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在一种新的慢性心力衰竭致心律失常犬模型中,室性心律失常的早晨激增与心率的昼夜依赖性减弱、自主神经适应性降低以及心脏混沌状态减轻有关。

Morning surge of ventricular arrhythmias in a new arrhythmogenic canine model of chronic heart failure is associated with attenuation of time-of-day dependence of heart rate and autonomic adaptation, and reduced cardiac chaos.

作者信息

Zhu Yujie, Hanafy Mohamed A, Killingsworth Cheryl R, Walcott Gregory P, Young Martin E, Pogwizd Steven M

机构信息

Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America.

出版信息

PLoS One. 2014 Aug 20;9(8):e105379. doi: 10.1371/journal.pone.0105379. eCollection 2014.

Abstract

Patients with chronic heart failure (CHF) exhibit a morning surge in ventricular arrhythmias, but the underlying cause remains unknown. The aim of this study was to determine if heart rate dynamics, autonomic input (assessed by heart rate variability (HRV)) and nonlinear dynamics as well as their abnormal time-of-day-dependent oscillations in a newly developed arrhythmogenic canine heart failure model are associated with a morning surge in ventricular arrhythmias. CHF was induced in dogs by aortic insufficiency & aortic constriction, and assessed by echocardiography. Holter monitoring was performed to study time-of-day-dependent variation in ventricular arrhythmias (PVCs, VT), traditional HRV measures, and nonlinear dynamics (including detrended fluctuations analysis α1 and α2 (DFAα1 & DFAα2), correlation dimension (CD), and Shannon entropy (SE)) at baseline, as well as 240 days (240 d) and 720 days (720 d) following CHF induction. LV fractional shortening was decreased at both 240 d and 720 d. Both PVCs and VT increased with CHF duration and showed a morning rise (2.5-fold & 1.8-fold increase at 6 AM-noon vs midnight-6 AM) during CHF. The morning rise in HR at baseline was significantly attenuated by 52% with development of CHF (at both 240 d & 720 d). Morning rise in the ratio of low frequency to high frequency (LF/HF) HRV at baseline was markedly attenuated with CHF. DFAα1, DFAα2, CD and SE all decreased with CHF by 31, 17, 34 and 7%, respectively. Time-of-day-dependent variations in LF/HF, CD, DFA α1 and SE, observed at baseline, were lost during CHF. Thus in this new arrhythmogenic canine CHF model, attenuated morning HR rise, blunted autonomic oscillation, decreased cardiac chaos and complexity of heart rate, as well as aberrant time-of-day-dependent variations in many of these parameters were associated with a morning surge of ventricular arrhythmias.

摘要

慢性心力衰竭(CHF)患者表现出室性心律失常的清晨激增,但潜在原因尚不清楚。本研究的目的是确定在新建立的致心律失常犬心力衰竭模型中,心率动力学、自主神经输入(通过心率变异性(HRV)评估)和非线性动力学及其异常的时间依赖性振荡是否与室性心律失常的清晨激增有关。通过主动脉瓣关闭不全和主动脉缩窄诱导犬发生CHF,并通过超声心动图进行评估。进行动态心电图监测以研究基线时以及CHF诱导后240天(240 d)和720天(720 d)室性心律失常(室性早搏、室性心动过速)、传统HRV指标和非线性动力学(包括去趋势波动分析α1和α2(DFAα1和DFAα2)、关联维数(CD)和香农熵(SE))的时间依赖性变化。在240 d和720 d时左室短轴缩短率均降低。室性早搏和室性心动过速均随CHF病程增加,且在CHF期间出现清晨升高(上午6点至中午比午夜至上午6点分别增加2.5倍和1.8倍)。随着CHF的发展,基线时清晨心率升高在240 d和720 d时均显著减弱52%。基线时低频与高频(LF/HF)HRV比值的清晨升高在CHF时明显减弱。DFAα1、DFAα2、CD和SE在CHF时分别下降31%、17%、34%和7%。基线时观察到的LF/HF、CD、DFAα1和SE的时间依赖性变化在CHF期间消失。因此,在这个新的致心律失常犬CHF模型中,清晨心率升高减弱、自主神经振荡减弱、心脏混沌和心率复杂性降低,以及许多这些参数异常的时间依赖性变化与室性心律失常的清晨激增有关。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a42d/4139365/64070d87d891/pone.0105379.g001.jpg

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