Kuch Bernhard, Parvanov Toma, Hense Hans W, Axmann Joerg, Bolte Heinz D
Medizinische Klinik, Akademisches Lehrkrankenhaus der Ludwig Maximilians Universität München, Zentralklinikum Augsburg, Germany.
Ann Noninvasive Electrocardiol. 2004 Apr;9(2):113-20. doi: 10.1111/j.1542-474X.2004.92523.x.
Our aim was to compare the distribution and determinants of heart rate variability (HRV) measures in a middle-aged population with patients of the same sex and age after an acute myocardial infarction (AMI), and to show, whether HRV values defined as abnormal from the general population are indicative for a worse prognosis even in AMI patients.
HRV was studied in a random sample of 149 middle-aged men and 137 women from the general population (45-65 years) as well as 129 consecutive AMI patients (25-74 years). Spectral analysis was used to compute low frequency (LF), high frequency (HF), and total frequency power. To the AMI population of age 45-65 years (N = 85) a sample out of the general population was matched by age and sex by 2:1 matching (N = 149). All AMI patients were followed for a median of 43 months (range 1-47) for death or malignant arrhythmia.
All measures of HRV were significantly and substantially lower in AMI patients than the general population (P < 0.001). Expression in relative terms revealed that the proportionate contributions of HF and LF to total power were significantly different in the two populations with relatively lower LF power in AMI patients (P < 0.01). The negative correlation with heart rate and HRV measures was significantly more pronounced in AMI patients (P < 0.01). The 2.5th percentile of the LF power distribution in the general population (3.08 ln ms2) corresponds to the 25th percentile in the AMI population. Subjects of the whole AMI population with values below this LF cutpoint revealed a significant increased risk of death or malignant arrhythmia during follow-up (odds ratio 5.1; 95% confidence interval: 1.3; 23).
AMI patients had strongly diminished HRV compared to the general population. The relatively lower LF power indicates an alteration of the sympathico-vagal balance, and the significantly stronger correlation of heart rate with HRV may be indicative for a more pronounced effect of sympathetic activation on autonomic modulation in the case of myocardial infarction. Finally, a value below the 2.5th percentile of the population LF power distribution may identify subjects at risk and warrant further testing.
我们的目的是比较中年人群与急性心肌梗死（AMI）后同性和同龄患者心率变异性（HRV）测量值的分布及决定因素，并表明，从一般人群定义为异常的HRV值是否即使在AMI患者中也预示着更差的预后。
对来自一般人群（45 - 65岁）的149名中年男性和137名女性以及129例连续的AMI患者（25 - 74岁）的随机样本进行HRV研究。采用频谱分析计算低频（LF）、高频（HF）和总频率功率。对于年龄在45 - 65岁的AMI人群（N = 85），从一般人群中按年龄和性别以2:1匹配选取样本（N = 149）。所有AMI患者随访43个月（范围1 - 47个月），观察死亡或恶性心律失常情况。
AMI患者的所有HRV测量值均显著且大幅低于一般人群（P < 0.001）。相对表达显示，HF和LF对总功率的比例贡献在两组人群中显著不同，AMI患者的LF功率相对较低（P < 0.01）。AMI患者中，心率与HRV测量值的负相关性显著更强（P < 0.01）。一般人群中LF功率分布的第2.5百分位数（3.08 ln ms²）对应于AMI人群的第25百分位数。整个AMI人群中LF值低于此切点的受试者在随访期间死亡或发生恶性心律失常的风险显著增加（优势比5.1；95%置信区间：1.3；23）。
与一般人群相比，AMI患者的HRV明显降低。相对较低的LF功率表明交感 - 迷走神经平衡改变，心率与HRV之间显著更强的相关性可能表明在心肌梗死情况下交感神经激活对自主调节的影响更为显著。最后，低于人群LF功率分布第2.5百分位数的值可能识别出有风险的受试者，值得进一步检查。
