Shvartz Vladimir A, Kiselev Anton R, Karavaev Anatoly S, Vulf Kristina A, Borovkova Ekaterina I, Prokhorov Mikhail D, Petrosyan Andrey D, Bockeria Olga L
Department of Surgical Treatment for Interactive Pathology, Bakulev Scientific Center for Cardiovascular Surgery, Moscow, Russia.
Department of New Cardiological Informational Technologies, Research Institute of Cardiology, Saratov State Medical University, Saratov, Russia.
J Cardiovasc Thorac Res. 2018;10(1):28-35. doi: 10.15171/jcvtr.2018.05. Epub 2018 Mar 17.
Our aim was to perform a comparative study of short-term cardiovascular autonomic control in cardiac surgery patients who underwent coronary artery bypass grafting (CABG) or surgical correction of valvular heart disease (SCVHD ). The synchronous 15 minutes records of heart rate variability (HRV) and finger's photoplethysmographic waveform variability (PPGV) were performed in 42 cardiac surgery patients (12 women) aged 61.8 ± 8.6 years (mean ± standard deviation), who underwent CABG, and 36 patients (16 women) aged 54.2 ± 14.9 years, who underwent SCVHD , before surgery and in 5-7 days after surgery. Conventional time and frequency domain measures of HRV and index S of synchronization between the slow oscillations in PPGV and HRV were analyzed. We also calculated personal dynamics of these indices after surgery. We found no differences ( > 0.05) in all studied autonomic indices (preoperative and post-surgery) between studied patients' groups, except for the preoperative heart rate, which was higher in patients who underwent SCVHD ( = 0.013). We have shown a pronounced preoperative and post-surgery variability (magnitude of inter-quartile ranges) of all autonomic indices in studied patients. In the cluster analysis based on cardiovascular autonomic indices (preoperative and post-surgery), we divided all patients into two clusters (38 and 40 subjects) which did not differ in all clinical characteristics (except for the preoperative hematocrit, P = 0.038), index S, and all post-surgery HRV indices. First cluster (38 patients) had higher preoperative values of the HR, TP, HF, and HF%, and lower preoperative values of the LF% and LF/HF. The variability of cardiovascular autonomic indices in on-pump cardiac surgery patients (two characteristic clusters were identified based on preoperative indices) was not associated with their clinical characteristics and features of surgical procedure (including cardioplegia).
我们的目的是对接受冠状动脉旁路移植术（CABG）或心脏瓣膜病手术矫正（SCVHD）的心脏手术患者的短期心血管自主神经控制进行比较研究。对42例年龄为61.8±8.6岁（均值±标准差）、接受CABG的心脏手术患者（12例女性）以及36例年龄为54.2±14.9岁、接受SCVHD的患者（16例女性），在手术前及术后5 - 7天进行了15分钟同步的心率变异性（HRV）和手指光电容积脉搏波波形变异性（PPGV）记录。分析了HRV的传统时域和频域指标以及PPGV和HRV慢振荡之间的同步指数S。我们还计算了术后这些指标的个体动态变化。我们发现，除了术前心率外，所研究的患者组之间所有研究的自主神经指标（术前和术后）均无差异（P>0.05），接受SCVHD的患者术前心率较高（P = 0.013）。我们显示所研究患者的所有自主神经指标在术前和术后均有显著的变异性（四分位间距大小）。在基于心血管自主神经指标（术前和术后）的聚类分析中，我们将所有患者分为两个聚类（38和40名受试者），这两个聚类在所有临床特征（除术前血细胞比容外，P = 0.038）、指数S以及所有术后HRV指标方面均无差异。第一聚类（38例患者）术前HR、TP、HF和HF%值较高，而术前LF%和LF/HF值较低。体外循环心脏手术患者心血管自主神经指标的变异性（基于术前指标确定了两个特征聚类）与其临床特征和手术过程特点（包括心脏停搏）无关。
