通过心率变异性分析评估主动脉内球囊反搏对自主神经系统功能的影响。

Evaluation of effects of intra aortic balloon counterpulsation on autonomic nervous system functions by heart rate variability analysis.

作者信息

Ozdemir Ozcan, Alyan Omer, Kacmaz Fehmi, Kaptan Zekeriya, Ozbakir Cemal, Geyik Bilal, Cagirci Goksel, Soylu Mustafa, Demir Ahmet Duran

机构信息

Akay Hospital, Cardiology Department, Ankara, Turkey.

出版信息

Ann Noninvasive Electrocardiol. 2007 Jan;12(1):38-43. doi: 10.1111/j.1542-474X.2007.00136.x.

DOI:10.1111/j.1542-474X.2007.00136.x

PMID:17286649

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6932200/

Abstract

BACKGROUND

In patients with acute myocardial infarction (AMI), intraaortic balloon counterpulsation (IABC) may improve cardiac performance, decrease the incidence of recurrent ischemia, and improve survival. Although there have been several reports concerning circulatory maintenance with the IABC, response of the autonomic nervous system to these hemodynamic changes is not clear. Heart rate variability (HRV) analysis has been extensively used to evaluate autonomic modulation of sinus node and to identify patients at risk for an increased cardiac mortality. In this study, we evaluated effects of the IABC on autonomic nervous system functions by HRV analysis.

METHODS

The study group was composed of 32 consecutive patients (13 female, 19 male aged 61.8 +/- 8.8 years) undergoing IABC. Transthoracic echocardiography and 1-hour Holter recordings for HRV analysis in each IAB pumping mode were obtained.

RESULTS

The IABC improved left ventricular diastolic and systolic functions as well as caused an increase in SDNN1, PNN50(1), RMSSD1, and HF1 and a decrease in LF1, LF/HF1, mean heart rate, and the number of ventricular extrasystoles. The improvements in HRV parameters were correlated with some hemodynamic changes such as the increase in MAP and CO during counterpulsation. The only independent factors affecting in-hospital mortality were the change in LF/HF1 ratio (DeltaLF/HF1) and the change in the number of ventricular extrasystole (DeltaVES). The decrease in LF/HF1 > or = 4.9 decreased the mortality by 1.7-folds (RR = 0.6, P = 0.04, 95% CI: 0.1-2.3). The decrease in VES > or = 27/15 minutes resulted in mortality reduction by 16-folds (RR = 0.06, P = 0.02, 95% CI: 0.01-0.4).

CONCLUSIONS

As a result, the IABC, especially in 1:1 support, causes an increase in HRV, decrease in sympathetic overactivity, and improvement in sympathovagal balance besides the favorable hemodynamic changes, and these electrophysiologic changes may explain the role of the IABC in the treatment of ventricular arrhythmias.

摘要

背景

在急性心肌梗死（AMI）患者中，主动脉内球囊反搏（IABC）可改善心脏功能，降低再发缺血的发生率，并提高生存率。尽管已有多篇关于IABC维持循环的报道，但自主神经系统对这些血流动力学变化的反应尚不清楚。心率变异性（HRV）分析已被广泛用于评估窦房结的自主调节，并识别心脏死亡风险增加的患者。在本研究中，我们通过HRV分析评估了IABC对自主神经系统功能的影响。

方法

研究组由32例连续接受IABC的患者组成（13例女性，19例男性，年龄61.8±8.8岁）。在每种IAB泵血模式下，进行经胸超声心动图检查和1小时动态心电图记录以进行HRV分析。

结果

IABC改善了左心室舒张和收缩功能，同时导致SDNN1、PNN50(1)、RMSSD1和HF1增加，LF1、LF/HF1、平均心率和室性早搏数量减少。HRV参数的改善与一些血流动力学变化相关，如反搏期间MAP和CO的增加。影响住院死亡率的唯一独立因素是LF/HF1比值的变化（DeltaLF/HF1）和室性早搏数量的变化（DeltaVES）。LF/HF1降低≥4.9使死亡率降低1.7倍（RR = 0.6，P = 0.04，95%CI：0.1 - 2.3）。VES降低≥27/15分钟使死亡率降低16倍（RR = 0.06，P = 0.02，95%CI：0.01 - 0.4）。