Nolan J, Flapan A D, Reid J, Neilson J M, Bloomfield P, Ewing D J
University Department of Medicine, Royal Infirmary, Edinburgh.
Br Heart J. 1994 Jun;71(6):515-20. doi: 10.1136/hrt.71.6.515.
Previous studies have suggested that coronary artery disease is independently associated with reduced cardiac parasympathetic activity, and that this is important in its pathophysiology. These studies included many patients with complications that might be responsible for the reported autonomic abnormalities.
To measure cardiac parasympathetic activity in patients with uncomplicated coronary artery disease.
44 patients of mean (SD) age 56 (8) with severe uncomplicated coronary artery disease (symptoms uncontrolled on maximal medical treatment; > 70% coronary stenosis at angiography; normal ejection fraction; no evidence of previous infarction, diabetes, or hypertension). Heart rate variability was measured from 24 hour ambulatory electrocardiograms by counting the number of times successive RR intervals exceeded the preceding RR interval by > 50 ms, a previously validated sensitive and specific index of cardiac parasympathetic activity.
Mean (range) of counts were: waking 112 (range 6-501)/h, sleeping 198 (0-812)/h, and total 3912 (151-14 454)/24 h. These mean results were unremarkable, and < 10% of patients fell below the lower 95% confidence interval for waking, sleeping, or total 24 hour counts in normal people. There was no relation between the severity of coronary artery disease or the use of concurrent antianginal drug treatment and cardiac parasympathetic activity.
In contrast with previous reports no evidence of a specific independent association between coronary artery disease and reduced cardiac parasympathetic activity was found. The results of previous studies may reflect the inclusion of patients with complications and not the direct effect of coronary artery disease itself.
先前的研究表明，冠状动脉疾病与心脏副交感神经活动降低独立相关，且这在其病理生理学中具有重要意义。这些研究纳入了许多可能导致所报道的自主神经异常的并发症患者。
测量无并发症冠状动脉疾病患者的心脏副交感神经活动。
44例平均（标准差）年龄为56（8）岁的患者，患有严重的无并发症冠状动脉疾病（最大药物治疗下症状未得到控制；血管造影显示冠状动脉狭窄>70%；射血分数正常；无既往梗死、糖尿病或高血压证据）。通过计算连续RR间期超过前一个RR间期>50毫秒的次数，从24小时动态心电图测量心率变异性，这是先前验证过的心脏副交感神经活动的敏感且特异指标。
计数的平均值（范围）为：清醒时112（范围6 - 501）/小时，睡眠时198（0 - 812）/小时，24小时总计3912（151 - 14454）/24小时。这些平均结果无异常，且<10%的患者低于正常人清醒、睡眠或24小时总计计数的95%置信区间下限。冠状动脉疾病的严重程度或同时使用抗心绞痛药物治疗与心脏副交感神经活动之间无关联。
与先前的报道相反，未发现冠状动脉疾病与心脏副交感神经活动降低之间存在特定独立关联的证据。先前研究的结果可能反映了纳入了有并发症的患者，而非冠状动脉疾病本身的直接影响。
