Bienias Piotr, Kostrubiec Maciej, Rymarczyk Zuzanna, Korczak Dariusz, Ciurzyński Michał, Kurzyna Marcin, Torbicki Adam, Fijałkowska Anna, Pruszczyk Piotr
Department of Internal Medicine and Cardiology with The Centre of Diagnosis and Treatment of Venous Thromboembolic Disease, The Medical University of Warsaw, Warsaw, Poland.
Ann Noninvasive Electrocardiol. 2015 Jan;20(1):69-78. doi: 10.1111/anec.12169. Epub 2014 Jun 5.
Heart rate turbulence (HRT) impairment is a validated and an independent indicator of cardiovascular death. There are limited data on HRT in pulmonary hypertension (PH), so we assessed potential HRT alterations in PH, especially in relation to its severity.
Thirty-three out of 41 patients were enrolled in the study aged 49.7 ± 15.9 years (22 with arterial, 11 with chronic thromboembolic PH). Routine evaluations, right heart catheterization, and 24-hour Holter monitoring with heart rate variability and HRT assessment were performed.
HRT was significantly impaired in PH patients, as compared to 25 healthy controls: mean turbulence onset (TO) was -0.27% versus -2.60% (P < 0.0001), and median turbulence slope (TS) was 3.13 versus 13.5 msRR (P < 0.0001). Abnormal HRT (TO ≥ 0.0% and/or TS ≤ 2.5 ms/RR) was found in 63.3% of PH patients. Patients with PH and abnormal HRT presented more compromised functional, biochemical, and hemodynamic status than PH patients with normal TO and TS values. Multivariate stepwise regression analysis showed that TO value was related to oxygen desaturation <90% in 6-minute walking test (6-MWT; OR 0.41, P < 0.001) and was related to N-Terminal pro-B type Natriuretic Peptide concentration (OR 0.40, P < 0.001); TS was related to 6-MWT distance (OR 0.53, P < 0.0001).
Patients with arterial or chronic thromboembolic PH are characterized by significant impairment of HRT which is related to the disease severity. We hypothesize that patients with abnormal HRT could be considered as subjects with an increased risk of cardiovascular death, however, it needs further investigation.
心率震荡（HRT）受损是心血管死亡的一个经过验证的独立指标。关于肺动脉高压（PH）患者心率震荡的数据有限，因此我们评估了PH患者心率震荡的潜在变化，特别是与疾病严重程度的关系。
41例患者中的33例纳入本研究，年龄49.7±15.9岁（22例动脉性PH，11例慢性血栓栓塞性PH）。进行了常规评估、右心导管检查以及24小时动态心电图监测以评估心率变异性和心率震荡。
与25名健康对照者相比，PH患者的心率震荡明显受损：平均震荡起始（TO）为-0.27%，而对照组为-2.60%（P<0.0001）；震荡斜率（TS）中位数为3.13，而对照组为13.5 msRR（P<0.0001）。63.3%的PH患者存在异常心率震荡（TO≥0.0%和/或TS≤2.5 ms/RR）。与TO和TS值正常的PH患者相比，存在异常心率震荡的PH患者的功能、生化和血流动力学状态受损更严重。多因素逐步回归分析显示，TO值与6分钟步行试验（6-MWT）中氧饱和度<90%相关（OR 0.41，P<0.001），与N末端B型脑钠肽前体浓度相关（OR 0.40，P<0.001）；TS与6-MWT距离相关（OR 0.53，P<0.0001）。
动脉性或慢性血栓栓塞性PH患者的特点是心率震荡明显受损，且与疾病严重程度相关。我们推测，心率震荡异常的患者可被视为心血管死亡风险增加的人群，然而，这需要进一步研究。
