Bonaduce D, Petretta M, Piscione F, Indolfi C, Migaux M L, Bianchi V, Esposito N, Marciano F, Chiariello M
Institute of Internal Medicine, Cardiology and Heart Surgery, University of Federico II, Naples, Italy.
J Am Coll Cardiol. 1994 Aug;24(2):399-405. doi: 10.1016/0735-1097(94)90294-1.
This study evaluated the relation between reversible segmental left ventricular dysfunction and frequency domain measures of heart period variability in patients with coronary artery disease.
Heart period variability is frequently reduced in patients with coronary artery disease. However, the mechanisms of this reduction are still unclear.
Echocardiographic left ventricular wall motion and frequency domain measures of heart period variability were evaluated in 32 patients with one-vessel coronary artery disease before and 16 to 24 days after successful percutaneous transluminal coronary angioplasty. Of these, 12 patients (Group A) had normal and 20 patients (Group B) had abnormal regional wall motion. A control group of 15 healthy subjects (Group C) underwent 24-h Holter recording twice at 2-week intervals to check for spontaneous variations.
At baseline, low and high frequency power were lower in Group B than in Groups A and C, whereas no difference was detectable in ultra low and very low frequency and total power. After coronary angioplasty, regional wall motion and frequency domain measures of heart period variability were unchanged in Group A. In Group B the mean (+/- SD) summed segment score improved from 17.1 +/- 3.6 to 12.8 +/- 2.0 (p < 0.01), and mean low and high frequency power (logarithmic units) increased from 6.14 +/- 0.23 to 6.35 +/- 0.34 (p < 0.01) and from 5.43 +/- 0.32 to 5.68 +/- 0.52 (p < 0.01), respectively. Furthermore, low and high frequency power, lower at baseline in Group B than in the other two groups, were comparable in the three groups after coronary angioplasty.
This study demonstrates that segmental left ventricular dysfunction is involved in determining sympathovagal imbalance in patients with one-vessel coronary artery disease; the reversal of left ventricular dysfunction by successful coronary angioplasty improves the heart period power spectrum. Thus, alterations in cardiac geometry influence the discharge of afferent sympathetic mechanoreceptors, contributing to the derangement in autonomic control of heart rate.
本研究评估了冠状动脉疾病患者可逆性节段性左心室功能障碍与心搏周期变异性频域指标之间的关系。
冠状动脉疾病患者的心搏周期变异性常降低。然而，这种降低的机制仍不清楚。
对32例单支冠状动脉疾病患者在成功进行经皮腔内冠状动脉成形术前及术后16至24天进行超声心动图左心室壁运动及心搏周期变异性频域指标评估。其中，12例患者（A组）局部壁运动正常，20例患者（B组）局部壁运动异常。15名健康受试者组成的对照组（C组）每隔2周进行两次24小时动态心电图记录以检查自发变化。
基线时，B组的低频和高频功率低于A组和C组，而超低频、极低频功率及总功率无差异。冠状动脉成形术后，A组的局部壁运动及心搏周期变异性频域指标未改变。B组的平均（±标准差）节段积分从17.1±3.6改善至12.8±2.0（p<0.01），平均低频和高频功率（对数单位）分别从6.14±0.23增至6.35±0.34（p<0.01）以及从5.43±0.32增至5.68±0.52（p<0.01）。此外，B组基线时低于其他两组的低频和高频功率在冠状动脉成形术后在三组中相当。
本研究表明节段性左心室功能障碍参与了单支冠状动脉疾病患者交感迷走神经失衡的决定；成功的冠状动脉成形术使左心室功能障碍逆转，改善了心搏周期功率谱。因此，心脏几何形状的改变影响传入交感神经机械感受器的放电，导致心率自主控制紊乱。
