析，并与70例健康婴儿（“健康对照”）的HRV进行比较。
将“地高辛/利尿剂”组与“健康对照”组进行比较，我们发现在时域和频域中HRV显著降低，而在“普萘洛尔”组中这种降低可以消除。没有任何HRV参数与年龄或任何血流动力学参数显著相关，但与正常范围内的射血分数呈负相关（pNN50：r = -0.58，p = 0.004；rMSSD：r = -0.42；p = 0.049）。HRV测量值（SDNN，r = -0.48）和血浆去甲肾上腺素水平（r = 0.7）与通过罗斯评分衡量的心力衰竭临床症状显著相关。
HRV是一种无创参数，在患有先天性心脏病的婴儿中会根据心力衰竭的严重程度而降低，但与血流动力学紊乱无关。普萘洛尔而非地高辛治疗可有效减轻因CHD导致严重心力衰竭婴儿中假定的自主神经失衡。
