Mehrabanian Mohammad Javad, Dehghani Firoozabadi Mehdi, Nooralishahi Behrang, Zamani Afarin, Kachoueian Naser
Department of Anesthesiology, Tehran Heart Center, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
Department of Cardiac Surgery, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
J Tehran Heart Cent. 2024 Oct;19(4):264-269. doi: 10.18502/jthc.v19i4.17611.
Heart rate variability (HRV) is known to play a significant role in predicting poor prognosis after acute myocardial infarction. Nonetheless, its potential for predicting long-term adverse outcomes following revascularization procedures remains unclear. This study aims to elucidate this relationship.
This prospective cohort study included 258 consecutive patients undergoing elective isolated coronary artery bypass grafting (CABG). All patients required ICU referral before hospital discharge. A 3-week cardiac rehabilitation program with 24-hour ECG Holter monitoring was planned for all patients. HRV was analyzed by computer and manually over-read. During a follow-up period ranging from 1 to 3 years, patients were contacted via phone to assess long-term outcomes, including death and major adverse cardiovascular events (MACE), such as myocardial infarction, reoperation, or brain stroke.
Out of 258 patients (177 males and 81 females) with an average age of 58.80±9.60 years, 4.3% of patients died due to cardiovascular events, and 15.1% experienced long-term MACE. A comparison of HRV indicators between the non-surviving and surviving subgroups revealed significantly lower mean RR, mean standard deviation of normal-to-normal HRV interval (SDNN), and low and high-frequency values in the former group. However, when comparing HRV indicators between the subgroups with and without long-term MACE, no significant differences were observed. Cox proportional hazard analysis demonstrated that decreased HRV (SDNN) effectively predicted long-term mortality in patients who underwent CABG.
Lower postoperative HRV serves as a valuable predictor of long-term mortality after CABG in ICU patients, with reduced SDNN values particularly relevant for anticipating long-term adverse events.
心率变异性（HRV）在预测急性心肌梗死后的不良预后中起着重要作用。尽管如此，其在预测血运重建术后长期不良结局方面的潜力仍不明确。本研究旨在阐明这种关系。
这项前瞻性队列研究纳入了258例连续接受择期单纯冠状动脉旁路移植术（CABG）的患者。所有患者在出院前均需转诊至重症监护病房（ICU）。计划为所有患者开展为期3周的心脏康复计划，并进行24小时动态心电图监测。通过计算机分析HRV，并进行人工复查。在1至3年的随访期内，通过电话联系患者以评估长期结局，包括死亡和主要不良心血管事件（MACE），如心肌梗死、再次手术或中风。
258例患者（177例男性和81例女性），平均年龄为58.80±9.60岁，4.3%的患者死于心血管事件，15.1%的患者经历了长期MACE。非存活亚组和存活亚组之间的HRV指标比较显示，前者的平均RR、正常到正常HRV间期的平均标准差（SDNN）以及低频和高频值显著更低。然而，在比较有和没有长期MACE的亚组之间的HRV指标时，未观察到显著差异。Cox比例风险分析表明，HRV降低（SDNN）可有效预测接受CABG患者的长期死亡率。
术后较低的HRV是ICU患者CABG术后长期死亡率的有价值预测指标，SDNN值降低对于预测长期不良事件尤为重要。
