Weinrauch Larry A, Berger Andrew J, Aronson Doron, Gleason Ray E, Lee Annette T, D'Elia John A
Joslin Diabetes Center, Boston, Mount Auburn Hospital, and Harvard Medical School, Cambridge, MA, USA.
J Clin Hypertens (Greenwich). 2006 May;8(5):330-5. doi: 10.1111/j.1524-6175.2005.04771.x.
Both left ventricular (LV) hypertrophy and decreased autonomic function are predictors of adverse cardiac events. Patients with diabetic nephropathy have an excess cardiovascular risk. The authors determined heart rate variability from 24-hour ambulatory electrocardiographic recordings and measures of LV mass with systolic and diastolic function from echocardiograms. Patients with diabetic nephropathy (n=16) were seen weekly for insulin and hypertension management. Glycohemoglobin decreased from 9.5+/-0.4% to 8.3+/-0.4% (p=0.01), and advanced glycated end products decreased from 12.1+/-2.2 to 7.4+/-1.2 units (p=0.03). Mean arterial pressure and body weight did not change. Serum creatinine increased (1.8+/-0.1 mg/dL to 2.0+/-0.2 mg/dL; p=0.03). The authors used a panel of markers of baseline heart rate variation to assess autonomic function. When covariance of the heart rate interval results were evaluated, the group below the median was found to have a significant decrease in LV mass, from 230 g to 184 g (p=0.013); the group above the median had an increase (182 g to 193 g; p=0.5329). Baseline covariance of the heart rate interval predicted 12-month changes in LV mass in 13 of 16 patients (predictive accuracy, 81%). Improvement in measures of heart rate variation correlated with a decrease in LV mass. Parallel improvement of LV mass and autonomic function suggests a common mechanism, allowing for prediction of LV mass improvement through analysis of baseline heart rate variation.
左心室肥厚和自主神经功能减退均为不良心脏事件的预测因素。糖尿病肾病患者存在额外的心血管风险。作者通过24小时动态心电图记录测定心率变异性，并通过超声心动图测量左心室质量及收缩和舒张功能。糖尿病肾病患者（n = 16）每周就诊进行胰岛素和高血压管理。糖化血红蛋白从9.5±0.4%降至8.3±0.4%（p = 0.01），晚期糖基化终产物从12.1±2.2降至7.4±1.2单位（p = 0.03）。平均动脉压和体重未发生变化。血清肌酐升高（1.8±0.1mg/dL至2.0±0.2mg/dL；p = 0.03）。作者使用一组基线心率变异性标志物评估自主神经功能。在评估心率间期结果的协方差时，发现中位数以下组的左心室质量显著降低，从230g降至184g（p = 0.013）；中位数以上组有所增加（182g至193g；p = 0.5329）。16例患者中有13例心率间期的基线协方差可预测左心室质量的12个月变化（预测准确性为81%）。心率变异性测量的改善与左心室质量的降低相关。左心室质量和自主神经功能的平行改善提示存在共同机制，使得通过分析基线心率变异性可预测左心室质量的改善。
