Arribas Jiménez A, Martín Luengo C, Pérez Méndez A, Castaño Bazo L, Nieto Ballesteros F, Pabón Osuna P, Diego Domínguez M, Sáez Jiménez A, Santos Rodríguez I, Rodríguez Collado J
Servicio de Cardiología, Hospital Universitario, Salamanca.
Rev Esp Cardiol. 1996 Jan;49(1):29-34.
BACKGROUND: The influence of ventricular function (VF) on prognosis in acute myocardial infarction (AMI) is well known. Heart rate variability (HRV), as a neurohumoral parameter could predict VF after discharge in AMI patients. Our goal is to investigate the possible relation among HRV, VF and another clinical variables in AMI. PATIENTS AND METHODS: We studied 37 patients with AMI after hospital discharge. Age, AMI type, location, enzymes, treatment (thrombolysis versus no thrombolysis) were evaluated. The left ventricular ejection fraction (LVEF) was assessed by radionuclide ventriculography in 27 subjects. Twenty nine subjects without cardiopathy were the control group. Twenty four hour electrocardiographic recordings were obtained and a proper software was used to measure HRV. This was evaluated with time domain measures: RR interval, standard deviation of the mean RR interval (SDNN), standard deviation of the average of the RR intervals measured every 5 minutes during 24 hours (SDANN) and number of two consecutive RR intervals with a variability > 50 ms (pNN50). We considered a decreased variability if SDANN was less than 100 ms. Two groups were established: 1) low heart rate variability (LHRV) if SDANN was less than 100 ms, and 2) normal heart rate variability (NHRV) if SDANN was larger than 100 ms. Continuous variables were examined by the t-test, chi square for discrete ones and linear regression analysis was used to assess the relation among variables. A p < 0.05 was considered significant. RESULTS: The percentage of infarcted patients in the group of LHRV is 75%, whereas it is 14% in the control group (p < 0.05). SDANN, SDNN and pNN50 values are significantly lower (p < 0.05) in the AMI than in the control group. LHRV was more frequent in patients with complicated AMI with congestive heart failure. LVEF was significantly lower (35% vs 56%) in the LHRV than in the NHRV group. No significant differences were found among: site, type infarct, treatment or ventricular ectopy in the Holter before discharge. There is good correlation (r = 0.635; p < 0.05) between LVEF and HRV measures. No correlation was found between HRV and age, or the enzymatic size of infarction. CONCLUSIONS: 1) LHRV is frequent in the late phase of AMI, and 2) LHRV can be an indirect index of left ventricular failure.
背景：心室功能（VF）对急性心肌梗死（AMI）预后的影响众所周知。心率变异性（HRV）作为一种神经体液参数，可预测AMI患者出院后的心室功能。我们的目标是研究HRV、心室功能与AMI其他临床变量之间的可能关系。 患者与方法：我们研究了37例AMI出院后的患者。评估了年龄、AMI类型、部位、酶、治疗（溶栓与未溶栓）情况。27例受试者通过放射性核素心室造影评估左心室射血分数（LVEF）。29例无心脏病的受试者作为对照组。进行24小时心电图记录，并使用合适的软件测量HRV。通过时域测量进行评估：RR间期、平均RR间期标准差（SDNN）、24小时内每5分钟测量的RR间期平均值的标准差（SDANN）以及两个连续RR间期变异性>50 ms的数量（pNN50）。如果SDANN小于100 ms，我们认为变异性降低。分为两组：1）如果SDANN小于100 ms，则为低心率变异性（LHRV）组；2）如果SDANN大于100 ms，则为正常心率变异性（NHRV）组。连续变量采用t检验，离散变量采用卡方检验，线性回归分析用于评估变量之间的关系。p<0.05被认为具有统计学意义。 结果：LHRV组梗死患者的百分比为75%，而对照组为14%（p<0.05）。AMI组的SDANN、SDNN和pNN50值显著低于对照组（p<0.05）。LHRV在合并充血性心力衰竭的复杂AMI患者中更常见。LHRV组的LVEF显著低于NHRV组（35%对56%）。出院前动态心电图的梗死部位、类型、治疗或室性早搏之间未发现显著差异。LVEF与HRV测量值之间存在良好的相关性（r=0.635；p<0.05）。未发现HRV与年龄或梗死酶学大小之间存在相关性。 结论：1）LHRV在AMI后期很常见；2）LHRV可能是左心室衰竭的间接指标。
Acta Med Croatica. 2003
Kardiol Pol. 2003-1
Med Sci Monit. 2004-7
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