Department of Pediatric Cardiology, Faculty of Medicine, Mersin University, Mersin, Turkey.
Department of Biostatistics and Medical Informatics, Faculty of Medicine, Mersin University, Mersin, Turkey.
Cardiol Young. 2024 Feb;34(2):421-427. doi: 10.1017/S1047951123004377. Epub 2024 Feb 2.
In pediatric multisystem inflammatory syndrome and isolated viral myocarditis/myopericarditis, autonomic nervous system function can be evaluated by a non-invasive method called heart rate variability. This study aims to evaluate heart rate variability in these two groups by comparing them with each other. This is the first study assessing these values in these two groups of patients.
Patients who are diagnosed with multisystem inflammatory syndrome in children and isolated viral myocarditis/myopericarditis at a university hospital from September 2021 to February 2023 are screened by electrocardiography, echocardiography, and 24-hour Holter monitoring. A healthy control group, compatible in age and gender with the patient groups, was selected from healthy subjects that applied to the hospital for palpitation, murmur, and/or chest pain. Heart rate variability parameters and related laboratory markers were analyzed and compared among the three groups.
There were 30 patients with multisystem inflammatory syndrome in children, 43 patients with isolated viral myocarditis/myopericarditis, and 109 participants in the healthy control group. Statistically significant differences were found in most of the heart rate variability parameters: standard deviation of normal to normal intervals (SDNN), the mean of the 5- minute RR interval standard deviations (SDNNİ), the standard deviation of 5-minute R wave to R wave(RR) interval means (SDANN), the root mean square of successive RR interval differences (RMSSD), and the percentage of the beats with a consecutive RR interval difference of more than 50 ms (pNN50%), very low frequency, high frequency, low frequency, triangular index, and low frequency/high-frequency ratio. Multisystem inflammatory syndrome in children patients had impaired and declined heart rate variability values compared to the other two groups. In patients with myocarditis/myopericarditis, we couldn't find a significant difference in these parameters with the control group.
Heart rate variability can be used as an important non-invasive autonomic function parameter in determining prognosis and treatment plans, especially in patients diagnosed with multisystem inflammatory syndrome in children. This impairment of autonomic activity could be more prominent in patients with decreased left ventricular systolic functions.
在儿科多系统炎症综合征和孤立性病毒性心肌炎/心包炎中，可以通过一种称为心率变异性的非侵入性方法来评估自主神经系统功能。本研究旨在通过相互比较来评估这两组患者的心率变异性。这是首次在这两组患者中评估这些值的研究。
通过心电图、超声心动图和 24 小时动态心电图监测，筛选 2021 年 9 月至 2023 年 2 月在一所大学医院诊断为儿童多系统炎症综合征和孤立性病毒性心肌炎/心包炎的患者。从因心悸、杂音和/或胸痛到医院就诊的健康受试者中选择年龄和性别与患者组相匹配的健康对照组。分析并比较三组之间的心率变异性参数和相关实验室标志物。
共有 30 例儿童多系统炎症综合征患者、43 例孤立性病毒性心肌炎/心包炎患者和 109 例健康对照组患者。大多数心率变异性参数存在统计学显著差异：正常-正常间期标准差（SDNN）、5 分钟 RR 间期标准差均值（SDNNİ）、5 分钟 R 波至 R 波（RR）间期均值标准差（SDANN）、连续 RR 间期差值的均方根（RMSSD）和连续 RR 间期差值大于 50ms 的心跳百分比（pNN50%）、极低频、高频、低频、三角指数和低频/高频比。与其他两组相比，儿童多系统炎症综合征患者的心率变异性值受损且下降。在心肌炎/心包炎患者中，我们没有发现这些参数与对照组之间存在显著差异。
心率变异性可作为确定预后和治疗计划的重要非侵入性自主功能参数，尤其是在诊断为儿童多系统炎症综合征的患者中。这种自主活动的损害在左心室收缩功能降低的患者中可能更为明显。
