冠心病患者冠状动脉病变与心率变异性的关系

Correlation between heart rate variability and coronary artery pathology in patients with coronary artery disease

目的了解冠心病患者冠状动脉病变与心率变异性(HRV)的关系。方法回顾性分析111例患者冠状动脉造影及24小时动态心电图检查资料,按冠状动脉造影结果分为3组:冠状动脉造影完全正常(正常组)、至少有一支冠状动脉狭窄>50%(狭窄组)、至少有一支冠状动脉完全阻塞(闭塞组);通过动态心电图检查分析HRV的时域指标:SDNN、SDANNind、SDNNind、rMSSD、PNN50。结果①随冠状动脉狭窄程度加重,SDNN、SDANNind、SDNNind逐渐下降,完全阻塞组这些指标下降最显著;②随冠状动脉病变支数增加,SDNN、SDANNind、SDNNind、rMSSD、PNN50有进一步下降趋势,但只有3支病变HRV下降才有统计学意义;③左冠状动脉病变SDNN、SDAN-Nind显著下降,而右冠状动脉病变下降不显著。结论冠心病患者HRV显著下降提示冠状动脉狭窄程度重、病变范围广、病变在左冠状动脉。

AIM To study the correlation between the heart rate variability （HRV） and the coronary artery pathology in patients with coronary artery disease （CAD）. METHODS One hundred and eleven patients who had had coronary angiography （CAG） studied. The subjects were classified into three groups and 24 h ECG Hoher record were retrospectively according to coronary artery pathology in CAG： no abnormality in all coronary artery （n =43）, narrowing 〉50% （n =43） and total occlusion （n =25） at least in one of coronary artery. In each subject, a 24 h ECG Holter tape had been recorded and subse- quently analyzed to obtain time-domain HRV （ SDNN, SDANNind, SDNNind, Rmssd, PNN50 ）. RESULTS ①SDNN, SDANNind and SDNNind lowered with the degree of coronary narrowing and were the lowest in subjects with total occlusion. to be lower with the increasing number of ② SDNN, SDANNind, SDNNind, rMSSD and PNN50 tended coronary artery abnormality. But the change was significant only in subjects who had abnormality in all the three coronary arteries. ③ SDNN and SDANNind were signifi- cantly lower in subjects with left coronary artery abnormality but not in those with right coronary artery abnormality. CONCLUSION The findings that HRV is significantly lower in patients with coronary artery disease indicate that patients with CAD may have total occlusion in one of the coronary arteries, severe narrowing in all the three coronary arteries and severe narrowing in the left coronary artery.