University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
BMC Cardiovasc Disord. 2023 Oct 21;23(1):513. doi: 10.1186/s12872-023-03558-4.
Due to recent advances in diagnosis and treatment, the number of adults with congenital heart disease (ACHD) has substantially increased. This achievement is mitigated by rhythm disorders. Here, we sought to determine alterations in heart rate variability (HRV) and their prognostic value in ACHD.
Ninety seven ACHD patients (39.2 ± 14.1 years, 51.5% female) and 19 controls (39.7 ± 15.0 years, 47.4% female) underwent 24-h Holter monitoring.
As compared to controls, ACHD patients offered a significantly higher burden of premature ventricular contractions (p = 0.02) and decreased HRV indices (natural logarithmic transformation of very low frequency (lnVLF): 7.46 ± 0.76 ms vs. 7.91 ± 0.92ms, p = 0.03; natural logarithmic transformation of low frequency (lnLF): 6.39 ± 0.95ms vs. 7.01 ± 1.07ms, p = 0.01; natural logarithmic transformation of the ratio of low to high frequency spectra (lnLF/HF): 0.81 ± 0.74 vs. 1.17 ± 0.51, p = 0.04). No differences in HRV measures were observed across ACHD lesion groups. NT-proBNP levels were significantly related to both time and frequency domain indices (natural logarithmic transformation of the standard deviation of NN intervals (lnSDNN): Spearman´s rho = -0.32, p = 0.001; natural logarithmic transformation of the standard deviation of the average NN intervals for each 5-min segment of a 24-h Holter monitoring (lnSDANN): Spearman´s rho: -0.33, p = 0.001; natural logarithmic transformation of the total power (lnTP): Spearman´s rho: -0.25, p = 0.01; lnVLF: Spearman´s rho: -0.33, p = 0.001; lnLF: Spearman´s rho: -0.35, p < 0.001; lnLF/HF: Spearman´s rho: -0.34, p = 0.001). After a mean follow-up of 3.9 ± 0.7 years, 8 patients died and 3 patients survived sudden cardiac death (SCD). Several HRV parameters were significantly higher in event-free ACHD patients than in those who died or survived SCD (natural logarithmic transformation of the average of the standard deviations of NN intervals for each 5-min segment of a 24-h Holter monitoring (lnASDNN): p = 0.04; lnPNN30: p = 0.04; lnVFL: p = 0.03; lnLF: p < 0.01). On univariate Cox regression analysis, the time domain indices lnSDNN, lnASDNN and lnPNN30, as well as the frequency domain parameters lnTP, lnVLF and lnLF were associated with death and survived cardiac arrest.
ACHD is accompanied by HRV impairment that carries prognostic implications on ACHD mortality and survived SCD.
由于近年来诊断和治疗方面的进步，先天性心脏病（ACHD）患者的数量显著增加。这一成就因节律障碍而受到影响。在这里，我们试图确定心率变异性（HRV）的变化及其在 ACHD 中的预后价值。
97 例 ACHD 患者（39.2±14.1 岁，51.5%为女性）和 19 名对照者（39.7±15.0 岁，47.4%为女性）接受了 24 小时动态心电图监测。
与对照组相比，ACHD 患者的室性期前收缩负担明显更高（p=0.02），且 HRV 指数降低（极低频的自然对数转换（lnVLF）：7.46±0.76ms 与 7.91±0.92ms，p=0.03；低频的自然对数转换（lnLF）：6.39±0.95ms 与 7.01±1.07ms，p=0.01；低频与高频谱之比的自然对数转换（lnLF/HF）：0.81±0.74 与 1.17±0.51，p=0.04）。ACHD 病变组之间 HRV 测量值无差异。NT-proBNP 水平与时间和频域指数均显著相关（NN 间期标准差的自然对数转换（lnSDNN）：Spearman´s rho=-0.32，p=0.001；24 小时动态心电图监测中每 5 分钟 NN 间期平均值的标准差的自然对数转换（lnSDANN）：Spearman´s rho：-0.33，p=0.001；总功率的自然对数转换（lnTP）：Spearman´s rho：-0.25，p=0.01；lnVLF：Spearman´s rho：-0.33，p=0.001；lnLF：Spearman´s rho：-0.35，p<0.001；lnLF/HF：Spearman´s rho：-0.34，p=0.001）。在平均 3.9±0.7 年的随访后，8 例患者死亡，3 例患者发生心源性猝死（SCD）。与无事件 ACHD 患者相比，死亡或发生 SCD 的患者的多项 HRV 参数明显较高（24 小时动态心电图监测中每 5 分钟 NN 间期平均值的标准差的自然对数转换（lnASDNN）：p=0.04；lnPNN30：p=0.04；lnVFL：p=0.03；lnLF：p<0.01）。单变量 Cox 回归分析显示，时域指标 lnSDNN、lnASDNN 和 lnPNN30 以及频域参数 lnTP、lnVLF 和 lnLF 与死亡和 SCD 存活相关。
ACHD 伴有 HRV 受损，对 ACHD 死亡率和 SCD 存活具有预后意义。
