Okólska Magdalena, Łach Jacek, Matusik Paweł T, Pająk Jacek, Mroczek Tomasz, Podolec Piotr, Tomkiewicz-Pająk Lidia
Cardiological Outpatient Clinic, Department of Cardiovascular Diseases, John Paul II Hospital, 31-202 Krakow, Poland.
Department of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, 31-202 Krakow, Poland.
J Clin Med. 2021 Sep 29;10(19):4492. doi: 10.3390/jcm10194492.
Reduction of heart rate variability (HRV) parameters may be a risk factor and precede the occurrence of arrhythmias or the development of heart failure and complications in people with postinfarct left ventricular dysfunction and after coronary artery bypass grafting. Data on this issue in adults after a Fontan operation (FO) are scarce. This study assessed the association between HRV, exercise capacity, and multiorgan complications in adults after FO. Data were obtained from 30 FO patients (mean age 24 ± 5.4 years) and 30 healthy controls matched for age and sex. HRV was investigated in all patients by clinical examination, laboratory tests, echocardiography, a cardiopulmonary exercise test, and 24-h electrocardiogram. The HRV parameters were reduced in the FO group. Reduced HRV parameters were associated with patients' age at the time of FO, time since surgery, impaired exercise capacity, chronotropic incompetence parameters, and multiorgan complications. Univariate analysis showed that saturated O at rest, percentage difference between adjacent NN intervals of >50 ms duration, and peak heart rate were associated with chronotropic index. Multivariable analysis revealed that all three variables were independent predictors of the chronotropic index. The results of this study suggest novel pathophysiological mechanisms that link HRV, physical performance, and organ damage in patients after FO.
心率变异性（HRV）参数降低可能是一种危险因素，且先于心肌梗死后左心室功能不全患者及冠状动脉旁路移植术后心律失常的发生或心力衰竭及并发症的发展。关于Fontan手术（FO）后成人这一问题的数据很少。本研究评估了FO后成人HRV、运动能力和多器官并发症之间的关联。数据来自30例FO患者（平均年龄24±5.4岁）和30例年龄及性别匹配的健康对照者。通过临床检查、实验室检查、超声心动图、心肺运动试验和24小时心电图对所有患者进行HRV研究。FO组的HRV参数降低。HRV参数降低与FO时患者的年龄、手术后时间、运动能力受损、变时性功能不全参数及多器官并发症相关。单因素分析显示静息时的血氧饱和度、相邻NN间期时长>50毫秒的百分比差异及心率峰值与变时指数相关。多变量分析显示这三个变量均为变时指数的独立预测因素。本研究结果提示了FO后患者中HRV、身体机能和器官损害之间关联的新的病理生理机制。
