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静息心率变异性与一般人群中新发心房颤动风险的就诊间变异性频率。

Frequency of Visit-to-Visit Variability of Resting Heart Rate and the Risk of New-Onset Atrial Fibrillation in the General Population.

机构信息

School of Medicine, Nankai University, Tianjin, China; Department of Cardiology, Chinese PLA General Hospital, Beijing, China.

Department of Cardiology, Chinese PLA General Hospital, Beijing, China.

出版信息

Am J Cardiol. 2021 Sep 15;155:45-51. doi: 10.1016/j.amjcard.2021.06.009. Epub 2021 Jul 17.

Abstract

Resting heart rate (RHR) has been an established predictor for atrial fibrillation (AF). However, the association of visit-to-visit heart rate variability (VVHRV) with new-onset AF risk over long term remains unclear. Our study investigates the relation of VVHRV to new-onset AF in general population in the prospective study of the Kailuan cohort. A total of 46,126 individuals without arrhythmia were included. They underwent 3 health examinations from 2006 to 2010 and performed follow up. VVHRV was measured by coefficient of variation (CV), variability independent of the mean (VIM), and standard deviation (SD). Participants were separately divided into 5 categories by quintiles of visit-to-visit RHR-CV, RHR-VIM and RHR-SD. Multivariate Cox regression and restricted cubic spline models were performed to establish the association between VVHRV and new-onset AF. 241 new-onset AF occurred during a median follow-up of 7.54 years. The incidence of new-onset AF in the group of the lowest (Q1) and highest quintiles (Q5) of RHR-CV were higher than that in other groups. The HRs for the new-onset AF were 2.07 (95% CI, 1.34-3.21, p < 0.01), in the highest quintile group(Q5) compared with group Q2, and 1.89(95% CI, 1.20-2.97, p < 0.01) in the lowest quintile group(Q1) compared with group Q2. The risk for new-onset AF showed a similar trend using RHR-VIM (p < 0.01) and RHR-SD (p < 0.05) parameters. Further sensitivity analyses indicated the consistent results in subjects without prior cardiovascular disease and without taking beta blockers or CCB. To match the covariates, analyses were also performed by propensity score matching, and prominent trends were also found in RHR-SD and RHR-VIM. In conclusion, the study indicated that higher and lower VVHRV were associated with the increasing risk of new-onset AF, which supporting a U-shaped curve existence.

摘要

静息心率(RHR)一直是心房颤动(AF)的既定预测因子。然而,长期来看,心率变异性(VVHRV)与新发 AF 风险之间的关联尚不清楚。我们的研究在开滦队列的前瞻性研究中,调查了一般人群中 VVHRV 与新发 AF 的关系。共有 46126 名无心律失常的个体被纳入。他们在 2006 年至 2010 年期间接受了 3 次健康检查,并进行了随访。VVHRV 通过变异系数(CV)、均值独立变异(VIM)和标准差(SD)来测量。根据静息心率-CV、静息心率-VIM 和静息心率-SD 的五分位法,将参与者分别分为 5 组。使用多变量 Cox 回归和限制立方样条模型来建立 VVHRV 与新发 AF 之间的关联。在中位随访 7.54 年期间,共发生 241 例新发 AF。在 RHR-CV 最低(Q1)和最高五分位组(Q5)中,新发 AF 的发生率高于其他组。与 Q2 组相比,Q5 组新发 AF 的 HR 为 2.07(95%CI,1.34-3.21,p<0.01),与 Q2 组相比,Q1 组新发 AF 的 HR 为 1.89(95%CI,1.20-2.97,p<0.01)。使用 RHR-VIM(p<0.01)和 RHR-SD(p<0.05)参数,新发 AF 的风险也呈现出相似的趋势。进一步的敏感性分析表明,在无心血管疾病史且未服用β受体阻滞剂或 CCB 的患者中,结果一致。为了匹配协变量,还通过倾向评分匹配进行了分析,在 RHR-SD 和 RHR-VIM 中也发现了显著的趋势。总之,该研究表明,较高和较低的 VVHRV 与新发 AF 风险的增加相关,这支持了 U 型曲线的存在。

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