心率调整后心率变异性在心脏性猝死风险分层中的表现。
Performance of heart rate adjusted heart rate variability for risk stratification of sudden cardiac death.
机构信息
Department of Biomedical Engineering and Imaging Medicine, Army Medical University, 30 Gaotanyan Main Street, Chongqing, 400038, China.
Department of Cardiology, Southwest Hospital, Army Medical University, Chongqing, 400038, China.
出版信息
BMC Cardiovasc Disord. 2023 Mar 22;23(1):144. doi: 10.1186/s12872-023-03184-0.
PURPOSE
As a non-invasive tool for the assessment of cardiovascular autonomic function, the predictive value of heart rate variability (HRV) for sudden cardiac death (SCD) risk stratification remains unclear. In this study, we investigated the performance of the individualized heart rate (HR) adjusted HRV (HRV) for SCD risk stratification in subjects with diverse risks.
METHODS
A total of 11 commonly used HRV metrics were analyzed in 192 subjects, including 88 healthy controls (low risk group), 82 hypertrophic cardiomyopathy (HCM) patients (medium risk group), and 22 SCD victims (high risk group). The relationship between HRV metrics and HR was examined with long-term and short-term analysis. The performance HRV was evaluated by area under the receiver operating characteristic curve (AUC) and covariance of variation (CV).
RESULTS
Most of the HRV metrics were exponentially decayed with the increase of HR, while the exponential power coefficients were significantly different among groups. The HRV metrics discriminated low, medium and high risk subjects with a median AUC of 0.72[0.11], which was considerably higher than that of the traditional long-term (0.63[0.04]) and short-term (0.58[0.05]) HRV without adjustment. The average CV of the HRV metrics was also significantly lower than traditional short-term HRV metrics (0.09 ± 0.02 vs. 0.24 ± 0.13, p < 0.01).
CONCLUSIONS
Subjects with diverse risks of SCD had similar exponential decay relationship between HRV metrics and HR, but with different decaying rates. HRV provides reliable and robust estimation for risk stratification of SCD.
目的
心率变异性（HRV）作为评估心血管自主神经功能的一种非侵入性工具，其对心脏性猝死（SCD）风险分层的预测价值仍不清楚。本研究旨在探讨不同风险患者中，个体化心率（HR）校正后的 HRV（HRV）对 SCD 风险分层的预测价值。
方法
对 192 例患者进行研究，包括 88 例健康对照者（低危组）、82 例肥厚型心肌病（HCM）患者（中危组）和 22 例 SCD 患者（高危组），分析了 11 种常用的 HRV 指标。采用长期和短期分析方法，考察 HRV 指标与 HR 的关系。采用受试者工作特征曲线（ROC）下面积（AUC）和变异系数（CV）评估 HRV 的性能。
结果
大多数 HRV 指标随 HR 的增加呈指数衰减，而组间指数衰减的幂系数存在显著差异。HRV 指标可将低危、中危和高危患者区分开，其 AUC 中位数为 0.72[0.11]，明显高于未经校正的传统长时程（0.63[0.04]）和短时程（0.58[0.05]）HRV（均 P<0.01）。HRV 指标的平均 CV 也明显低于传统的短时程 HRV 指标（0.09 ± 0.02 比 0.24 ± 0.13，P<0.01）。
结论
SCD 风险不同的患者 HRV 指标与 HR 之间存在相似的指数衰减关系，但衰减率不同。HRV 为 SCD 风险分层提供了可靠和稳健的估计。
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