Tsuji H, Venditti F J, Manders E S, Evans J C, Larson M G, Feldman C L, Levy D
Kansai Medical University, Osaka, Japan.
J Am Coll Cardiol. 1996 Nov 15;28(6):1539-46. doi: 10.1016/s0735-1097(96)00342-7.
This study sought to examine clinical determinants of heart rate variability and to report normative reference values for eight heart rate variability measures.
Although the clinical implications of heart rate variability have been described, clinical determinants and normative values of heart rate variability measures have not been studied systematically in a large community-based population.
The first 2 h of ambulatory electrocardiographic recordings obtained in Framingham Heart Study subjects attending a routine examination were reprocessed for heart rate variability. Recordings with transient or persistent nonsinus rhythm, premature beats > 10% of total beats, < 1-h recording time or processed time < 50% of recorded time were excluded; subjects receiving antiarrhythmic medications also were excluded. Among five frequency domain and three time domain measures that were obtained, low frequency power (0.04 to 0.15 Hz), high frequency power (0.15 to 0.40 Hz) and the standard deviation of total normal RR intervals based on 2-h recordings were selected for the principal analyses. Variables with potential physiologic effects or possible technical influences on heart rate variability measures were chosen for multiple linear regression analysis. Normative values, derived from a subset of healthy subjects, were adjusted for age and heart rate.
There were 2,722 eligible subjects with a mean age (+/-SD) of 55 +/- 14 years. Three separate multiple linear regression analyses revealed that higher heart rate, older age, beta-adrenergic blocking agent use, history of myocardial infarction or congestive heart failure, diuretic use, diastolic blood pressure > or = 90 mm Hg, diabetes mellitus, consumption of three or more cups of coffee per day and smoking were associated with lower values of one or more heart rate variability measures, whereas longer processed time, start time in the morning, frequent supraventricular and ventricular premature beats, female gender and systolic blood pressure > or = 160 mm Hg were associated with higher values. Age and heart rate were the major determinants of all three selected heart rate variability measures (partial R2 values 0.125 to 0.389). Normative reference values for all eight heart rate variability measures are presented.
Age and heart rate must be taken into account when assessing heart rate variability.
本研究旨在探讨心率变异性的临床决定因素，并报告八项心率变异性测量指标的正常参考值。
尽管心率变异性的临床意义已得到描述，但心率变异性测量指标的临床决定因素和正常参考值尚未在大规模社区人群中进行系统研究。
对参加常规检查的弗雷明汉心脏研究受试者的动态心电图记录的前2小时进行重新处理以分析心率变异性。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小时或处理时间<记录时间50%的记录；接受抗心律失常药物治疗的受试者也被排除。在所获得的五个频域和三个时域测量指标中，选择低频功率（0.04至0.15Hz）、高频功率（0.15至0.40Hz）以及基于2小时记录的正常RR间期总标准差进行主要分析。选择对心率变异性测量指标有潜在生理影响或可能技术影响的变量进行多元线性回归分析。从健康受试者子集中得出的正常参考值根据年龄和心率进行了调整。
共有2722名符合条件的受试者，平均年龄（±标准差）为55±14岁。三项独立的多元线性回归分析显示，心率较高、年龄较大、使用β-肾上腺素能阻滞剂、有心肌梗死或充血性心力衰竭病史、使用利尿剂、舒张压≥90mmHg、糖尿病、每天饮用三杯或更多咖啡以及吸烟与一项或多项心率变异性测量指标值较低相关，而处理时间较长、上午开始记录、频繁的室上性和室性早搏、女性以及收缩压≥160mmHg与较高的值相关。年龄和心率是所有三项选定的心率变异性测量指标的主要决定因素（偏R2值为0.125至0.389）。给出了所有八项心率变异性测量指标的正常参考值。
评估心率变异性时必须考虑年龄和心率。
