Assessment of Cardiac Autonomic Function by Using Heart Rate Turbulence in Behcet’s Disease

Behcet’s disease (BD) is a chronic inflammatory disorder that can affect many systems in the body. Cardiac involvement increases the risk of cardiovascular mortality and occurs in 1%-5% of patients with BD. Ventricular arrythmias are believed to be the cause of this increased risk of cardiovascular mortality and it is also thought to be related with cardiac autonomic dysfunction. Heart rate turbulence (HRT) is a new predictor of cardiac autonomic activity. HRT is an independent and powerful predictor of mortality. In this study, we investigated the cardiac autonomic activity which can be determined by HRT in patients with BD. Forty patients with BD (20 men, mean age: 40 ± 9 years, range: 27-55 years) were diagnosed according to the International Study Group Criteria (ISGC) and gender and age matched healthy volunteers (20 men, mean age: 39 ± 8 years, range: 26-56 years) were included in this study. All of the participants (patients and controls) underwent 24 hours Holter electrocardiogram. HRT parameters, turbulence onset (TO) and turbulence slope (TS) were calculated with HRT (View Version 0.60-0.1 of Software Program). There were no significant differences in TO and TS values between patients with BD and control subject (TO-BD: 0.014 ± 0.03, TO-Control: 0.011 ± 0.04;TS-BD: 7.88 ± 4.9, TS-Control: 9.42 ± 6.7 respectively). Although increased cardiovascular mortality rates in BD have been shown in many studies, HRT values—detecting the risk of sudden death—do not seem to be altered in this disease.

Effects of Combined Therapy of Xuezhikang Capsule(血脂康胶囊)and Valsartan on Hypertensive Left Ventricular Hypertrophy and Heart Rate Turbulence

Objective：To observe the effect of combined therapy with Xuezhikang Capsule（血脂康胶囊,XZK） and Valsartan on left ventricular hypertrophy（LVH） and heart rate turbulence（HRT） in hypertensive patients. Methods：Ninety primary hypertensive patients with LVH were randomly assigned to three groups.Basic treatment,including aspirin,β-blockers,calcium antagonists,etc.were administered to all patients.Additionally, Valsartan（VS,80 mg once a day） was given to the 30 patients in the VS group.Valsartan（in the same dosage） and XZK（600 mg,twice a day） were given to the 32 patients in the Chinese medicine（CM） group,while none was given to the 28 patients in the control group.The therapeutic course lasted for 24 months.Changes in left ventricular mass index（LVMI） measured by cardiac ultrasonic indices,HRT parameters,including the original heart rate（TO） and slope coefficient（TS）,systolic and diastolic blood pressures（SBP and DBP）,as well as blood cholesterol level（TC） were measured before and after treatment.Results：After treatment,TO and LVMI were lowered,while TS increased in both the VS group and the CM group（P〈0.01）,but changed insignificantly in the control group.Significant differences between the CM group and the control group were shown in terms of TO,LVMI,SBP,DBP and TS（P〈0.01）;and between the CM group and the VS group in terms of TO,LVMI and TS（P〈0.01）.Moreover,HRT parameters showed an evident correlation with LVMI（r=0.519-0.635,P〈0.01）. Conclusion：Combined therapy with XZK and Valsartan can improve hypertensive LVH and HRT parameters, and lessen the damage on the autonomous nervous system.

Clinical Efficacy of Ningxin Tongluo Decoction(宁心通络汤)Combined with Dapagliflozin on Patients of Type 2 Diabetes Mellitus Complicated with Ventricular Premature Beats

Objective:To explore the clinical efficacy of Ningxin Tongluo Decoction(宁心通络汤)combined with Dapagliflozin in the treatment of type 2 diabetes mellitus complicated with ventricular premature beats.Methods:Ninety-two patients with type 2 diabetes mellitus complicated with ventricular premature beats in our hospital were randomly divided into control group(n=46)and observation group(n=46).The control group was treated with routine Western medicine,and the observation group was treated with Ningxin Tongluo Decoction on the basis of the control group.The clinical efficacy of the two groups before and after treatment,TCM syndrome score,blood glucose levels[fasting blood glucose(GLU),glycosylated hemoglobin(Hb A1c)],glucose metabolism levels[fasting insulin(FINS),insulin resistance index(HOMA-IR)],the number of ventricular premature beats detected by 24-hour ambulatory electrocardiogram,heart rate turbulence(HRT)[initial oscillation(TO),oscillation slope(TS)],and heart rate variability(HRV)standard deviation of two normal R-R intervals(SDNN),standard deviation of average normal R-R intervals every 5 minutes(SDANN)and root mean square of adjacent normal R-R intervals(RMSSD)were observed.Results:After treatment,the total effective rate of the observation group was 89.13%,significantly higher than that of the control group(73.91%),and the difference was statistically significant(P<0.05).Both groups could reduce TCM syndrome score,blood glucose level,glucose metabolism level,reduce the number of ventricular premature beats,improve HRT and HRV levels,and the observation group was superior to the control group,and the difference was statistically significant(P<0.05).Conclusion:Ningxin Tongluo Decoction combined with Dapagliflozin is effective in treating type 2 diabetes mellitus patients with ventricular premature beats.It can reduce blood glucose level,improve HRV and HRT,improve autonomic nerve function and exert antiarrhythmic effect.

Cardiac Autonomic Control in Relation to Other Prognostic Markers in Idiopathic Dilated Cardiomyopathy

Objectives: We set out to study cardiac autonomic tone in patients with idiopathic dilated cardio-myopathy (IDC), and whether it correlates with other established markers of disease progression and patient ultimate outcome. Design: Fifty-one IDC patients in sinus rhythm underwent extensive non-invasive and invasive evaluation during a three-day hospitalization period. The control group consisted of thirty-eight apparently healthy subjects who underwent 24-hour ambulatory ECG recording. Results: Heart rate variability (HRV) and heart rate turbulence (HRT) correlated with many previously established prognostic markers of IDC and congestive heart failure, especially measures of cardiorespiratory performance capacity and circulating neurohumoral factors (p < 0.05 for all). Furthermore, attenuated HRV correlated with worse prognosis during a median follow-up of 6.8 years (range 5.1 - 8.1). Additionally, 24-hour time domain, low and high frequency components of frequency domain and non-linear HRV, excluding scaling exponents (α), were lower in IDC patients as compared with controls (p < 0.05 for all);however, HRT was not significantly different. Conclusions: The magnitude of impairment in cardiac autonomic control correlates well with other prognostic markers of IDC, and is associated with unfavorable outcome.

Effects of emergency or late PCI therapy on autonomic nervous function in myocardial infarction patients

Background It＇s an effective treatment to achieve percutaneous coronary intervention in AMI patients, which rapidly improves the blood supply of coronary artery. Studies have shown that different modes of PCI therapy have different effects in AMI patients. The aim of this study was to explore the effects and clinical significances of emergency or late PCI therapy on left ventricular remodeling and cardiac autonomic function in acute myocardial infarction （AMI） patients. Methods One hundred and fifty cases of AMI patients were randomly divided into three groups, which all were given the routine medicine. The two therapy groups were the emergency PCI group （n = 60） and the late PCI group （n = 50）. The variations of heart rate turbulence （HRT） and heart rate variability （HRV） parameters were observed after 2 weeks of treatment by 24-hour ambulatory ECG. Results Compared with the control group, after 2 weeks of treatment, the levels of TS, SDNN and SDANN of two PCI-treated group was significantly higher （P 〈 0.01）, TO were lower （P 〈 0.01） than which in the control group. There were significant differences in TS, SDNN, SDANN and TO between the two PCI treatment group （P 〈 0.05）. Conclusion Emergency PCI or late PCI may give coronary effective reperfusion, improve left ventricular function and autonomic nervous function, and prevent malignant arrhythmias to occur. The treatment of primary PCI is superior to delayed PCI.