Pousset F, Copie X, Lechat P, Jaillon P, Boissel J P, Hetzel M, Fillette F, Remme W, Guize L, Le Heuzey J Y
Département de Cardiologie, Hôpital Broussais, Paris, France.
Am J Cardiol. 1996 Mar 15;77(8):612-7. doi: 10.1016/s0002-9149(97)89316-2.
Analysis of heart rate variability (HRV) provides a non-invasive index of autonomic nervous system activity. HRV has been shown to be reduced in heart failure. Preliminary data indicate that beta blockers improve clinical status in patients with heart failure, but HRV improvement remains to be demonstrated. Fifty-four patients from the randomized double-blind, placebo-controlled Cardiac Insufficiency Bisoprolol Study were included in the HRV study. The bisoprolol daily dose was 5 mg once daily. We assessed HRV during 24-hour Holter recordings before randomization and after 2 months of treatment. HRV as measured in the time domain by root-mean-square successive differences (rMSSD), the percentage of adjacent RR differences >50 ms (pNN50), and the SD of RR intervals (SDNN), and in the frequency domain by high-frequency (0.16 to 0.40 Hz) and low-frequency (0.04 to 0.15 Hz) power. Most patients were in New York Heart Association functional class III. The mean left ventricular ejection fraction was 27 +/- 7%, and heart failure was idiopathic or ischemic. After 2 months, the patients receiving bisoprolol had a reduced mean heart rate compared with that in placebo patients (p=0.0004). Bisoprolol increased 24-hour rMSSD (p=0.04) and 24-hour pNN50 (p=0.04), daytime SDNN (p=0.05), and daytime high-frequency power (p=0.03) power. Bisoprolol induced a significant increase in HRV parameters related to parasympathetic activity in heart failure. Increased vagal tone may contribute to the protective effect of beta blockers and may have prognostic implications.
心率变异性（HRV）分析提供了一种自主神经系统活动的非侵入性指标。心力衰竭患者的HRV已被证实降低。初步数据表明，β受体阻滞剂可改善心力衰竭患者的临床状况，但HRV的改善仍有待证实。来自随机双盲、安慰剂对照的比索洛尔治疗心力衰竭研究的54例患者被纳入HRV研究。比索洛尔的每日剂量为5mg，每日一次。我们在随机分组前和治疗2个月后通过24小时动态心电图记录评估HRV。HRV在时域通过均方根连续差值（rMSSD）、相邻RR间期差值>50ms的百分比（pNN50）以及RR间期标准差（SDNN）进行测量，在频域通过高频（0.16至0.40Hz）和低频（0.04至0.15Hz）功率进行测量。大多数患者为纽约心脏协会心功能Ⅲ级。平均左心室射血分数为27±7%，心力衰竭为特发性或缺血性。2个月后，与安慰剂组患者相比，接受比索洛尔治疗的患者平均心率降低（p=0.0004）。比索洛尔使24小时rMSSD（p=0.04）、24小时pNN50（p=0.04）、日间SDNN（p=0.05）和日间高频功率（p=0.03）增加。比索洛尔使与心力衰竭患者副交感神经活动相关的HRV参数显著增加。迷走神经张力增加可能有助于β受体阻滞剂的保护作用，并且可能具有预后意义。
