IRCCS Istituti Clinici Scientifici Maugeri, Milan, Italien.
Department of Biomedical Sciences for Health, University of Milan, Milan, Italien.
Herzschrittmacherther Elektrophysiol. 2021 Sep;32(3):315-319. doi: 10.1007/s00399-021-00780-5. Epub 2021 Jul 8.
Heart rate variability (HRV) refers to the beat-to-beat variation of the cardiac cycle. Since heart rate is modulated on a beat-to-beat basis by the combined influence of the sympathetic and parasympathetic nervous system at the sinus node level, HRV has been considered an indirect biomarker of cardiac autonomic control and widely exploited for the assessment of autonomic function in many pathological subjects. This focus article summarizes the main findings derived from HRV analysis applied to 24‑h Holter monitoring in both cardiac and non-cardiac diseases as well as in physiological conditions in the healthy population. Even if the prognostic role of HRV indices is well recognized and its use ever more widespread, its implementation in the diagnostic and prognostic processes in routine clinical practice remains limited. Several reasons for these limitations can be identified: first the lack of reliable reference values, and secondly, the low specificity of HRV indices in particular when considering the constant evolution of clinical practice and therapeutic approaches, making it difficult to refer to a specific and stable combination of clinical and HRV markers. Therefore, the clinical use of HRV should be further investigated. Finally, HRV represents a substantial tool for investigating the physiological conditions in healthy people that can have important implications in primary prevention and the understanding of gender differences, as well as in sport and occupational medicine.
心率变异性（HRV）是指心脏周期的逐拍变化。由于心率在窦房结水平上受到交感和副交感神经系统的综合影响而逐拍调节，因此 HRV 一直被认为是心脏自主控制的间接生物标志物，并广泛应用于许多病理患者的自主功能评估。本文重点总结了从 HRV 分析中得出的主要发现，这些分析应用于 24 小时动态心电图监测，涉及心脏和非心脏疾病以及健康人群的生理状况。尽管 HRV 指数的预后作用已得到充分认可，其应用也越来越广泛，但在常规临床实践中的诊断和预后过程中的实施仍然有限。造成这些限制的原因有几个：首先是缺乏可靠的参考值，其次是 HRV 指数的特异性低，特别是在考虑到临床实践和治疗方法的不断发展时，因此很难参考特定且稳定的临床和 HRV 标志物组合。因此，需要进一步研究 HRV 的临床应用。最后，HRV 是研究健康人群生理状况的重要工具，它对一级预防、性别差异的理解以及运动和职业医学都有重要意义。
