School of Population Health, University of Auckland, Auckland, New Zealand.
Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, USA.
Int J Cardiol. 2019 Jan 15;275:83-88. doi: 10.1016/j.ijcard.2018.10.026. Epub 2018 Oct 10.
Many patients with atrial fibrillation (AF) present with stroke as their first clinical manifestation and since improved AF screening methods are thus required, we investigated whether pulse rate variability parameters predict future AF and cerebrovascular events.
In an observational cohort study of 5000 community-resident adults (58% male; 50-84 years), the beat-to-beat variability of suprasystolic brachial blood pressure waveforms was measured with root mean square of successive differences (RMSSD) and irregularity index (IrrIx). Based on outcome-oriented and previously validated thresholds for detecting AF, RMSSD and IrrIx were dichotomised at 100 ms and 7.7%, respectively. Participants were followed up for 4.6 years (median), accruing 249 AF and 120 cerebrovascular events in the total sample (n = 5000), and 133 AF and 90 cerebrovascular events among those without prior AF diagnosis (n = 4296).
In multivariable-adjusted analyses, an elevated RMSSD (>100 ms) or IrrIx (>7.7%) was strongly associated with a higher risk of AF (hazard ratios (HRs) = 2.00-2.95) and cerebrovascular events (HRs = 1.91-2.28), even among people without prior AF diagnosis: HRs for AF = 1.70-2.05 and cerebrovascular events = 2.00-2.28. These associations were strongest in the highest RMSSD tertile >100 ms or IrrIx tertile >7.7%: HRs for AF = 2.32-4.47 and cerebrovascular events = 2.43-3.69. Among those without prior AF diagnosis, the highest categorical net reclassification improvement for 5-year cerebrovascular risk was 14% (95% confidence interval: 7-21%).
Elevated RMSSD or IrrIx values indicative of the presence of AF predict future AF and cerebrovascular events; more so with increasing pulse irregularity and even among those without prior AF diagnosis.
许多房颤（AF）患者以中风为首发临床表现，因此需要改进 AF 筛查方法，我们研究了脉搏率变异性参数是否可以预测未来的 AF 和脑血管事件。
在一项针对 5000 名社区居住的成年人（58%为男性；50-84 岁）的观察性队列研究中，通过均方根差（RMSSD）和不规则指数（IrrIx）测量超收缩肱动脉血压波形的逐搏变异性。基于以检测 AF 为导向的、经过验证的临界值，将 RMSSD 和 IrrIx 分别分为 100ms 和 7.7%。所有参与者随访 4.6 年（中位数），在总样本（n=5000）中累计发生 249 例 AF 和 120 例脑血管事件，在无既往 AF 诊断的人群中（n=4296）分别发生 133 例 AF 和 90 例脑血管事件。
在多变量调整分析中，RMSSD 升高（>100ms）或 IrrIx 升高（>7.7%）与 AF（危险比[HR]为 2.00-2.95）和脑血管事件（HR 为 1.91-2.28）风险升高密切相关，甚至在无既往 AF 诊断的人群中也是如此：AF 的 HR 为 1.70-2.05，脑血管事件的 HR 为 2.00-2.28。在 RMSSD 最高三分位数>100ms 或 IrrIx 最高三分位数>7.7%时，这些关联最强：AF 的 HR 为 2.32-4.47，脑血管事件的 HR 为 2.43-3.69。在无既往 AF 诊断的人群中，5 年脑血管风险的最高分类净重新分类改善为 14%（95%置信区间：7-21%）。
提示 AF 存在的 RMSSD 或 IrrIx 升高值可预测未来的 AF 和脑血管事件；随着脉搏不规则性的增加，预测作用更强，甚至在无既往 AF 诊断的人群中也是如此。
