Gyawali Bishal, Roto Dominick, Lachant Michael, White R James, Lachant Daniel
University of Rochester Medical Center, Pulmonary and Critical Care Rochester New York USA.
Pulm Circ. 2025 Feb 8;15(1):e70048. doi: 10.1002/pul2.70048. eCollection 2025 Jan.
Resting heart rate has been incorporated in REVEAL risk assessment. Rest and sleep heart rate variability (HRV) measured in the home setting could provide early insight into worsening physiology in patients with pulmonary arterial hypertension (PAH). We hypothesized continuous HRV monitoring in the home setting for 7 days would be a treatment responsive measure and be associated with outcomes in PAH. This was a prospective observational study completed at the University of Rochester. We recruited two groups, one with stable background therapy and another with therapy intensification during the study. MC10 Biostamp (continuous electrocardiogram heart rate monitoring) was worn for 7 days at baseline and follow up; stable patients completed monitoring twice within 4 weeks while treatment intensification patients were assessed 3 months later. HRV was calculated using MC10 proprietary algorithm. Baseline, follow up, and changes in heart rate and HRV (rest and sleep) were compared between the groups and correlated to clinical outcomes at 2 years. Periods of activity were excluded from analysis. Non-parametric testing was performed. Twenty-four (10 stable and 14 treatment intensification) PAH patients had paired monitoring sessions during sleep and rest. There were no statistical differences in heart rate or HRV values at baseline or follow-up within either stable PAH patients or those requiring treatment escalation. Additionally, the change in heart rate from baseline to follow-up did not differ significantly between the two groups. There was no difference in HRV between patients who had clinical worsening (parenteral therapy, hospitalization, or death) within 2 years, while elevated rest and sleep heart rate did predict clinical worsening at 2 years. Unlike left ventricular systolic failure, continuous HRV for 7 days in the home setting does not appear to improve assessment in PAH, and functional testing appears to be a better way to assess treatment response and risk for clinical worsening.
静息心率已被纳入REVEAL风险评估。在家中测量的静息和睡眠心率变异性（HRV）可为肺动脉高压（PAH）患者生理状况恶化提供早期洞察。我们假设在家中连续7天监测HRV将是一种对治疗有反应的指标，并与PAH的预后相关。这是一项在罗切斯特大学完成的前瞻性观察性研究。我们招募了两组患者，一组接受稳定的基础治疗，另一组在研究期间强化治疗。在基线和随访时佩戴MC10生物印记（连续心电图心率监测）7天；病情稳定的患者在4周内完成两次监测，而强化治疗的患者在3个月后进行评估。使用MC10专有算法计算HRV。比较两组之间的基线、随访情况以及心率和HRV（静息和睡眠）的变化，并将其与2年时的临床结局相关联。分析中排除活动期。进行非参数检验。24名（10名病情稳定和14名强化治疗）PAH患者在睡眠和静息时进行了配对监测。在病情稳定的PAH患者或需要升级治疗的患者中，基线或随访时的心率或HRV值没有统计学差异。此外，两组之间从基线到随访的心率变化没有显著差异。2年内出现临床恶化（接受肠外治疗、住院或死亡）的患者之间的HRV没有差异，而静息和睡眠心率升高确实可预测2年时的临床恶化。与左心室收缩功能衰竭不同，在家中连续7天监测HRV似乎并不能改善对PAH的评估，而功能测试似乎是评估治疗反应和临床恶化风险的更好方法。
