Sosnowski Maciej, Macfarlane Peter W, Tendera Michał
Unit of Noninvasive Cardiovascular Diagnostics 3rd Chair and Division of Cardiology, Medical University of Silesia, Ziolowa St 47, Katowice, Poland.
Ann Noninvasive Electrocardiol. 2011 Oct;16(4):321-6. doi: 10.1111/j.1542-474X.2011.00458.x.
We aimed to evaluate whether clinical factors, which influence heart rate variability (HRV) in the presence of undisturbed sinus rhythm, have any associations with HRV in patients with permanent atrial fibrillation (AF).
One hundred ninety-seven consecutive patients with permanent AF were included (122 males, 75 females, aged 64 ± 11 years, range 25-85). In each patient a 24-hour electrocardiographic recording was performed and an HRV fraction (HRVF)-the index based on scatter plot numerical processing-was calculated. Additionally, standard HRV measures were analyzed. Reduced HRVF was defined as its value lower than lower normal limit. Demographic and clinical factors were examined for their association with a reduced HRVF by means of a univariate and multivariate logistic regression analysis.
The reduced HRVF was associated with advanced age, clinical diagnosis of a previous MI or dilated cardiomyopathy, presence of diabetes, depressed left ventricular function, NYHA class > II, treatment regimen, use of digoxin, diuretics or antiarrhythmic agents, nonuse of beta-blockers, and increased heart rate. The independent determinants that sustained after multivariate analysis were: heart rate (per 10 bpm increase, odds ratio 2.77 [1.88-4.07]), age (per 5 years increase 1.43 [1.1-1.85]), depressed left ventricular EF (<30% vs higher 2.26 [1.19-4.31]), and presence of diabetes (3.45 [1.1-10.85]). The HRVF correlated moderately with standard HRV measures. This index showed also the strongest correlation with left ventricular ejection fraction.
We concluded that advanced age, left ventricular systolic dysfunction, increased heart rate, and presence of diabetes are cofactors of a reduced HRV in AF patients. Thus, the determinants of heart rate variability in the presence of atrial fibrillation are the same as those in sinus rhythm.
我们旨在评估在窦性心律未受干扰时影响心率变异性（HRV）的临床因素与永久性心房颤动（AF）患者的HRV是否存在关联。
纳入197例连续性永久性AF患者（男性122例，女性75例，年龄64±11岁，范围25 - 85岁）。对每位患者进行24小时心电图记录，并计算HRV分数（HRVF）——基于散点图数值处理的指标。此外，分析标准HRV指标。HRVF降低定义为其值低于正常下限。通过单因素和多因素逻辑回归分析检查人口统计学和临床因素与HRVF降低的关联。
HRVF降低与高龄、既往心肌梗死或扩张型心肌病的临床诊断、糖尿病的存在、左心室功能降低、纽约心脏协会（NYHA）心功能分级> II级、治疗方案、地高辛、利尿剂或抗心律失常药物的使用、未使用β受体阻滞剂以及心率增加有关。多因素分析后持续存在的独立决定因素为：心率（每增加10次/分钟，比值比2.77 [1.88 - 4.07]）、年龄（每增加5岁1.43 [1.1 - 1.85]）、左心室射血分数降低（<30% 对比更高水平2.26 [1.19 - 4.31]）以及糖尿病的存在（3.45 [1.1 - 10.85]）。HRVF与标准HRV指标中度相关。该指标与左心室射血分数的相关性也最强。
我们得出结论，高龄、左心室收缩功能障碍、心率增加和糖尿病的存在是AF患者HRV降低的协同因素。因此，心房颤动时心率变异性的决定因素与窦性心律时相同。
