Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy.
Dipartimento di Medicina Clinica e Molecolare, S. Andrea Hospital, "Sapienza" University of Rome, Rome, Italy.
Clin Ter. 2023 Mar-Apr;174(2):139-145. doi: 10.7417/CT.2023.2510.
Aortic valve stenosis (AVS) is a well-known risk factor for sudden cardiac death. Therefore, some non-invasive, electrocardiographic markers are capable to stratify the risk of sudden death at rest and during light mental challenge [mini-mental state examination (MMSE) administration].
We compared short period RR, QT and Te intervals variability in 42 candidates to and 12 age-matched hypertensive control patients at rest and during mental challenge.
At rest, AVS patients showed a higher QT standard deviation (sd), QT low frequency power (LF), QT High Frequency (HF), Tpeak-Tend intervals sd (Te sd) and Te HF than the control group. During mental challenge AVS group showed a decrease of RR mean and RR HF, expressed in normalized units (NU), and an increase of RR total power (TP), RR LF, RR LF NU, RR LF, HF ratio (LF/HF). During this same mental test, QT sd, QT LF, QT HF, Te sd, Te LF, Te HF, QT variability index (VI), TeVI, QT normalized variance (VN) were higher in AVS patients than the control group. During mental challenge Te LF (r:0.825, p<0.05) was significantly associated to: serum albumin (β:-0.473, p<0.001), MMSE (β:-0.267, p:0.038), diastolic blood pressure (β:-0.443, p:0.03) and cardiac index (β:-0.303, p:0.029).
AVS patients showed temporal dispersion of ventricular repolarization phase, useful maker to individuate high risk patients. MMSE administration induced a sympathetic sinus activation and vagal deactivation in AVS subjects. Frailty and mental function influenced Te HF and Te LF.
主动脉瓣狭窄（AVS）是心脏性猝死的一个众所周知的危险因素。因此，一些非侵入性的、心电图标志物能够对静息和轻度精神挑战期间的猝死风险进行分层[迷你精神状态检查（MMSE）管理]。
我们比较了 42 名 AVS 候选者和 12 名年龄匹配的高血压对照组在静息和精神挑战期间的短周期 RR、QT 和 Te 间期变异性。
在静息状态下，AVS 患者的 QT 标准差（sd）、QT 低频功率（LF）、QT 高频（HF）、Tpeak-Tend 间期标准差（Te sd）和 Te HF 均高于对照组。在精神挑战期间，AVS 组的 RR 均值和 RR HF 呈下降趋势，以标准化单位（NU）表示，并增加了 RR 总功率（TP）、RR LF、RR LF NU、RR LF、HF 比值（LF/HF）。在同一心理测试中，QT sd、QT LF、QT HF、Te sd、Te LF、Te HF、QT 变异性指数（VI）、TeVI、QT 标准化方差（VN）在 AVS 患者中均高于对照组。在精神挑战期间，Te LF（r：0.825，p<0.05）与血清白蛋白（β：-0.473，p<0.001）、MMSE（β：-0.267，p：0.038）、舒张压（β：-0.443，p：0.03）和心指数（β：-0.303，p：0.029）呈显著相关。
AVS 患者表现出心室复极时相的时间离散，是识别高危患者的有用标志物。MMSE 管理在 AVS 患者中诱导了交感神经激活和迷走神经去激活。虚弱和精神功能影响 Te HF 和 Te LF。
