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健康个体和慢性心力衰竭个体的心率变异性不对称与呼吸窦性心律失常之间缺乏关联。

Lack of association between heart period variability asymmetry and respiratory sinus arrhythmia in healthy and chronic heart failure individuals.

机构信息

IRCCS Istituti Clinici Scientifici Maugeri, Milan, Italy.

IRCCS Istituti Clinici Scientifici Maugeri, Montescano, Pavia, Italy.

出版信息

PLoS One. 2021 Feb 16;16(2):e0247145. doi: 10.1371/journal.pone.0247145. eCollection 2021.


DOI:10.1371/journal.pone.0247145
PMID:33592077
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7886158/
Abstract

Temporal asymmetry is a peculiar aspect of heart period (HP) variability (HPV). HPV asymmetry (HPVA) is reduced with aging and pathology, but its origin is not fully elucidated. Given the impact of respiration on HPV resulting in the respiratory sinus arrhythmia (RSA) and the asymmetric shape of the respiratory pattern, a possible link between HPVA and RSA might be expected. In this study we tested the hypothesis that HPVA is significantly associated with RSA and asymmetry of the respiratory rhythm. We studied 42 middle-aged healthy (H) subjects, and 56 chronic heart failure (CHF) patients of whom 26 assigned to the New York Heart Association (NYHA) class II (CHF-II) and 30 to NYHA class III (CHF-III). Electrocardiogram and lung volume were monitored for 8 minutes during spontaneous breathing (SB) and controlled breathing (CB) at 15 breaths/minute. The ratio of inspiratory (INSP) to expiratory (EXP) phases, namely the I/E ratio, and RSA were calculated. HPVA was estimated as the percentage of negative HP variations, traditionally measured via the Porta's index (PI). Departures of PI from 50% indicated HPVA and its significance was tested via surrogate data. We found that RSA increased during CB and I/E ratio was smaller than 1 in all groups and experimental conditions. In H subjects the PI was about 50% during SB and it increased significantly during CB. In both CHF-II and CHF-III groups the PI was about 50% during SB and remained unmodified during CB. The PI was uncorrelated with RSA and I/E ratio regardless of the experimental condition and group. Pooling together data of different experimental conditions did not affect conclusions. Therefore, we conclude that the HPVA cannot be explained by RSA and/or I/E ratio, thus representing a peculiar feature of the cardiac control that can be aroused in middle-aged H individuals via CB.

摘要

时间不对称性是心率(HP)变异性(HPV)的一个特殊方面。HPV 不对称(HPVA)随年龄增长和病理变化而降低,但其起源尚未完全阐明。鉴于呼吸对 HPV 的影响导致呼吸窦性心律失常(RSA)和呼吸模式的不对称形状,HPVA 与 RSA 之间可能存在关联。在这项研究中,我们检验了 HPVA 与 RSA 和呼吸节律不对称性显著相关的假设。我们研究了 42 名中年健康(H)受试者和 56 名慢性心力衰竭(CHF)患者,其中 26 名被分配到纽约心脏协会(NYHA)心功能分级 II 级(CHF-II),30 名被分配到 NYHA 心功能分级 III 级(CHF-III)。在自主呼吸(SB)和 15 次/分钟控制呼吸(CB)期间,监测心电图和肺容积 8 分钟。计算吸气(INSP)和呼气(EXP)阶段的比值,即 I/E 比值和 RSA。HPVA 作为负 HP 变化的百分比,传统上通过 Porta 指数(PI)来测量。PI 偏离 50%表示 HPVA,并通过替代数据测试其显著性。我们发现,在 CB 期间 RSA 增加,并且在所有组和实验条件下 I/E 比值均小于 1。在 H 组中,在 SB 期间 PI 约为 50%,在 CB 期间显著增加。在 CHF-II 和 CHF-III 组中,在 SB 期间 PI 约为 50%,在 CB 期间保持不变。PI 与 RSA 和 I/E 比值无关,无论实验条件和组如何。汇总不同实验条件的数据并不影响结论。因此,我们得出结论,HPVA 不能用 RSA 和/或 I/E 比值来解释,因此代表了一种心脏控制的特殊特征,这种特征可以通过 CB 在中年 H 个体中被激发。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7196/7886158/fcf37e6b17b0/pone.0247145.g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7196/7886158/d2959d42dd76/pone.0247145.g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7196/7886158/9123db79cf88/pone.0247145.g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7196/7886158/96aec2244639/pone.0247145.g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7196/7886158/fcf37e6b17b0/pone.0247145.g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7196/7886158/d2959d42dd76/pone.0247145.g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7196/7886158/9123db79cf88/pone.0247145.g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7196/7886158/96aec2244639/pone.0247145.g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7196/7886158/fcf37e6b17b0/pone.0247145.g004.jpg

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本文引用的文献

[1]
Cardiac baroreflex hysteresis is one of the determinants of the heart period variability asymmetry.

Am J Physiol Regul Integr Comp Physiol. 2019-10-1

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Am J Physiol Heart Circ Physiol. 2018-3-9

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Different estimation methods of spontaneous baroreflex sensitivity have different predictive value in heart failure patients.

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