Khalaf Kinda, Jelinek Herbert F, Robinson Caroline, Cornforth David J, Tarvainen Mika P, Al-Aubaidy Hayder
Department of Biomedical Engineering, Khalifa University of Science, Technology and Research Abu Dhabi, UAE.
Australian School of Advanced Medicine, Macquarie University Sydney, NSW, Australia ; Centre for Research in Complex Systems and School of Community Health, Charles Sturt University Albury, NSW, Australia.
Front Physiol. 2015 Mar 27;6:101. doi: 10.3389/fphys.2015.00101. eCollection 2015.
Physiological interactions are abundant within, and between, body systems. These interactions may evolve into discrete states during pathophysiological processes resulting from common mechanisms. An association between arterial stenosis, identified by low ankle-brachial pressure index (ABPI) and cardiovascular disease (CVD) as been reported. Whether an association between vascular calcification-characterized by high ABPI and a different pathophysiology-is similarly associated with CVD, has not been established. The current study aims to investigate the association between ABPI, and cardiac rhythm, as an indicator of cardiovascular health and functionality, utilizing heart rate variability (HRV).
Two hundred and thirty six patients underwent ABPI assessment. Standard time and frequency domain, and non-linear HRV measures were determined from 5-min electrocardiogram. ABPI data were divided into normal (n = 101), low (n = 67) and high (n = 66) and compared to HRV measures.(DFAα1 and SampEn were significantly different between the low ABPI, high ABPI and control groups (p < 0.05).
A possible coupling between arterial stenosis and vascular calcification with decreased and increased HRV respectively was observed. Our results suggest a model for interpreting the relationship between vascular pathophysiology and cardiac rhythm. The cardiovascular system may be viewed as a complex system comprising a number of interacting subsystems. These cardiac and vascular subsystems/networks may be coupled and undergo transitions in response to internal or external perturbations. From a clinical perspective, the significantly increased sample entropy compared to the normal ABPI group and the decreased and increased complex correlation properties measured by DFA for the low and high ABPI groups respectively, may be useful indicators that a more holistic treatment approach in line with this more complex clinical picture is required.
生理相互作用在身体系统内部以及之间大量存在。在由共同机制导致的病理生理过程中，这些相互作用可能演变为离散状态。已有报道称，通过低踝臂压力指数（ABPI）识别的动脉狭窄与心血管疾病（CVD）之间存在关联。以高ABPI为特征且具有不同病理生理学的血管钙化与CVD之间是否同样存在关联，尚未得到证实。本研究旨在利用心率变异性（HRV），调查作为心血管健康和功能指标的ABPI与心律之间的关联。
236名患者接受了ABPI评估。从5分钟心电图中确定标准时域、频域以及非线性HRV测量值。将ABPI数据分为正常组（n = 101）、低ABPI组（n = 67）和高ABPI组（n = 66），并与HRV测量值进行比较。低ABPI组、高ABPI组和对照组之间的去趋势波动分析α1（DFAα1）和样本熵（SampEn）存在显著差异（p < 0.05）。
观察到动脉狭窄与血管钙化之间可能分别存在与HRV降低和升高的耦合关系。我们的结果提示了一个用于解释血管病理生理学与心律之间关系的模型。心血管系统可被视为一个由多个相互作用子系统组成的复杂系统。这些心脏和血管子系统/网络可能相互耦合，并响应内部或外部扰动而发生转变。从临床角度来看，与正常ABPI组相比显著增加的样本熵，以及低ABPI组和高ABPI组分别通过DFA测量的复杂相关性属性的降低和增加，可能是有用的指标，表明需要一种更符合这种更复杂临床情况的整体治疗方法。
