AIMTo assess the prevalence of depressed heart rate variability (HRV) after an acute myocardial infarction (MI), and to evaluate its prognostic significance in the present era of immediate reperfusion.METHODSTime-doma...AIMTo assess the prevalence of depressed heart rate variability (HRV) after an acute myocardial infarction (MI), and to evaluate its prognostic significance in the present era of immediate reperfusion.METHODSTime-domain HRV (obtained from 24-h Holter recordings) was assessed in 326 patients (63.5 ± 12.1 years old; 80% males), two weeks after a complicated MI treated by early reperfusion: 208 ST-elevation myocardial infarction (STEMI) patients (in which reperfusion was successfully obtained within 6 h of symptoms in 94% of cases) and 118 non-ST-elevation myocardial infarction (NSTEMI) patients (percutaneous coronary intervention was performed within 24 h and successful in 73% of cases). Follow-up of the patients was performed via telephone interviews a median of 25 mo after the index event (95%CI of the mean 23.3-28.0). Primary end-point was occurrence of all-cause or cardiac death; secondary end-point was occurrence of major clinical events (MCE, defined as mortality or readmission for new MI, new revascularization, episodes of heart failure or stroke). Possible correlations between HRV parameters (mainly the standard deviation of all normal RR intervals, SDNN), clinical features (age, sex, type of MI, history of diabetes, left ventricle ejection fraction), angiographic characteristics (number of coronary arteries with critical stenoses, success and completeness of revascularization) and long-term outcomes were analysed.RESULTSMarkedly depressed HRV parameters were present in a relatively small percentage of patients: SDNN < 70 ms was found in 16% and SDNN < 50 ms in 4% of cases. No significant differences were present between STEMI and NSTEMI cases as regards to their distribution among quartiles of SDNN (χ<sup>2</sup> =1.536, P = 0.674). Female sex and history of diabetes maintained a significant correlation with lower values of SDNN at multivariate Cox regression analysis (respectively: P = 0.008 and P = 0.008), while no correlation was found between depressed SDNN and history of previous MI (P = 0.999) or number of diseased coronary arteries (P = 0.428) or unsuccessful percutaneous coronary intervention (PCI) (P = 0.691). Patients with left ventricle ejection fraction (LVEF) < 40% presented more often SDNN values in the lowest quartile (P < 0.001). After > 2 years from infarction, a total of 10 patients (3.1%) were lost to follow-up. Overall incidence of MCE at follow-up was similar between STEMI and NSTEMI (P = 0.141), although all-cause and cardiac mortality were higher among NSTEMI cases (respectively: 14% vs 2%, P = 0.001; and 10% vs 1.5%, P = 0.001). The Kaplan-Meier survival curves for all-cause mortality and for cardiac deaths did not reveal significant differences between patients with SDNN in the lowest quartile and other quartiles of SDNN (respectively: P = 0.137 and P = 0.527). Also the MCE-free survival curves were similar between the group of patients with SDNN in the lowest quartile vs the patients of the other SDNN quartiles (P = 0.540), with no difference for STEMI (P = 0.180) or NSTEMI patients (P = 0.541). By the contrary, events-free survival was worse if patients presented with LVEF < 40% (P = 0.001).CONCLUSIONIn our group of patients with a recent complicated MI, abnormal autonomic parameters have been found with a prevalence that was similar for STEMI and NSTEMI cases, and substantially unchanged in comparison to what reported in the pre-primary-PCI era. Long-term outcomes did not correlate with level of depression of HRV parameters recorded in the subacute phase of the disease, both in STEMI and in NSTEMI patients. These results support lack of prognostic significance of traditional HRV parameters when immediate coronary reperfusion is utilised.展开更多
目的探讨四维自动左室定量分析(4D AUTO LVQ)技术联合动态心电图预测急性心肌梗死(AMI)患者预后的临床应用价值。方法选取我院收治的AMI患者83例,依据是否发生主要不良心血管事件(MACE)分为MACE组12例和非MACE组71例(非MACE组),两组均...目的探讨四维自动左室定量分析(4D AUTO LVQ)技术联合动态心电图预测急性心肌梗死(AMI)患者预后的临床应用价值。方法选取我院收治的AMI患者83例,依据是否发生主要不良心血管事件(MACE)分为MACE组12例和非MACE组71例(非MACE组),两组均行常规超声心动图、4D AUTO LAQ和动态心电图检查,比较相关检测参数的差异。分析两组超声心动图参数、动态心电图心率变异性参数与MACE发生的相关性。绘制受试者工作特征(ROC)曲线分析4D AUTO LVQ技术联合动态心电图预测AMI患者预后的诊断效能。结果常规超声心动图检查结果显示,两组左房排空容积(LAEV)、左房被动射血分数(LAPEF)、左房主动射血分数(LAAEF)、左室射血分数(LVEF)、左房最大容积指数(LAVImax)比较差异均有统计学意义(均P<0.05);4D AUTO LVQ检查结果显示,两组整体峰值纵向应变(GLPS)、面积应变(GAPS)、环向应变(GCPS)、径向应变(GRPS)比较差异均有统计学意义(均P<0.05);动态心电图检查结果显示,两组全部窦性心搏RR间期的标准差(SDNN)、RR间期平均值的标准差(SDANN)、相邻RR间期差值的均方根(RMSSD)、低频成分与高频成分的比值(LF/HF)、相邻RR间期相差>50 ms的个数占总窦性心搏个数的百分比(PNN50)比较差异均有统计学意义(均P<0.001)。相关性分析显示,LAEV、LAPEF、LVEF、GAPS、SDNN与MACE发生均呈负相关,LAVImax与MACE发生呈正相关(均P<0.001)。ROC曲线分析显示,LAEV、LAPEF、LVEF、LAVImax、GAPS、SDNN联合应用预测AMI患者预后的曲线下面积为0.841,灵敏度、特异度分别为65.36%、79.22%。结论4D AUTO LVQ技术联合动态心电图对AMI患者预后有较高的预测价值,可为临床治疗提供参考依据。展开更多
Objective:To explore the influence of depression on heart rate variability(HRV) and short term prognosis of patients with acute myocardial infarction(AMI).Methods:120 AMI patients were evaluated with Zung’s self-rati...Objective:To explore the influence of depression on heart rate variability(HRV) and short term prognosis of patients with acute myocardial infarction(AMI).Methods:120 AMI patients were evaluated with Zung’s self-rating depression scale within 24 hours after admission.The patients were divided into depressive group(45 cases) and non-depressive group(75 cases) according to depressive index.Post-infarction angina pectoris,reinfarction,heart failure and ventricular fibrillation as well as cardiac death were observed during 4 weeks.HRV analysis with 24-hour holter of survivals was perfomed in 1 week after infarction.Results:The prevalence of post-infarction angina pectoris,ventricular fibrillation and cardiac death in depressive group was remarkably elevated compared with non-depressive group(40.0% vs 22.7%,20.0% vs 6.7%,17.8% vs 4.0%,respectively. P <0.05).Multivariate logistic regression analysis results indicated that depression was independently and significantly related to the occurrence of post-infarction angina pectoris,ventricular fibrillation and cardiac death.SDNN,SDANN,RMNN and PNN50 as well as HF in depressive group were obviously reduced,whereas VLF,LF and LF/HF were remarkedly increased compared with non-depressive group( P <0.01 or 0.05).Correlation analysis found that depressive index was negatively related with SDNN,SDANN,RMNN,PNN50 and HF(P<0.01),and positively correlated with VLF,LF and LF/HF( P <0.01).Conclusion:Depression impacts adversely HRV,and was an independent risk factor of the short term prognosis of AMI patients.展开更多
目的观察心肌梗死患者入院即时和治疗前心率变异(HRV)的变化,并分析HRV各参数的敏感性。方法采集正常人(正常对照组)、冠心病患者、急性心肌梗死(AMI)患者以及急性心肌缺血动物模型的心电图,进行短时程HRV分析。结果与正常对照组比较,AM...目的观察心肌梗死患者入院即时和治疗前心率变异(HRV)的变化,并分析HRV各参数的敏感性。方法采集正常人(正常对照组)、冠心病患者、急性心肌梗死(AMI)患者以及急性心肌缺血动物模型的心电图,进行短时程HRV分析。结果与正常对照组比较,AMI患者除心率减慢外,其他HRV参数均显著增高,其中反映交感神经兴奋性的窦性心搏RR(N-N)间期的标准差(SDNN)、反映迷走神经张力的相邻RR(N-N)间期差值的标准差(SD of delta NN)、相邻RR(N-N)间期差值>50 ms个数占RR间期总数的百分比(NN50)和poincare散点图短轴参数SD1分别为正常对照组的1.8、2.7、7.5和3.1倍。用垂体后叶素诱发动物产生急性心肌缺血后,HRV的变化也呈类似改变。与正常对照组比较,冠心病患者的HRV各参数减小,其中SDNN和SD of delta NN与正常对照组差异无统计学意义(P>0.05),但SD1则明显减小(P<0.01)。结论 AMI时HRV参数显著增大,慢性稳定型冠心病的HRV参数较正常人减小。用HRV判断自主神经活动变化时,SD1优于其他HRV参数。展开更多
文摘AIMTo assess the prevalence of depressed heart rate variability (HRV) after an acute myocardial infarction (MI), and to evaluate its prognostic significance in the present era of immediate reperfusion.METHODSTime-domain HRV (obtained from 24-h Holter recordings) was assessed in 326 patients (63.5 ± 12.1 years old; 80% males), two weeks after a complicated MI treated by early reperfusion: 208 ST-elevation myocardial infarction (STEMI) patients (in which reperfusion was successfully obtained within 6 h of symptoms in 94% of cases) and 118 non-ST-elevation myocardial infarction (NSTEMI) patients (percutaneous coronary intervention was performed within 24 h and successful in 73% of cases). Follow-up of the patients was performed via telephone interviews a median of 25 mo after the index event (95%CI of the mean 23.3-28.0). Primary end-point was occurrence of all-cause or cardiac death; secondary end-point was occurrence of major clinical events (MCE, defined as mortality or readmission for new MI, new revascularization, episodes of heart failure or stroke). Possible correlations between HRV parameters (mainly the standard deviation of all normal RR intervals, SDNN), clinical features (age, sex, type of MI, history of diabetes, left ventricle ejection fraction), angiographic characteristics (number of coronary arteries with critical stenoses, success and completeness of revascularization) and long-term outcomes were analysed.RESULTSMarkedly depressed HRV parameters were present in a relatively small percentage of patients: SDNN < 70 ms was found in 16% and SDNN < 50 ms in 4% of cases. No significant differences were present between STEMI and NSTEMI cases as regards to their distribution among quartiles of SDNN (χ<sup>2</sup> =1.536, P = 0.674). Female sex and history of diabetes maintained a significant correlation with lower values of SDNN at multivariate Cox regression analysis (respectively: P = 0.008 and P = 0.008), while no correlation was found between depressed SDNN and history of previous MI (P = 0.999) or number of diseased coronary arteries (P = 0.428) or unsuccessful percutaneous coronary intervention (PCI) (P = 0.691). Patients with left ventricle ejection fraction (LVEF) < 40% presented more often SDNN values in the lowest quartile (P < 0.001). After > 2 years from infarction, a total of 10 patients (3.1%) were lost to follow-up. Overall incidence of MCE at follow-up was similar between STEMI and NSTEMI (P = 0.141), although all-cause and cardiac mortality were higher among NSTEMI cases (respectively: 14% vs 2%, P = 0.001; and 10% vs 1.5%, P = 0.001). The Kaplan-Meier survival curves for all-cause mortality and for cardiac deaths did not reveal significant differences between patients with SDNN in the lowest quartile and other quartiles of SDNN (respectively: P = 0.137 and P = 0.527). Also the MCE-free survival curves were similar between the group of patients with SDNN in the lowest quartile vs the patients of the other SDNN quartiles (P = 0.540), with no difference for STEMI (P = 0.180) or NSTEMI patients (P = 0.541). By the contrary, events-free survival was worse if patients presented with LVEF < 40% (P = 0.001).CONCLUSIONIn our group of patients with a recent complicated MI, abnormal autonomic parameters have been found with a prevalence that was similar for STEMI and NSTEMI cases, and substantially unchanged in comparison to what reported in the pre-primary-PCI era. Long-term outcomes did not correlate with level of depression of HRV parameters recorded in the subacute phase of the disease, both in STEMI and in NSTEMI patients. These results support lack of prognostic significance of traditional HRV parameters when immediate coronary reperfusion is utilised.
文摘目的探讨四维自动左室定量分析(4D AUTO LVQ)技术联合动态心电图预测急性心肌梗死(AMI)患者预后的临床应用价值。方法选取我院收治的AMI患者83例,依据是否发生主要不良心血管事件(MACE)分为MACE组12例和非MACE组71例(非MACE组),两组均行常规超声心动图、4D AUTO LAQ和动态心电图检查,比较相关检测参数的差异。分析两组超声心动图参数、动态心电图心率变异性参数与MACE发生的相关性。绘制受试者工作特征(ROC)曲线分析4D AUTO LVQ技术联合动态心电图预测AMI患者预后的诊断效能。结果常规超声心动图检查结果显示,两组左房排空容积(LAEV)、左房被动射血分数(LAPEF)、左房主动射血分数(LAAEF)、左室射血分数(LVEF)、左房最大容积指数(LAVImax)比较差异均有统计学意义(均P<0.05);4D AUTO LVQ检查结果显示,两组整体峰值纵向应变(GLPS)、面积应变(GAPS)、环向应变(GCPS)、径向应变(GRPS)比较差异均有统计学意义(均P<0.05);动态心电图检查结果显示,两组全部窦性心搏RR间期的标准差(SDNN)、RR间期平均值的标准差(SDANN)、相邻RR间期差值的均方根(RMSSD)、低频成分与高频成分的比值(LF/HF)、相邻RR间期相差>50 ms的个数占总窦性心搏个数的百分比(PNN50)比较差异均有统计学意义(均P<0.001)。相关性分析显示,LAEV、LAPEF、LVEF、GAPS、SDNN与MACE发生均呈负相关,LAVImax与MACE发生呈正相关(均P<0.001)。ROC曲线分析显示,LAEV、LAPEF、LVEF、LAVImax、GAPS、SDNN联合应用预测AMI患者预后的曲线下面积为0.841,灵敏度、特异度分别为65.36%、79.22%。结论4D AUTO LVQ技术联合动态心电图对AMI患者预后有较高的预测价值,可为临床治疗提供参考依据。
文摘Objective:To explore the influence of depression on heart rate variability(HRV) and short term prognosis of patients with acute myocardial infarction(AMI).Methods:120 AMI patients were evaluated with Zung’s self-rating depression scale within 24 hours after admission.The patients were divided into depressive group(45 cases) and non-depressive group(75 cases) according to depressive index.Post-infarction angina pectoris,reinfarction,heart failure and ventricular fibrillation as well as cardiac death were observed during 4 weeks.HRV analysis with 24-hour holter of survivals was perfomed in 1 week after infarction.Results:The prevalence of post-infarction angina pectoris,ventricular fibrillation and cardiac death in depressive group was remarkably elevated compared with non-depressive group(40.0% vs 22.7%,20.0% vs 6.7%,17.8% vs 4.0%,respectively. P <0.05).Multivariate logistic regression analysis results indicated that depression was independently and significantly related to the occurrence of post-infarction angina pectoris,ventricular fibrillation and cardiac death.SDNN,SDANN,RMNN and PNN50 as well as HF in depressive group were obviously reduced,whereas VLF,LF and LF/HF were remarkedly increased compared with non-depressive group( P <0.01 or 0.05).Correlation analysis found that depressive index was negatively related with SDNN,SDANN,RMNN,PNN50 and HF(P<0.01),and positively correlated with VLF,LF and LF/HF( P <0.01).Conclusion:Depression impacts adversely HRV,and was an independent risk factor of the short term prognosis of AMI patients.
文摘目的观察心肌梗死患者入院即时和治疗前心率变异(HRV)的变化,并分析HRV各参数的敏感性。方法采集正常人(正常对照组)、冠心病患者、急性心肌梗死(AMI)患者以及急性心肌缺血动物模型的心电图,进行短时程HRV分析。结果与正常对照组比较,AMI患者除心率减慢外,其他HRV参数均显著增高,其中反映交感神经兴奋性的窦性心搏RR(N-N)间期的标准差(SDNN)、反映迷走神经张力的相邻RR(N-N)间期差值的标准差(SD of delta NN)、相邻RR(N-N)间期差值>50 ms个数占RR间期总数的百分比(NN50)和poincare散点图短轴参数SD1分别为正常对照组的1.8、2.7、7.5和3.1倍。用垂体后叶素诱发动物产生急性心肌缺血后,HRV的变化也呈类似改变。与正常对照组比较,冠心病患者的HRV各参数减小,其中SDNN和SD of delta NN与正常对照组差异无统计学意义(P>0.05),但SD1则明显减小(P<0.01)。结论 AMI时HRV参数显著增大,慢性稳定型冠心病的HRV参数较正常人减小。用HRV判断自主神经活动变化时,SD1优于其他HRV参数。
