Nagayoshi Yasuhiro, Kawano Hiroaki, Nishihara Taiki, Morikawa Kei, Nagano Haruka, Hanatani Shinsuke, Sakaino Naritsugu, Tsujita Kenichi
Department of Cardiology Amakusa Medical Center Amakusa Japan.
Department of Cardiovascular Medicine, Graduate School of Medical Sciences Kumamoto University Kumamoto Japan.
Health Sci Rep. 2022 Nov 30;6(1):e938. doi: 10.1002/hsr2.938. eCollection 2023 Jan.
An autonomic nervous disorder is an important characteristic of cardiac amyloidosis; however, the prevalence of autonomic dysfunction in wild-type transthyretin amyloidosis (ATTR) has not been established. Analysis of the R-R interval coefficient of variation (CVR-R) is a noninvasive method to measure parasympathetic activity. We aimed to assess autonomic dysfunction of ATTR and determine the utility of CVR-R for the detection of ATTR in other cardiac diseases.
This is a single-center, retrospective, case-control study. Fifty patients with heart failure (HF) were studied. The etiologies of HF were as follows: ATTR, = 10; previous myocardial infarction (MI), = 20; and left ventricular hypertrophy (LVH) due to other disease processes (e.g., aortic stenosis), = 20. We measured the CVR-R at rest (CVR-R), CVR-R with deep breaths (CVR-R), and the change rate (CVR-R. The relative change formula is as follows: CVR-R = (CVR-R - CVR-R)/CVR-R 100 (%).
There was no difference in the CVR-R levels among the three groups. The CVR-R levels in the ATTR group were significantly lower (ATTR: -8.77 [-43.8 to 10.9]; LVH: 67.4 [38.7 to 89.4]; MI: 83.7 [60.4 to 142.9]). Based on the receiver operative characteristic curve analysis to identify ATTR in HF, the best cut-off value for the CVR-R was 19.7 (area under the curve: 0.848).
Our data suggested autonomic dysfunction in patients with ATTR. Measurement of the CVR-R in HF patients may be a convenient support tool for the detection of ATTR.
自主神经功能紊乱是心脏淀粉样变性的一个重要特征；然而，野生型转甲状腺素蛋白淀粉样变性（ATTR）中自主神经功能障碍的患病率尚未确定。RR间期变异系数（CVR-R）分析是一种测量副交感神经活动的非侵入性方法。我们旨在评估ATTR的自主神经功能障碍，并确定CVR-R在检测其他心脏疾病中的ATTR的效用。
这是一项单中心、回顾性、病例对照研究。研究了50例心力衰竭（HF）患者。HF的病因如下：ATTR，=10；既往心肌梗死（MI），=20；以及其他疾病过程（如主动脉狭窄）导致的左心室肥厚（LVH），=20。我们测量了静息时的CVR-R（CVR-R）、深呼吸时的CVR-R（CVR-R）和变化率（CVR-R。相对变化公式如下：CVR-R =（CVR-R - CVR-R）/CVR-R×100（%）。
三组之间的CVR-R水平没有差异。ATTR组的CVR-R水平显著较低（ATTR：-8.77[-43.8至10.9]；LVH：67.4[38.7至89.4]；MI：83.7[60.4至142.9]）。基于用于识别HF中ATTR的受试者工作特征曲线分析，CVR-R的最佳截断值为19.7（曲线下面积：0.848）。
我们的数据表明ATTR患者存在自主神经功能障碍。测量HF患者的CVR-R可能是检测ATTR的一种方便的辅助工具。
