Tsuji H, Venditti F J, Manders E S, Evans J C, Larson M G, Feldman C L, Levy D
Lahey Clinic Medical Center, Burlington, Mass.
Circulation. 1994 Aug;90(2):878-83. doi: 10.1161/01.cir.90.2.878.
The prognostic implications of alterations in heart rate variability have not been studied in a large community-based population.
The first 2 hours of ambulatory ECG recordings obtained on original subjects of the Framingham Heart Study attending the 18th biennial examination were reprocessed to assess heart rate variability. Subjects with transient or persistent nonsinus rhythm, premature beats > 10% of total beats, < 1 hour of recording time, processed time < 50% of recorded time, and those taking antiarrhythmic medications were excluded. The associations between heart rate variability measures and all-cause mortality during 4 years of follow-up were assessed. There were 736 eligible subjects with a mean age (+/- SD) of 72 +/- 6 years. The following five frequency domain measures and three time domain measures were obtained: very-low-frequency power (0.01 to 0.04 Hz), low-frequency power (0.04 to 0.15 Hz), high-frequency power (0.15 to 0.40 Hz), total power (0.01 to 0.40 Hz), the ratio of low-frequency to high-frequency power, the standard deviation of total normal RR intervals, the percentage of differences between adjacent normal RR intervals that are > 50 milliseconds, and the square root of the mean of the squared differences between adjacent normal RR intervals. During follow-up, 74 subjects died. In separate proportional hazards regression analyses that adjusted for relevant risk factors, very-low-frequency power (P < .0001), low-frequency power (P < .0001), high-frequency power (P = .0014), total power (P < .0001), and the standard deviation of total normal RR intervals (P = .0019) were significantly associated with all-cause mortality. When all eight heart rate variability measures were assessed in a stepwise analysis that included other risk factors, low-frequency power entered the model first (P < .0001); thereafter, none of the other measures of heart rate variability significantly contributed to the prediction of all-cause mortality. A 1 SD decrement in low-frequency power (natural log transformed) was associated with 1.70 times greater hazard for all-cause mortality (95% confidence interval of 1.37 to 2.09).
The estimation of heart rate variability by ambulatory monitoring offers prognostic information beyond that provided by the evaluation of traditional risk factors.
心率变异性改变的预后意义尚未在大规模社区人群中进行研究。
对参加第18次两年一次检查的弗雷明汉心脏研究原始受试者的动态心电图记录的前2小时进行重新处理，以评估心率变异性。排除有短暂或持续性非窦性心律、早搏超过总心搏数10%、记录时间<1小时、处理时间<记录时间50%的受试者，以及正在服用抗心律失常药物的受试者。评估心率变异性指标与4年随访期间全因死亡率之间的关联。共有736名符合条件的受试者，平均年龄（±标准差）为72±6岁。获得了以下五个频域指标和三个时域指标：极低频功率（0.01至0.04Hz）、低频功率（0.04至0.15Hz）、高频功率（0.15至0.40Hz）、总功率（0.01至0.40Hz）、低频与高频功率之比、正常RR间期总和的标准差、相邻正常RR间期差异>50毫秒的百分比，以及相邻正常RR间期平方差均值的平方根。随访期间，74名受试者死亡。在调整了相关危险因素的单独比例风险回归分析中，极低频功率（P<.0001）、低频功率（P<.0001）、高频功率（P=.0014）、总功率（P<.0001）以及正常RR间期总和的标准差（P=.0019）与全因死亡率显著相关。当在包括其他危险因素的逐步分析中评估所有八个心率变异性指标时，低频功率首先进入模型（P<.0001）；此后，心率变异性的其他指标均未对全因死亡率的预测有显著贡献。低频功率（自然对数转换）每降低1个标准差与全因死亡率风险增加1.70倍相关（95%置信区间为1.37至2.09）。
通过动态监测评估心率变异性可提供超出传统危险因素评估的预后信息。
