Goernig Matthias, Schroeder Rico, Roth Tino, Truebner Sandra, Palutke Ingo, Figulla Hans R, Leder Uwe, Voss Andreas
Clinic Internal Medicine I, University of Jena, Jena, Germany.
Pacing Clin Electrophysiol. 2008 Jul;31(7):858-62. doi: 10.1111/j.1540-8159.2008.01100.x.
Autonomic regulation analysis is useful in risk stratification of ventricular tachycardia and sudden cardiac death in chronic heart failure (CHF). Heart rate variability (HRV) reflects the condition of autonomic regulation. For analyzing the autonomic control the whole cardiovascular system has to be considered. Therefore, the aim of our study was to assess the influence of peripheral arterial disease (PAD) on the autonomic regulation.
In 53 men (age: 67 +/- 11 years) from the cardiovascular unit we compared standard HRV parameters in 27 with (ankle brachial index, ABI < 0.9) and 26 patients without (ABI >0.9) PAD as well as with 12 healthy subjects as reference. High-resolution electrocardiograms were recorded over 30 minutes under resting conditions. Pulse wave velocity as well as ABI was estimated using the vascular screening system VASERA.
In cardiac patients with PAD, we found both significant differences in linear and nonlinear HRV parameters. Higher increase of low-than high-frequency components indicated higher elevated sympathetic than vagal activation. Altered autonomic control can be interpreted as a compensatory mechanism for diminished vascular arteriolar vasodilator capacity in PAD. To maintain the arterial blood pressure, an elevated setpoint of sympathovagal balance is required.
Our data indicate PAD alters the HRV in cardiovascular patients. PAD should be considered in the assessment of cardiac autonomic regulation especially in risk stratification.
自主神经调节分析对于慢性心力衰竭（CHF）患者室性心动过速和心源性猝死的风险分层很有用。心率变异性（HRV）反映自主神经调节状况。为分析自主神经控制，必须考虑整个心血管系统。因此，我们研究的目的是评估外周动脉疾病（PAD）对自主神经调节的影响。
在心血管科的53名男性患者（年龄：67±11岁）中，我们比较了27名患有PAD（踝臂指数，ABI<0.9）和26名未患PAD（ABI>0.9）患者的标准HRV参数，以及12名健康受试者作为对照。在静息状态下记录30分钟的高分辨率心电图。使用血管筛查系统VASERA估计脉搏波速度以及ABI。
在患有PAD的心脏病患者中，我们发现线性和非线性HRV参数均存在显著差异。低频成分比高频成分增加得更多，表明交感神经激活比迷走神经激活升高得更高。自主神经控制的改变可解释为PAD中血管小动脉舒张能力降低的一种代偿机制。为维持动脉血压，需要提高交感神经-迷走神经平衡的设定点。
我们的数据表明PAD会改变心血管疾病患者的HRV。在评估心脏自主神经调节时，尤其是在风险分层中，应考虑PAD。
