Stein K M, Borer J S, Hochreiter C, Okin P M, Herrold E M, Devereux R B, Kligfield P
Department of Medicine, New York Hospital-Cornell Medical Center, New York 10021.
Circulation. 1993 Jul;88(1):127-35. doi: 10.1161/01.cir.88.1.127.
A variety of measures of heart rate variability have been devised to measure high-frequency (0.15-0.40 Hz), low-frequency (0.04-0.15 Hz), or ultralow-frequency (< 0.0033 Hz) fluctuations in sinus cycle length. Although measures of low-frequency and ultralow-frequency heart rate variability have been shown to correlate with prognosis in several populations with ischemic heart disease, their relevance to patients with primary valvular heart disease remains to be determined.
Thirty-eight patients with nonischemic causes of chronic severe mitral regurgitation who were in sinus rhythm underwent 24-hour ambulatory electrocardiography as part of a prospective study of the natural history of regurgitant valvular heart disease. Patients were followed for as long as 9.2 years, and end points of mortality, progression to mitral valve surgery, and development of chronic atrial fibrillation were tabulated. Time- and frequency-domain measurements of high-frequency, low-frequency, and ultralow-frequency heart rate variability were computed and compared with resting ventricular function by radionuclide cineangiography and outcome. The standard deviation of the 5-minute mean RR intervals (SDANN), a measure of ultralow-frequency heart rate variability, was correlated with left ventricular ejection fraction (r = 0.49, p = 0.002) and right ventricular ejection fraction (r = 0.43, p = 0.007), whereas low-frequency and high-frequency heart rate variabilities were not. Heart rate, ultralow-frequency heart rate variability, and, to a lesser extent, high-frequency heart rate variability exhibited significant diurnal variation, but low-frequency heart rate variability did not. Heart rate and ultralow-frequency, low-frequency, and combined low- and high-frequency heart rate variability predicted mortality and total events. The most powerful predictor of subsequent events was SDANN: Patients with reduced SDANN were significantly more likely to develop end-point events (p < 0.001) with increased progression to mitral valve surgery (p < 0.001) as well as increased early mortality (p = 0.02). In a multivariate proportional hazards model, SDANN retained independent predictive power (p = 0.001). Likewise, SDANN was the only variable that was significantly associated with the subsequent development of atrial fibrillation (relative risk, 3.1; p = 0.03).
Ultralow-frequency heart rate variability, as measured by SDANN, correlates with right and left ventricular performance and predicts development of atrial fibrillation, mortality, and progression to valve surgery in patients with chronic severe mitral regurgitation.
已设计出多种心率变异性测量方法，用于测量窦性周期长度中的高频（0.15 - 0.40赫兹）、低频（0.04 - 0.15赫兹）或超低频（< 0.0033赫兹）波动。尽管在一些缺血性心脏病患者群体中，低频和超低频心率变异性测量已显示与预后相关，但其与原发性瓣膜性心脏病患者的相关性仍有待确定。
作为反流性瓣膜性心脏病自然史前瞻性研究的一部分，38例慢性重度二尖瓣反流非缺血性病因且处于窦性心律的患者接受了24小时动态心电图检查。对患者进行长达9.2年的随访，并将死亡、进展至二尖瓣手术以及慢性房颤发生等终点事件制成表格。计算高频、低频和超低频心率变异性的时域和频域测量值，并通过放射性核素电影血管造影术与静息心室功能及结局进行比较。5分钟平均RR间期的标准差（SDANN），一种超低频心率变异性测量指标，与左心室射血分数（r = 0.49，p = 0.002）和右心室射血分数（r = 0.43，p = 0.007）相关，而低频和高频心率变异性则不然。心率、超低频心率变异性以及在较小程度上的高频心率变异性表现出显著的昼夜变化，但低频心率变异性没有。心率和超低频、低频以及低频与高频合并的心率变异性可预测死亡率和总事件。后续事件的最强预测指标是SDANN：SDANN降低的患者发生终点事件的可能性显著更高（p < 0.001），进展至二尖瓣手术的比例增加（p < 0.001）以及早期死亡率增加（p = 0.02）。在多变量比例风险模型中，SDANN保留了独立的预测能力（p = 0.001）。同样，SDANN是唯一与随后房颤发生显著相关的变量（相对风险，3.1；p = 0.03）。
通过SDANN测量的超低频心率变异性与慢性重度二尖瓣反流患者的左右心室功能相关，并可预测房颤的发生、死亡率以及进展至瓣膜手术的情况。
