Leiza Jose Ramon Garmendia, de Llano Jesus Maria Andres, Messa Juan Bautista Lopez, Lopez Carlos Alberola, Fernandez Julio Ardura
Chronobiology Recognized Investigation Group, Universidad de Valladolid, Valladolid, Spain.
Chronobiol Int. 2007;24(1):129-41. doi: 10.1080/07420520601140027.
The aim of this study was to determine the existence of the circadian rhythm (CR) in the onset of acute myocardial infarction (AMI) in different patient subgroups. Information was collected about 41,244 infarctions from the database of the ARIAM (Analysis of Delay in AMI) Spanish multicenter study. CR in AMI were explored in subgroups of cases categorized by age, gender, previous ischemic heart disease (PIHD), outcome in coronary care unit, infarction electrocardiograph (ECG) characteristics (Q wave or non-Q wave), and location of AMI. Cases were classified according to these variables in the different subgroups. To verify the presence of CR, a simple test of equality of time series based on the multiple-sinusoid (24, 12, and 8 h periods) cosinor analysis was developed. For the groups as a whole, the time of pain onset as an indicator of the AMI occurrence showed a CR (p<0.0001), with a morning peak at 10:10 h. All the analyzed subgroups also showed CR. Comparison between subgroups showed significant differences in the PIHD (p<0.01) and infarction ECG characteristics (p<0.01) groups. The CR of the subgroup with Q-wave infarction differed from that of non-Q wave subgroup (p<0.01) when the patients had PIHD (23% in Q wave infarction vs. 39.2% in non-Q wave). AMI onset followed a CR pattern, which is also observed in all analyzed subgroups. Differences in the CR according to the Q/non-Q wave infarction characteristics could be determined by PIHD. The cosinor model fit with three components (24, 12, and 8 h periods) showed a higher sensitivity than the single 24 h period analysis.
本研究的目的是确定不同患者亚组中急性心肌梗死（AMI）发病时昼夜节律（CR）的存在情况。从西班牙多中心ARIAM（急性心肌梗死延迟分析）研究数据库中收集了41244例梗死病例的信息。在按年龄、性别、既往缺血性心脏病（PIHD）、冠心病监护病房结局、梗死心电图（ECG）特征（Q波或非Q波）以及AMI部位分类的病例亚组中探讨了AMI中的CR。根据这些变量将病例分类到不同亚组中。为了验证CR的存在，开发了一种基于多正弦（24、12和8小时周期）余弦分析的时间序列平等性简单测试。对于总体组而言，表示AMI发生的疼痛发作时间显示出昼夜节律（p<0.0001），上午10:10出现峰值。所有分析的亚组也显示出昼夜节律。亚组间比较显示，PIHD组（p<0.01）和梗死ECG特征组（p<0.01）存在显著差异。当患者患有PIHD时，Q波梗死亚组的昼夜节律与非Q波亚组不同（Q波梗死中为23%，非Q波中为39.2%，p<0.01）。AMI发病遵循昼夜节律模式，在所有分析的亚组中均有观察到。根据Q/非Q波梗死特征的昼夜节律差异可由PIHD确定。与单24小时周期分析相比，拟合三个成分（24、12和8小时周期）的余弦模型显示出更高的敏感性。
