Germano-Soares Antonio Henrique, Cucato Gabriel Grizzo, Leicht Anthony Scott, Andrade-Lima Aluísio, Peçanha Tiago, de Almeida Correia Marilia, Zerati Antonio Eduardo, Wolosker Nelson, Ritti-Dias Raphael Mendes
Department of Physical Education, University of Pernambuco, Recife, Pernambuco, Brazil.
Hospital Israelita Albert Einstein, São Paulo, Brazil.
Ann Vasc Surg. 2019 Nov;61:72-77. doi: 10.1016/j.avsg.2019.04.021. Epub 2019 Jul 20.
The objective of this study was to analyze the association between cardiac autonomic modulation and arterial stiffness in patients with peripheral artery disease (PAD).
This cross-sectional study included one hundred fourteen patients with symptomatic PAD (67.5% men; 65 ± 7 years; body mass index: 26.8 ± 4.5 kg/m). Heart rate variability (HRV) was measured within time (standard deviation of all RR intervals [beat to beat heart interval] [SDNN], root mean square of the successive differences between adjacent normal RR intervals [RMSSD], and the proportion of successive RR intervals that differed by more than 50 msec [pNN50]) and frequency (low frequency [LF] and high frequency [HF]) domains. Arterial stiffness was assessed by carotid-femoral pulse wave velocity (cfPWV). Crude and adjusted linear regression analyses examined the relationship between HRV and cfPWV.
Nonsignificant crude associations were identified among cfPWV and RMSSD (P = 0.181), SDNN (P = 0.105), pNN50 (P = 0.087), LF (P = 0.376), HF (P = 0.175), and LF/HF ratio (P = 0.426). After adjustments for age, sex, smoking, body mass index, ankle-brachial index, and use of beta-blockers, significant associations were identified among cfPWV and RMSSD (P = 0.037), SDNN (P = 0.049), and pNN50 (P = 0.049).
Cardiac autonomic modulation was significantly associated with arterial stiffness in patients with PAD after adjustment for confounding factors. This relationship may contribute to the enhanced cardiovascular disease risk for PAD patients and provides a target for strategies to improve patient clinical outcomes.
本研究的目的是分析外周动脉疾病（PAD）患者心脏自主神经调节与动脉僵硬度之间的关联。
这项横断面研究纳入了114例有症状的PAD患者（男性占67.5%；年龄65±7岁；体重指数：26.8±4.5kg/m）。在时域（所有RR间期的标准差[逐搏心跳间期][SDNN]、相邻正常RR间期差值的均方根[RMSSD]以及相差超过50毫秒的连续RR间期比例[pNN50]）和频域（低频[LF]和高频[HF]）测量心率变异性（HRV）。通过颈股脉搏波速度（cfPWV）评估动脉僵硬度。采用粗线性回归分析和校正线性回归分析来研究HRV与cfPWV之间的关系。
在cfPWV与RMSSD（P = 0.181）、SDNN（P = 0.105）、pNN50（P = 0.087）、LF（P = 0.376）、HF（P = 0.175）以及LF/HF比值（P = 0.426）之间未发现显著的粗关联。在对年龄、性别、吸烟、体重指数、踝臂指数和β受体阻滞剂使用情况进行校正后，在cfPWV与RMSSD（P = 0.037）、SDNN（P = 0.049）和pNN50（P = 0.049）之间发现了显著关联。
在校正混杂因素后，PAD患者的心脏自主神经调节与动脉僵硬度显著相关。这种关系可能导致PAD患者心血管疾病风险增加，并为改善患者临床结局的策略提供了一个靶点。
