Giordano Ugo, Michielon Guido, Calò Carducci Francesca, Ravà Lucilla, Alfieri Sara, Parisi Francesco, Grutter Giorgia
CardioRespiratory and Sport Medicine Unit, Bambino Gesù Children's Hospital, Rome, Italy.
Pediatr Transplant. 2013 Aug;17(5):441-4. doi: 10.1111/petr.12105. Epub 2013 Jun 5.
Hypertension and reduced HRV are frequent in heart-transplanted recipients. We studied 26 young recipients to investigate the relationship between BP and HRV during simultaneous 24-h monitoring. Presence of CAV was considered. All HRV measures were significantly lower than normal values. Significant correlations were found between mean daytime systolic BP and the rMSSD (p = 0.04), and mean daytime DBP and SDANN for all 5-min segments (p = 0.03) and between rMSSD and mean nighttime DBP (p = 0.03). Four patients were hypertensive during daytime, seven had a reduced nocturnal fall and two had a nocturnal rise in BP. Eight patients showed severe CAV grade (grade IV) on the Stanford scale, 13 moderate (grade III) and five mild (grade I-II). After a follow-up time of 30 months, four of the 13 patients (30%) with CAV grade III showed an increase to grade IV and all showed abnormalities of both HRV and ABPM patterns. The relationship between HRV abnormalities and arterial hypertension and CAV should be further explored.
高血压和心率变异性降低在心脏移植受者中很常见。我们研究了26名年轻受者，以在同步24小时监测期间调查血压与心率变异性之间的关系。考虑了冠状动脉粥样硬化性血管病（CAV）的存在。所有心率变异性指标均显著低于正常值。在所有5分钟时间段内，日间平均收缩压与连续差值均方根（rMSSD）之间（p = 0.04）、日间平均舒张压与标准化平均NN间期标准差（SDANN）之间（p = 0.03）以及rMSSD与夜间平均舒张压之间（p = 0.03）均发现显著相关性。4例患者日间高血压，7例夜间血压下降减弱，2例夜间血压升高。8例患者在斯坦福量表上显示严重CAV分级（IV级），13例中度（III级），5例轻度（I-II级）。经过30个月的随访，13例CAV III级患者中有4例（30%）升至IV级，且均显示心率变异性和动态血压监测模式异常。心率变异性异常与动脉高血压和CAV之间的关系应进一步探讨。
