Department of Cardiology, Virgen de Arrixaca University Hospital, Murcia, Spain.
Circ J. 2012;76(9):2124-9. doi: 10.1253/circj.cj-12-0192. Epub 2012 Jun 6.
Abnormalities in autonomic control are a feature of neuroendocrine activation in HF and are responsible for dysregulation of biological rhythms. The purpose was to investigate the presence and the prognostic significance of long-period heart rate (HR) rhythms in heart failure (HF) patients.
In the study, 92 HF patients were enrolled (age 53 ± 14 years and left ventricular ejection fraction [LVEF] 37 ± 10%). A rhythmometric analysis was used to assess the HR rhythms in 7-days (7D) Holter recordings. Rhythms properties were quantified by mesor and amplitude, in beats/min and by acrophase, in hours. Cardiac death or HF decompensation were registered. All patients had 24-h rhythm, 61 patients (77%) had 8-h rhythm, and 66 patients (83%) had 7D rhythm. Twelve patients (15%) experienced events. Among rhythm parameters only 7D median amplitude was different between patients with or without events: 1.1 beats/min [0.5-1.5] vs. 2.0 beats/min [0.0-3.9], P=0.049 respectively. After multivariate adjustment, LVEF (per 1%, hazard ratio 0.92, 95% confidence interval (CI) 0.87 to 0.98, P=0.01), N-terminal portion of pro-natriuretic hormone type B (per 100 pg/ml, hazard ratio 1.036, 95% CI 1.005-1.069, P=0.022), and 7D amplitude of the HR ≤1.71 beats/min (hazard ratio 5.4, 95% CI 1.2-34.4, P=0.047) were independent predictors of events.
A 7D HR rhythm is present in most patients with HF, and has prognostic significance.
自主神经控制异常是心力衰竭时神经内分泌激活的特征，负责生物节律的失调。目的是研究心力衰竭（HF）患者是否存在长周期心率（HR）节律及其预后意义。
在这项研究中，共纳入 92 名 HF 患者（年龄 53±14 岁，左心室射血分数[LVEF] 37±10%）。使用节律分析评估 7 天（7D）动态心电图记录中的 HR 节律。通过均数和幅度（以每分钟跳动数表示）以及顶点（以小时表示）来量化节律特征。记录心脏死亡或 HF 失代偿事件。所有患者均有 24 小时节律，61 例（77%）有 8 小时节律，66 例（83%）有 7D 节律。12 例（15%）发生事件。在节律参数中，只有 7D 中位数幅度在有或无事件的患者之间存在差异：分别为 1.1 次/分钟[0.5-1.5]和 2.0 次/分钟[0.0-3.9]，P=0.049。经多变量调整后，LVEF（每增加 1%，风险比 0.92，95%置信区间[CI]为 0.87 至 0.98，P=0.01）、B 型利钠肽前体 N 端（每增加 100pg/ml，风险比 1.036，95%CI 为 1.005-1.069，P=0.022）和 HR 7D 幅度≤1.71 次/分钟（风险比 5.4，95%CI 为 1.2-34.4，P=0.047）是事件的独立预测因子。
大多数 HF 患者存在 7D HR 节律，具有预后意义。
