Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands.
Department of Medical Informatics, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands.
BMC Med. 2022 Feb 21;20(1):91. doi: 10.1186/s12916-022-02273-9.
HRV has mostly shown associations with systolic dysfunction and more recently, with diastolic dysfunction in Heart failure (HF) patients. But the role of sympathetic nervous system in changes of left ventricular (LV) systolic and diastolic function and new-onset HF has not been extensively studied.
Among 3157 men and 4405 women free of HF and atrial fibrillation retrospectively included from the population-based Rotterdam Study, we used linear mixed models to examine associations of RR-interval differences and standard deviation of RR-intervals corrected for heart rate (RMSSDc and SDNNc) with longitudinal changes of LV ejection fraction (LVEF), E/A ratio, left atrial (LA) diameter, E/e' ratio. Afterwards, using cox regressions, we examined their association with new-onset HF.
Mean (SD) age was 65 (9.95) in men and 65.7 (10.2) in women. Every unit increase in log RMSSDc was accompanied by 0.75% (95%CI:-1.11%;-0.39%) and 0.31% (- 0.60%;-0.01%) lower LVEF among men and women each year, respectively. Higher log RMSSDc was linked to 0.03 (- 0.04;-0.01) and 0.02 (- 0.03;-0.003) lower E/A and also - 1.76 (- 2.77;- 0.75) and - 1.18 (- 1.99;-0.38) lower LVM index in both sexes and 0.72 mm (95% CI: - 1.20;-0.25) smaller LA diameters in women. The associations with LVEF in women diminished after excluding HF cases during the first 3 years of follow-up. During a median follow-up of 8.7 years, hazard ratios (95%CI) for incident HF were 1.34 (1.08;1.65) for log RMSSDc in men and 1.15 (0.93;1.42) in women. SDNNc showed similar associations.
Indices of HRV were associated with worse systolic function in men but mainly with improvement in LA size in women. Higher HRV was associated with higher risk of new-onset HF in men. Our findings highlight potential sex differences in autonomic function underlying cardiac dysfunction and heart failure in the general population.
心率变异性（HRV）主要与心力衰竭（HF）患者的收缩功能障碍相关，最近还与舒张功能障碍相关。但是，交感神经系统在左心室（LV）收缩和舒张功能变化以及新发 HF 中的作用尚未得到广泛研究。
在这项来自人群的鹿特丹研究中，我们回顾性纳入了 3157 名男性和 4405 名女性，这些人最初均无 HF 和心房颤动。我们使用线性混合模型来研究 RR 间期差异和 RR 间期校正心率后的标准差（RR 间期差值和 RMSSDc、SDNNc）与 LV 射血分数（LVEF）、E/A 比值、左心房（LA）直径、E/e' 比值的纵向变化之间的关联。之后，我们使用 Cox 回归来研究它们与新发 HF 的关联。
男性的平均（标准差）年龄为 65（9.95）岁，女性为 65.7（10.2）岁。男性和女性中，log RMSSDc 每增加一个单位，每年 LVEF 分别下降 0.75%（95%CI：-1.11%；-0.39%）和 0.31%（-0.60%；-0.01%）。较高的 log RMSSDc 与男女的 E/A 比值分别降低 0.03（-0.04；-0.01）和 0.02（-0.03；-0.003），也与男女的 LVM 指数分别降低-1.76（-2.77；-0.75）和-1.18（-1.99；-0.38）相关，且女性的 LA 直径缩小 0.72mm（95%CI：-1.20；-0.25）。在随访的前 3 年排除 HF 病例后，女性与 LVEF 的相关性减弱。中位随访 8.7 年后，男性的 log RMSSDc 发生 HF 的 HR（95%CI）为 1.34（1.08；1.65），女性为 1.15（0.93；1.42）。SDNNc 也显示出类似的关联。
HRV 指标与男性的收缩功能障碍相关，但主要与女性的 LA 大小改善相关。较高的 HRV 与男性新发 HF 的风险增加相关。我们的研究结果强调了人群中心律失常潜在的性别差异，这些差异可能与心脏功能障碍和心力衰竭有关。
