应用HRV评价急性心梗患者自主神经功能

Evaluation of autonomic nerve function by using heart rate variability in patients with acute myocardial infarction

目的探讨急性心肌梗死(AMI)患者动态心电图心率变异性(HRV)的特点,并分析其对AMI患者心脏自主神经功能的评判作用。方法选取2020年11月至2021年11月武汉大学中南医院收治的245例患者,根据临床症状、辅助检查及冠脉造影分为ST段抬高型心肌梗死(STEMI)组、非ST段抬高型心肌梗死(NSTEMI)组和对照组。比较三组患者的一般资料、超声心动图指标,动态心电图HRV各项指标,分析HRV对心脏自主神经功能的评判作用。结果STEMI及NSTEMI组SDNN、SDANN及TRIIDX明显低于对照组(p<0.05),三组RMSSD、LF、HF及LF/HF比较无明显差异(p>0.05)。急性心肌梗死伴左室射血分数(LVEF)值下降与LVEF值正常组比较,SDNN、SDANN、TRIIDX等均降低(p<0.05)。ROC曲线分析显示,HRV各指标可以用于评判冠脉正常的准确度、特异度及敏感度。SDNN分别为82.9%、83.7%、68.5%(p<0.001);SDANN分别为85.4%、77.8%、79.8%(p<0.001);TRIIDX分别为83.4%、80.4%、75.3%(p<0.001)。结论心率变异性SDNN、SDANN、TRIIDX等指标与急性STEMI及NSTEMI是否伴LVEF值下降有一定的相关性,可作为评判急性STEMI及NSTEMI患者心脏自主功能的重要指标。

Objective To investigate the characteristics of heart rate variability(HRV)recorded by ambulate electrocardiogram(ACG)in patients with acute myocardial infarction(AMI),and to explore the role of HRV in evaluating cardiac autonomic nerve function.Methods A total of 245 patients admitted to Zhongnan Hospital of Wuhan University from November 2020 to November 2021 were enrolled and divided into STEMI,NSTEMI and Control groups according to the clinical symptoms,auxiliary examination and coronary angiography.The general data and echocardiography of the patients were compared,and the index of HRVwere collected to evaluatethe cardiac autonomic nerve function.Results SDNN,SDANN and TRIIDX in STEMI and NSTEMI patients were significantly lower than those in control group,but there was no significant difference in RMSSD,LF,HF and LF/HF among the three groups.Compared to the group with normal left ventricular ejection fraction(LVEF),the SDNN,SDANN and TRIIDX in patients with acute myocardial infarction with decreased LVEF were significantly lower(p<0.05).ROC curve was used to show the accuracy,specificity and sensitivity of HRV in identifying patients with normal coronary artery.For SDNN,it was 82.9%,83.7% and 68.5%,respectively(p<0.001).For SDANN,it was 85.4%,77.8% and 79.8%,respectively(p<0.001).For TRIIDX,it was 83.4%,80.4% and 75.3%,respectively(p<0.001).Conclusions SDNN,SDANN,TRIIDX and other indicators in HRV are related to a decrease of LVEF in patients with STEMI or NSTEMI,which can be used as important indicators to evaluate the cardiac autonomic function in patients with acute STEMI and NSTEMI.