Kawasaki T, Azuma A, Kuribayashi T, Taniguchi T, Asada S, Kamitani T, Kawasaki S, Matsubara H, Sugihara H
Department of Cardiology, Matsushita Memorial Hospital, Osaka 570-8540, Japan.
Heart. 2006 Mar;92(3):325-30. doi: 10.1136/hrt.2005.063230. Epub 2005 Jun 6.
To determine whether the Bezold-Jarisch reflex or enhancement of vagal nerves, which are preferentially distributed in the inferoposterior myocardium, results from exercise induced ischaemia in this region.
On the basis of exercise myocardial scintigraphy and coronary angiography, 145 patients were classified as follows: group I, 34 patients with inferoposterior ischaemia; group A, 32 with anterior ischaemia; and control, 79 without ischaemia. The relation between ischaemic areas and ECG leads with ST segment changes and vagal modulation assessed by heart rate variability (HRV) (high frequency (HF) component (0.15-0.40 Hz) and coefficient of HF component variance (CCVHF), which is the square root of HF divided by mean RR interval) were assessed.
The rate of ST segment depression in any lead did not differ between group I and group A. HF and CCV(HF) were similar before exercise but higher in group I than in group A and the control group after exercise (mean (SEM) HF: 94 (17) ms2, 41 (7) ms2, and 45 (6) ms2, respectively, p = 0.021; CCV(HF): 1.18 (0.09)%, 0.81 (0.07)%, and 0.89 (0.05)%, p = 0.0053). Furthermore, the percentage change in CCV(HF) before and after exercise was higher in group I than in group A or controls (mean (SEM) 22 (10)%, -24 (4)%, and -21 (3)%, p < 0.0001). The optimal cut off for diagnosis of inferoposterior ischaemia was -5% with a sensitivity of 74%, specificity 75%, and accuracy 75%.
Vagal modulation as assessed by HRV analysis was enhanced in association with exercise induced inferoposterior ischaemia. Exercise ECG testing combined with HRV analysis would increase accuracy in the diagnosis of ischaemic areas in selected patients with angina pectoris.
确定贝佐尔德-雅里什反射或迷走神经增强（迷走神经优先分布于心肌下后壁）是否由该区域运动诱发的缺血所致。
基于运动心肌闪烁显像和冠状动脉造影，将145例患者分类如下：I组，34例下后壁缺血患者；A组，32例前壁缺血患者；对照组，79例无缺血患者。评估缺血区域与出现ST段改变的心电图导联之间的关系，以及通过心率变异性（HRV）评估的迷走神经调节（高频（HF）成分（0.15 - 0.40Hz）和HF成分方差系数（CCVHF），即HF除以平均RR间期的平方根）。
I组和A组在任何导联中ST段压低的发生率无差异。运动前HF和CCV（HF）相似，但运动后I组高于A组和对照组（均值（标准误）HF：分别为94（17）ms²、41（7）ms²和45（6）ms²，p = 0.021；CCV（HF）：1.18（0.09）%、0.81（0.07）%和0.89（0.05）%，p = 0.0053）。此外，I组运动前后CCV（HF）的百分比变化高于A组或对照组（均值（标准误）22（10）%、 - 24（4）%和 - 21（3）%，p < 0.0001）。诊断下后壁缺血的最佳截断值为 - 5%，敏感性为74%，特异性为75%，准确性为75%。
通过HRV分析评估的迷走神经调节与运动诱发的下后壁缺血相关增强。运动心电图测试结合HRV分析可提高对特定心绞痛患者缺血区域诊断的准确性。
