Rosas-Peralta Martin, Sandoval-Zárate Julio, Attie Fause, Pulido Tomás, Santos Efrén, Granados Nuria Z, Miranda Teresa, Escobar Verónica
Departamento de Investigación Cardiopulmonar, Instituto Nacional de Cardiología Ignacio Chávez, México, DF México.
Gac Med Mex. 2006 Jan-Feb;142(1):19-28.
A reduction of heart rate variability (HRV) is currently considered an independent risk factor for morbidity, mortality and severity of severalcardiac disease, however, the dynamic sympathovagal modulation on HRV during 24 hr in primary pulmonary hypertension (PPH) had not been described.
24 hr Holter monitoring (HA) were recorded in 32 patients (mean age 34, +/-12, 90% female) with severe primary pulmonary hypertension (mean pulmonary pressure, 90:t:12 mm Hg), and in 34 patients (mean age 36 +/-14, 60% female) with Eisenmenger syndrome (ES) secondary to septal ventricular defect or atent ductus arteriosus. A control group (n=44) paired for age, gender and arterial pulmonary pressure was included. HRV time and spectral parameters (mean, SDNN, SDANN, rMSSD, PNN50, LF, HF and LF/HF ratio) were analyzed during three periods: 24 hr; day (8-22:00), night (23-07:00) and also every hour of recording at 5 min-intervals). After detection of sympatho-vagal balance 15 patients were randomized, Treprostinil (prostaglandin) was administered to 6 patients and subcutaneous placebo to 9.
HRV frequency parameters during 24 hr HM were significantly different among groups. LF/HF (day) 5.9:1:12.5:1:1P.001 and LF/HF night) 2.8:tlvs.1.5:l:.8.034. Sympathovagal modulation on 24 hr HRV showed that heart rate circadian rhythm is clearly altered in both PPH and ES, but the sympathetic tone in PPH is higher at l 24 hr. (p < .05), after administering treprostinil a recovery of sympathovagal balance was observed
Autonomic cardiac disturbance is clearly present in PPH and ES. The circadian rhythm of HRV is first lost due to an increase of sympathetic tone. These changes may be markers of autonomic disbalance that favor the development of arrhythmias and sudden death. The sympathovagal balance in PPH could be considered an important risk marker.
心率变异性（HRV）降低目前被认为是多种心脏疾病发病、死亡和严重程度的独立危险因素，然而，原发性肺动脉高压（PPH）患者24小时内HRV的动态交感迷走神经调节尚未见报道。
对32例重度原发性肺动脉高压患者（平均年龄34岁，±12岁，90%为女性，平均肺动脉压90±12mmHg）和34例继发于室间隔缺损或动脉导管未闭的艾森曼格综合征（ES）患者（平均年龄36±14岁，60%为女性）进行24小时动态心电图监测（HA）。纳入一组按年龄、性别和动脉肺动脉压配对的对照组（n = 44）。分析HRV的时间和频谱参数（平均值、SDNN、SDANN、rMSSD、PNN50、LF、HF和LF/HF比值）在三个时间段的数据：24小时；白天（8:00 - 22:00）、夜间（23:00 - 07:00）以及记录过程中每隔5分钟的每小时数据。在检测到交感迷走神经平衡后，将15例患者随机分组，6例患者给予曲前列尼尔（前列腺素），9例患者给予皮下安慰剂。
24小时动态心电图监测期间，各组的HRV频率参数存在显著差异。LF/HF（白天）5.9±1.2 vs. 12.5±1.1，P <.001；LF/HF（夜间）2.8±0.8 vs. 1.5±0.8，P =.034。24小时HRV的交感迷走神经调节显示，PPH和ES患者的心率昼夜节律均明显改变，但PPH患者24小时的交感神经张力更高（p <.05），给予曲前列尼尔后观察到交感迷走神经平衡恢复。
PPH和ES患者明显存在自主神经功能紊乱。HRV的昼夜节律首先因交感神经张力增加而丧失。这些变化可能是自主神经失衡的标志，有利于心律失常和猝死的发生。PPH患者的交感迷走神经平衡可被视为一个重要的风险标志物。
