Ortak Jasmin, Khattab Kerstin, Barantke Melanie, Wiegand Uwe K H, Bänsch Dietmar, Ince Hüseyin, Nienaber Christoph A, Bonnemeier Hendrik
Department of Medicine, Division of Cardiology at University Hospital, Rostock, Rostock School of Medicine, Germany.
Pacing Clin Electrophysiol. 2009 Mar;32 Suppl 1:S21-5. doi: 10.1111/j.1540-8159.2008.02221.x.
Transient left ventricular (LV) apical ballooning (AB) is characterized by a rapidly reversible, acute LV systolic dysfunction, triggered by physical or emotional stress. Despite observations strongly suggesting catecholamine-mediated myocardial stunning due to enhanced sympathetic activity, the early time course of heart rate variability (HRV) has not been described.
We prospectively enrolled 39 consecutive patients (median age = 68 years, range 35-85 years, 38 women) with LV AB. Indices of HRV were extracted from 24-hour ambulatory electrocardiograms on the day of hospital admission, on days 2 and 3, and 3 months after the hospitalization.
Within 48 hours after hospital admission, the indices of HRV were markedly depressed (standard deviation of normal-to-normal [NN] intervals [SDNN] 89.6 +/- 19.9 ms; mean standard deviation of NN intervals for 5-minute segments [SDNNi] 37.8 +/- 6.2 ms; root mean square of consecutive difference of normal-to-normal intervals [rMSSD] 23.0 +/- 9 ms; standard deviation of the averages of NN intervals for all 5-minute segments [SDANN] 70.1 +/- 18.0 ms; geometric triangular index [TI] 23.7 +/- 5.9 ms), recovered in the subacute phase and had normalized at 3 months follow-up (SDNN 124.7 +/- 24 ms; SDNNi 47.1 +/- 5.7 ms; rMSSD 31.1 +/- 10.5 ms; SDANN 118.5 +/- 27 ms; TI 31.2 +/- 8 ms; all P < 0.05). Mean RR-interval increased from 845 +/- 121 ms on day 1, to 929 +/- 84 ms at 3 months (P=0.06).
A marked depression of cardiac parasympathetic activity was observed in the acute phase of LV AB, followed by recovery of autonomic modulation between the subacute and the chronic phases. The rapid return of parasympathetic function may partially explain the favorable outcomes of patients presenting with LV AB.
短暂性左心室心尖气球样变（AB）的特征是由身体或情绪应激引发的快速可逆性急性左心室收缩功能障碍。尽管有观察结果强烈提示由于交感神经活动增强导致儿茶酚胺介导的心肌顿抑，但尚未描述心率变异性（HRV）的早期时间进程。
我们前瞻性纳入了39例连续性左心室AB患者（中位年龄 = 68岁，范围35 - 85岁，38例女性）。在入院当天、第2天和第3天以及住院后3个月，从24小时动态心电图中提取HRV指标。
入院后48小时内，HRV指标显著降低（正常RR间期标准差[SDNN] 89.6±19.9毫秒；5分钟节段的正常RR间期平均标准差[SDNNi] 37.8±6.2毫秒；正常RR间期连续差值的均方根[rMSSD] 23.0±9毫秒；所有5分钟节段的正常RR间期平均值的标准差[SDANN] 70.1±18.0毫秒；几何三角指数[TI] 23.7±5.9毫秒），在亚急性期恢复，并在3个月随访时恢复正常（SDNN 124.7±24毫秒；SDNNi 47.1±5.7毫秒；rMSSD 31.1±10.5毫秒；SDANN 118.5±27毫秒；TI 31.2±8毫秒；所有P < 0.05）。平均RR间期从第1天的845±121毫秒增加到3个月时的929±84毫秒（P = 0.06）。
在左心室AB的急性期观察到心脏副交感神经活动显著降低，随后在亚急性期和慢性期之间自主神经调节恢复。副交感神经功能的快速恢复可能部分解释了左心室AB患者的良好预后。
