Division of Cardiology, Luzerner Kantonsspital, Lucerne , Switzerland.
Ann Med. 2011 Aug;43(5):403-11. doi: 10.3109/07853890.2010.550309. Epub 2011 Mar 2.
INTRODUCTION. The circadian variation of heart function and heart sounds in patients with and without heart failure (HF) is poorly understood. We hypothesized HF patients would exhibit less circadian variation with worsened cardiac function and sleep apnea. METHODS. We studied 67 HF patients (age 67.4 ± 8.2 years; 42% acute HF) and 63 asymptomatic control subjects with no history of HF (age 61.6 ± 7.7 years). Subjects wore a heart sound/ECG/respiratory monitor. The data were analyzed for sleep apnea, diastolic heart sounds, and systolic time intervals. RESULTS. The HF group had significantly greater prevalence of the third heart sound and prolongation of electro-mechanical activation time, while the control group had an age-related increase in the prevalence of the fourth heart sound. The control group showed more circadian variation in cardiac function. The HF subjects had more sleep apnea and higher occurrence of heart rate non-dipping. CONCLUSIONS. The control subjects demonstrated an increasing incidence of diastolic dysfunction with age, while systolic function was mostly unchanged with aging. Parameters related to systolic function were significantly worse in the HF group with little diurnal variation, indicating a constant stimulation of sympathetic tone in HF and reduction of diurnal regulation.
简介。心力衰竭（HF）患者和无心力衰竭患者的心脏功能和心音的昼夜变化知之甚少。我们假设 HF 患者的心脏功能恶化和睡眠呼吸暂停会导致昼夜变化减少。方法。我们研究了 67 例 HF 患者（年龄 67.4±8.2 岁；42%为急性 HF）和 63 例无 HF 病史的无症状对照者（年龄 61.6±7.7 岁）。受试者佩戴心音/心电图/呼吸监测仪。对睡眠呼吸暂停、舒张期心音和收缩时间间隔进行数据分析。结果。HF 组第三心音和电机械激活时间延长的患病率显著更高，而对照组第四心音的患病率随年龄增长而增加。对照组的心脏功能昼夜变化较大。HF 患者的睡眠呼吸暂停更多，心率非杓型出现的频率更高。结论。对照组随着年龄的增长舒张功能的发生率逐渐增加，而收缩功能在衰老过程中基本保持不变。与收缩功能相关的参数在 HF 组中明显较差，昼夜变化较小，表明 HF 中交感神经刺激持续存在，昼夜调节减少。
