Longenecker J C, Zubaid M, Johny K V, Attia A I, Ali J, Rashed W, Suresh C G, Omar M
Department of Community Medicine, Faculty of Medicine, Health Sciences Centre, Kuwait University, Safat, Kuwait.
Med Princ Pract. 2009;18(2):85-92. doi: 10.1159/000189804. Epub 2009 Feb 9.
The aim of this study was to investigate the left-ventricular (LV) mass-adjusted association between low heart rate variability (HRV) and atherosclerotic cardiovascular disease (ASCVD) among hemodialysis patients in Kuwait.
One hundred and eight patients were enrolled in the study. HRV time domain measures were obtained by 48-hour Holter monitoring, including the standard deviation of all R-wave-to-R-wave (RR) intervals (SDNN), standard deviation of all 5-min averaged intervals (SDANN), HRV triangular index (HRV-TI), percent of adjacent RR intervals differing by >50 ms (pNN50), and root mean square of sums of squares of all differences (rMSSD). Left ventricular ejection fraction (LVEF) and LV mass index (LVMI) were measured by M-mode echocardiography. Comorbidity was assessed using medical record review. Prevalent ASCVD was defined as coronary artery, cerebrovascular, or peripheral vascular disease.
Prevalence of ASCVD, LV hypertrophy, and LVEF <40% were 56, 59, and 10%, respectively. The SDANN was negatively associated with ASCVD (-20 ms; p = 0.003), LV systolic dysfunction (-20 ms; p = 0.001), elevated LVMI (-20 ms; p = 0.002), hypertension (-34 ms; p = 0.01), and diabetes (-20 ms; p = 0.001). After adjustment for hypertension and LVMI using logistic regression, ASCVD was associated with the lowest quartile of SDANN (OR = 4.3, p = 0.009), HRV-TI (OR = 3.3, p = 0.03), and SDNN (OR = 2.3, p = 0.10). These associations persisted after adjusting for LVEF.
In dialysis patients, low HRV indices were strongly associated with prevalent ASCVD, independent of LVMI and LVEF. The interrelationships among HRV, diabetes, hypertension, and LVMI should be addressed in studies of HRV and ASCVD.
本研究旨在调查科威特血液透析患者中低心率变异性（HRV）与动脉粥样硬化性心血管疾病（ASCVD）之间经左心室（LV）质量校正后的关联。
108名患者纳入本研究。通过48小时动态心电图监测获得HRV时域测量值，包括所有R波到R波（RR）间期的标准差（SDNN）、所有5分钟平均间期的标准差（SDANN）、HRV三角指数（HRV-TI）、相邻RR间期差值>50毫秒的百分比（pNN50）以及所有差值平方和的均方根（rMSSD）。通过M型超声心动图测量左心室射血分数（LVEF）和左心室质量指数（LVMI）。使用病历审查评估合并症。将现患ASCVD定义为冠状动脉、脑血管或外周血管疾病。
ASCVD、左心室肥厚和LVEF<40%的患病率分别为56%、59%和10%。SDANN与ASCVD（-20毫秒；p = 0.003）、左心室收缩功能障碍（-20毫秒；p = 0.001）、LVMI升高（-20毫秒；p = 0.002）、高血压（-34毫秒；p = 0.01）和糖尿病（-20毫秒；p = 0.001）呈负相关。使用逻辑回归对高血压和LVMI进行校正后，ASCVD与SDANN的最低四分位数（OR = 4.3，p = 0.009）、HRV-TI（OR = 3.3，p = 0.03）和SDNN（OR = 2.3，p = 0.10）相关。在校正LVEF后，这些关联仍然存在。
在透析患者中，低HRV指数与现患ASCVD密切相关，独立于LVMI和LVEF。在HRV与ASCVD的研究中应探讨HRV、糖尿病、高血压和LVMI之间的相互关系。
