Saul J P, Arai Y, Berger R D, Lilly L S, Colucci W S, Cohen R J
Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge 02139.
Am J Cardiol. 1988 Jun 1;61(15):1292-9. doi: 10.1016/0002-9149(88)91172-1.
Neurohumoral modulation of cardiovascular function is an important component of the hemodynamic alterations in patients with chronic congestive heart failure (CHF). Analysis of heart rate (HR) variability is a noninvasive means of investigating the autonomic control of the heart. The variability of HR and respiratory signals, both derived from ambulatory electrocardiographic recordings, were analyzed with power spectral analysis to evaluate autonomic control in 25 patients with chronic stable CHF (class III or IV) and 21 normal control subjects. In the patients with CHF, HR spectral power was markedly reduced (p less than 0.0001) at all frequencies examined (0.01 to 1.0 Hz, period 1 to 100 seconds) and virtually absent at frequencies greater than 0.04 Hz. Heart rate fluctuations at very low frequencies (0.01 to 0.04 Hz) less effectively differentiated CHF patients from control subjects, due to discrete (about 65 seconds, 0.015 Hz) oscillation in HR, which was associated with a similar pattern in respiratory activity in many of the patients with CHF. These findings demonstrate a marked derangement of HR modulation in patients with severe CHF. The frequency characteristics of HR fluctuations in these patients are consistent with abnormal baroreflex responsiveness to physiologic stimuli, and suggest that there is diminished vagal, but relatively preserved sympathetic, modulation of HR.
神经体液对心血管功能的调节是慢性充血性心力衰竭（CHF）患者血流动力学改变的重要组成部分。心率（HR）变异性分析是研究心脏自主控制的一种非侵入性方法。对25例慢性稳定型CHF（Ⅲ级或Ⅳ级）患者和21名正常对照者的动态心电图记录所获得的HR和呼吸信号变异性进行功率谱分析，以评估自主控制情况。在CHF患者中，在所检查的所有频率（0.01至1.0Hz，周期1至100秒）下，HR频谱功率均显著降低（p<0.0001），而在大于0.04Hz的频率下几乎消失。由于HR中离散的（约65秒，0.015Hz）振荡，低频（0.01至0.04Hz）的心率波动在区分CHF患者和对照者方面效果较差，这在许多CHF患者中与呼吸活动的类似模式相关。这些发现表明重度CHF患者存在明显的HR调节紊乱。这些患者HR波动的频率特征与压力反射对生理刺激的异常反应一致，提示迷走神经对HR的调节减弱，但交感神经调节相对保留。
