恰加斯病患者心率分形动力学异常。
Abnormalities in fractal heart rate dynamics in Chagas disease.
作者信息
de Sousa Marcos Roberto, Huikuri Heikki V, Lombardi Federico, Perez Amanda A, Gomes Murilo E D, Barros Marcio Vinícius Lins, Barros Vladimir Costa Val, Rocha Manoel Otávio Costa, Ribeiro Antonio Luiz Pinho
机构信息
Hospital das Clínicas and Internal Medicine Department, School of Medicine, Federal University of Minas Gerais, Minas Gerais, Brazil.
出版信息
Ann Noninvasive Electrocardiol. 2006 Apr;11(2):145-53. doi: 10.1111/j.1542-474X.2006.00096.x.
BACKGROUND AND METHODS
In order to study fractal HR dynamics in Chagas disease, we performed detrended fluctuation analysis (DFA)-along with analysis of power-law beta slope (beta index) and standard deviation of N-N intervals (SDNN)-in edited and unedited (with ventricular premature beats - VPBs, only in DFA analysis) series of R-R intervals from Holter monitoring of healthy controls (Group 0, n = 27) and Chagas disease patients with left ventricular (LV) ejection fraction >50% (Group 1, n = 137) and with LV ejection fraction <50% (Group 2, n = 23).
RESULTS
When analyzed from the edited R-R interval data, the long-term scaling exponent alpha(2) is altered both among the Chagas patients with and without LV dysfunction. The short-term scaling exponent alpha(1) was higher in Group 1 Chagas patients as compared to controls (P < 0.01) and did not differ between Group 2 and controls. In unedited R-R interval series, alpha(1) was significantly reduced in Group 2 Chagas patients (0.55 +/- 0.002) as compared to controls (0.90 +/- 0.002) and Group 1 (0.91 +/- 0.003) (P < 0.001), but did not differ between Group 1 and controls. Similarly alpha(2) was lower in Group 2 compared to other groups (P < 0.001). SDNN did not differ between the groups, but the beta index derived from 1/f model was reduced both in Group 1 and 2 Chagas patients as compared to controls (P < 0.01). There was strong correlation (rs = 0.82; P < 0.001) between the beta and alpha(2) index from edited series. There was an inverse correlation (rs =-0.63, P < 0.01) between the number of VPBs and alpha(1) index of unedited series.
CONCLUSIONS
The long-term fractal HR dynamics altered in chagasic patients with and without LV dysfunction could be an early sign of autonomic dysfunction. Patients with impaired LV function show marked alterations in short-term fractal HR dynamics toward more random behavior, mainly due to frequent ectopy. Prospective studies are necessary to define the value of these indices as predictors of death in Chagas disease.
背景与方法
为研究恰加斯病的分形心率动力学，我们对健康对照组（0组，n = 27）、左心室射血分数>50%的恰加斯病患者（1组，n = 137）和左心室射血分数<50%的恰加斯病患者（2组，n = 23）动态心电图监测的R-R间期系列进行了去趋势波动分析（DFA），同时分析了幂律β斜率（β指数）和N-N间期标准差（SDNN），其中1组和2组分析的是编辑后的R-R间期系列，2组还分析了未编辑的（包含室性早搏——VPB，仅用于DFA分析）R-R间期系列。
结果
从编辑后的R-R间期数据分析，有无左心室功能障碍的恰加斯病患者的长期标度指数α(2)均发生改变。1组恰加斯病患者的短期标度指数α(1)高于对照组（P < 0.01），2组与对照组无差异。在未编辑的R-R间期系列中，2组恰加斯病患者的α(1)显著低于对照组（0.55±0.002）和1组（0.91±0.003）（P < 0.001），1组与对照组无差异。同样，2组的α(2)低于其他组（P < 0.001）。各组间SDNN无差异，但1组和2组恰加斯病患者的1/f模型衍生的β指数低于对照组（P < 0.01）。编辑后系列的β指数与α(2)指数之间存在强相关性（rs = 0.82；P < 0.001）。未编辑系列的VPB数量与α(1)指数呈负相关（rs = -0.63，P < 0.01）。
结论
有无左心室功能障碍的恰加斯病患者长期分形心率动力学改变可能是自主神经功能障碍的早期迹象。左心室功能受损患者的短期分形心率动力学表现为向更随机行为的明显改变，主要是由于频发异位搏动。有必要进行前瞻性研究以确定这些指标作为恰加斯病死亡预测指标的价值。
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