Department of Cardiology, Central Clinic Hospital, Baku, Azerbaijan.
Department of Cardiology, Ege University School of Medicine, İzmir, Türkiye.
Turk Kardiyol Dern Ars. 2023 Oct;51(7):454-463. doi: 10.5543/tkda.2023.27078.
Heart rate variability (HRV), which is defined as cyclic changes in sinus rate with time, is used as a measure of cardiac autonomic tone. Our aim was to determine the impact of HRV on short-term prognosis in pulmonary hypertension (PH).
We enrolled 64 PH patients and 69 healthy subjects (control group). Patients were evaluated by Holter-ECG, echocardiography, and laboratory tests. 24-h Holter-ECG monitoring was used for HRV. The development of adverse events (right heart failure, hospitalization, syncope, and death) during the 6-month follow-up was evaluated in PH group.
PH group (39 ± 16 years, 37.5% males) comprised of 16 patients with idiopathic pulmonary arterial hypertension (PAH) (25%), 36 patients with PAH associated with congenital heart disease (56.3%), 3 PAH associated with connective tissue disease (4.7%), 1 with portopulmonary (1.6%), and 8 chronic thromboembolic PH (12.5%). The time-dependent (standard deviation of all NN intervals for a selected time period [SDNN], standard deviation of the 5-min mean R-R intervals tabulated over an entire day [SDANN], SDNN Index, and Triangular Index) and frequency-dependent HRV indices (low frequency, high-frequency power, and total power,) were significantly reduced in those with PH. Functional class was negatively associated with SDNN, SDANN, SDNN Index, and Triangular Index. Adverse events developed in 25% of the patients during the 6-month follow-up period (200 ± 92 days) (7 patients had right-heart failure, 5 syncope, 12 patients were hospitalized, and 9 had died). All the time and frequency-dependent indices significantly associated with adverse events. Mortality correlated with SDNN (rS = -0.354, P = 0.005), SDANN (rS = -0.368, P = 0.004), SDNN Index (rS = -0.257, P = 0.045), Triangular Index (rS = -0.310, P = 0.014), and VLF (rS = -0.265, P = 0.039).
HRV is significantly depressed in patients with PH and is associated with the clinical status. HRV indices might predict clinical deterioration, adverse events, and mortality for 6 months. Non-invasive assessment of HRV through Holter-ECG may be a valuable and practical tool in risk stratification of patients with PH for short-term outcomes.
心率变异性（HRV）定义为窦性心率随时间的周期性变化，可作为心脏自主神经张力的衡量指标。本研究旨在探讨 HRV 对肺动脉高压（PH）短期预后的影响。
我们纳入了 64 例 PH 患者和 69 例健康对照者（对照组）。患者接受动态心电图、超声心动图和实验室检查评估。通过 24 小时动态心电图监测进行 HRV 分析。在 PH 组中评估 6 个月随访期间不良事件（右心衰竭、住院、晕厥和死亡）的发生情况。
PH 组（39±16 岁，男性占 37.5%）包括特发性肺动脉高压（PAH）患者 16 例（25%）、PAH 合并先天性心脏病患者 36 例（56.3%）、PAH 合并结缔组织病患者 3 例（4.7%）、门静脉高压患者 1 例（1.6%）和慢性血栓栓塞性 PH 患者 8 例（12.5%）。PH 患者的时间依赖性（所选时间段内所有 NN 间期标准差[SDNN]、全天 5 分钟平均 RR 间期的标准差[SDANN]、SDNN 指数和三角指数）和频率依赖性 HRV 指数（低频、高频功率和总功率）显著降低。心功能分级与 SDNN、SDANN、SDNN 指数和三角指数呈负相关。在 6 个月的随访期间（200±92 天），25%的患者出现不良事件（7 例出现右心衰竭、5 例晕厥、12 例住院、9 例死亡）。所有时间和频率依赖性指标均与不良事件显著相关。死亡率与 SDNN（rS=-0.354，P=0.005）、SDANN（rS=-0.368，P=0.004）、SDNN 指数（rS=-0.257，P=0.045）、三角指数（rS=-0.310，P=0.014）和极低频（rS=-0.265，P=0.039）相关。
PH 患者的 HRV 显著降低，并与临床状态相关。HRV 指数可能预测 6 个月内临床恶化、不良事件和死亡率。通过动态心电图进行 HRV 的无创评估可能是 PH 患者短期预后风险分层的一种有价值且实用的工具。
