Musialik-Łydka Agata, Sredniawa Beata, Pasyk Stanisław
Department of Cardiology, Silesian Medical Academy, Silesian Centre for Heart Diseases, Zabrze, Poland.
Kardiol Pol. 2003 Jan;58(1):10-6.
Heart rate variability (HRV) depicts the functional status of the autonomic nervous system and its effects on sinus node. Recently, HRV analysis has been introduced in patients with heart failure (CHF) to identify those who are at risk of cardiac death.
To analyse HRV in patients with CHF with depressed left ventricular ejection fraction (EF) and to relate HRV parameters to EF, NYHA functional class and other clinical parameters.
The study group consisted of 105 patients with CHF (88 males, 17 females, mean age 54+/-12 years); 77 patients had ischaemic cardiomyopathy, and 28 - dilated cardiomyopathy. All patients were in NYHA class II-IV and had EF <40%. The mean value of echocardiographically assessed EF was 26.9+/-8.3%. The control group consisted of 30 gender- and age-matched healthy subjects. HRV analysis was performed in the time-domain from 24-hour Holter ECG.
All HRV variables were significantly lower in patients with CHF than in controls. Patients with NYHA class II had higher values of SDNN and SDANN than those in class III or IV. Patients with sustained or non-sustained ventricular tachycardia (VT) detected during Holter monitoring had lower SDNN and SDANN values than those without VT. Patients with diabetes had significantly lower SDNN and rMSSD values than the patients without diabetes. Similar results were found when patients with or without hypertension were compared. HRV parameters were similar in patients either with ischaemic or dilated cardiomyopathy. Also the values of EF were similar (27.4+/-8.4 vs 25.0+/-8.3%, respectively, NS). In the whole group of patients with CHF the values of SDNN and SDANN significantly correlated with EF (SDNN p<0.001, r=0.42; SDANN p<0.001, r=0.51). This correlation was stronger in the subset of patients with ischaemic cardiomyopathy (SDNN p=0.002. r=0.54; SDANN p=0.002; r=0.53) than in those with dilated cardiomyopathy (SDNN p=0.012, r=0.23; SDANN p=0.008, r=0.42). A significant negative correlation was found between all HRV parameters and NYHA class (SDNN p<0.001, r = -0.33; SDANN p<0.001, r = -0.38; rMSSD p<0.001, r = -0.13).
HRV is depressed in patients with CHF compared with healthy subjects. Among patients with CHF, HRV is further decreased in patients with more advanced NYHA class, lower EF and in those with diabetes, hypertension or VT on Holter monitoring.
心率变异性（HRV）描述了自主神经系统的功能状态及其对窦房结的影响。最近，HRV分析已被引入心力衰竭（CHF）患者中，以识别有心脏死亡风险的患者。
分析左心室射血分数（EF）降低的CHF患者的HRV，并将HRV参数与EF、纽约心脏协会（NYHA）功能分级及其他临床参数相关联。
研究组由105例CHF患者组成（88例男性，17例女性，平均年龄54±12岁）；77例患者患有缺血性心肌病，28例患有扩张型心肌病。所有患者均处于NYHA II-IV级，且EF<40%。经超声心动图评估的EF平均值为26.9±8.3%。对照组由30名年龄和性别匹配的健康受试者组成。通过24小时动态心电图在时域内进行HRV分析。
CHF患者的所有HRV变量均显著低于对照组。NYHA II级患者的SDNN和SDANN值高于III级或IV级患者。在动态监测期间检测到持续性或非持续性室性心动过速（VT）的患者，其SDNN和SDANN值低于无VT的患者。糖尿病患者的SDNN和rMSSD值显著低于无糖尿病的患者。比较有或无高血压的患者时也发现了类似结果。缺血性或扩张型心肌病患者的HRV参数相似。EF值也相似（分别为27.4±8.4%和25.0±8.3%，无显著性差异）。在整个CHF患者组中，SDNN和SDANN值与EF显著相关（SDNN p<0.001，r=0.42；SDANN p<0.001，r=0.51）。这种相关性在缺血性心肌病患者亚组中比在扩张型心肌病患者中更强（SDNN p=0.002，r=0.54；SDANN p=0.002，r=0.53）（SDNN p=0.012，r=0.23；SDANN p=0.008，r=0.42）。在所有HRV参数与NYHA分级之间发现显著的负相关（SDNN p<0.001，r = -0.33；SDANN p<0.001，r = -0.38；rMSSD p<0.001，r = -0.13）。
与健康受试者相比，CHF患者的HRV降低。在CHF患者中，NYHA分级更高、EF更低以及动态监测时有糖尿病、高血压或VT的患者，其HRV进一步降低。
