冠心病患者动态心电图监测的意义

目的：评价动态心电图（Holter)在冠心病病人中的临床价值。方法：经冠脉造影诊断为冠心病病人36例,进行Holter监测,分析心律失常和ST－T变化。结果：29例检出严重心律失常（80．6％）,26例（72％）检出有缺血性ST段,有症状心肌缺血10例（27．8％）,无症状心肌缺血23例（63．9％）,显多于有症状心肌缺血（P＜0．01）,多支病变与单支病变的缺血性ST段检出率,SMI发生频率两无差异,结论：Holter对冠心病心律失常和SMI检出有重要意义,可评估危险性,但无法提示冠脉病变程度。     

心率变异性减低与老年人心血管事件

目的　评价老年人群心率变异性 (heartrate variability,HRV)减低与心血管事件的关系。方法　回顾性分析我院干部查体 2 4h动态心电图 HRV资料与心血管事件的关系。共 390例。HRV分析包括时域分析和频域分析。时域分析包括正常 RR间期的标准差 (SDNN) ;5 m in平均 RR间期的标准差 (SDANN) ;相邻 RR间期之差的均方根值 (r MSSD) ;爱丁堡指数 (PNN5 0 ) ,频域分析用快速傅立叶转换方法获得心率功率谱密度。并分析总频谱 (TF,0 .0 1～ 0 .5 0 Hz) ,低频 (L F,0 .0 4～ 0 .15 Hz)成分 ,高频(HF,0 .15～ 0 .40 Hz)成分和低频与高频比率 (L F/ HF)。心血管事件包括急性心肌梗死 ,心力衰竭 ,持续性室性心动过速 ,心室颤动 ,心脏性死亡 (包括心脏性猝死 )。比较查体者有和无心血管事件组之 SDNN,SDANN,RMSSD,PNN5 0 ,L F,HF,TF和低频与高频比率 (L F/ HF)有无差别。　结果　有 2 9例老年人发生心血管事件 (n=2 9) ,有心血管事件组之 SDNN为 (91.7± 30 .3) ms,SDANN(84.6± 2 7.9) ms,r MSSD(2 0 .8± 8.8) ms,PNN5 0 (3.8± 5 .0 ) % ,L F(85 .5± 6 9.3) m s2 ,HF(5 2 .1± 35 .5 ) ms2 ,TF(333.3± 2 2 1.2 ) m s2 ,L F/ HF1.6± 1.0。无心血管事件组 (n=36 1)之 SDNN为 (115 .8± 39.2 ) m s,SDANN(10 3.0±     

Correlation of heart rate recovery and heart rate variability with atrial fibrillation progression

ObjectiveTo examine the combination of heart rate recovery (HRR) and heart rate variability (HRV) in predicting atrial fibrillation (AF) progression.MethodsData from patients with a first detected episode of AF who underwent treadmill exercise testing and 24-h Holter electrocardiography were retrospectively analysed. Autonomic dysfunction was verified using HRR values. Sympathetic and parasympathetic modulation was analysed by HRV. AF progression was defined as transition from the first detected paroxysmal episode to persistent/permanent AF.ResultsOf 306 patients, mean LF/HF ratio and HRR did not differ significantly by AF progression regardless of age (< or ≥65 years). However, when the LF/HF ratio was divided into tertiles, in patients aged <65 years, the mid LF/HF (1.60–2.40) ratio was significantly associated with lower AF progression rates and longer maintenance of normal sinus rhythm. For patients aged <65 years, less metabolic equivalents were related to higher AF progression rates. For patients aged ≥65 years, a low HRR was associated with high AF progression rates.ConclusionIn relatively younger age, high physical capacity and balanced autonomic nervous system regulation are important predictors of AF progression. Evaluation of autonomic function assessed by age could predict AF progression.     

Altered cardiac autonomic function after recovery from COVID‐19

BackgroundAutonomic dysfunction may occur during the acute phase of COVID‐19. Heart rate variability (HRV) is a useful tool for the assessment of cardiac sympathetic and parasympathetic balance. We aimed to evaluate cardiac autonomic function by using HRV in subjects after recovery from COVID‐19 who had previously symptomatic and were followed outpatiently.MethodsThe study group composed of 50 subjects with a confirmed history of COVID‐19 and the control group composed of 50 healthy subjects without a history of COVID‐19 and vaccination. All the study participants underwent 2‐dimensional, pulsed‐ and tissue‐Doppler echocardiographic examinations and 24‐hour Holter monitoring for HRV analysis.ResultsTime domain parameters of SDNN, SDANN, SDNNi, RMSSD, pNN50, and HRV triangular index were all decreased in the study group when compared with the control group. Frequency domain parameters of TP, VLF, LF, HF, and HFnu were also decreased in the study group in comparison with the control group. LFnu was similar between groups. Nonlinear parameters of HRV including α₁ and α₂ decreased in the study group. By contrast, Lmax, Lmean, DET, REC, and Shannon entropy increased in the study population. Approximate and sample entropies also enhanced in the study group.ConclusionsThe present study showed that all three domain HRV significantly altered in patients after recovery from COVID‐19 indicating some degree of dysfunction in cardiac autonomic nervous system. HRV may be a useful tool for the detection of preclinical autonomic dysfunction in this group of patients.     

稳心颗粒与乙胺碘肤酮联用治疗慢性房颤的临床研究

目的 探讨稳心颗粒与乙胺碘肤酮联用治疗慢性房颤的临床疗效。方法 将168例慢性房颤病人随机分为稳心颗粒加乙胺碘肤酮组（A组）57例、乙胺碘肤酮组（B组）55例、稳心颗粒组（C组）56例,观察治疗前后临床症状和心律失常改善情况及不良反应。结果 治疗前后动态心电图观察对比：A组总有效率为91．22％（52例）,B组总有效率为69．09％（38例）,C组总有效率为69．64％（39例）。A组与B组比较P〈0．05差异有显著性,与C组比较P〈0．05,差异有显著性,B组与C组比较P〉0．05,差异无显著性;治疗后临床症状改善情况：A组与B组比较P〈0．05,差异有显著性,与C组比较P〈0．05,差异有显著性,B级与C组比较P〉0．05,差异无显著性。结论 稳心颗粒与乙胺碘肤酮联用治疗慢性房颤明显优于各自单用疗效,且不良反应少。     

Clinical utility of a personalized and long-term monitoring device for Parkinson's disease in a real clinical practice setting: An expert opinion survey on STAT-ON™

BackgroundSTAT-ON™ is an objective tool that registers ON-OFF fluctuations making possible to know the state of the patient at every moment of the day in normal life. Our aim was to analyze the opinion of different Parkinson's disease experts about the STAT-ON™ tool after using the device in a real clinical practice setting (RCPS).MethodsSTAT-ON™ was provided by the Company Sense4Care to Spanish neurologists for using it in a RCPS. Each neurologist had the device for at least three months and could use it in PD patients at his/her own discretion. In February 2020, a survey with 30 questions was sent to all participants.ResultsTwo thirds of neurologists (53.8% females; mean age 44.9 ± 9 years old) worked in a Movement Disorders Unit, the average experience in PD was 16 ± 6.9 years, and 40.7% of them had previously used other devices. A total of 119 evaluations were performed in 114 patients (range 2–9 by neurologist; mean 4.5 ± 2.3). STAT-ON™ was considered “quite” to “very useful” by 74% of the neurologists with an overall opinion of 6.9 ± 1.7 (0, worst; 10, best). STAT-ON™ was considered better than diaries by 70.3% of neurologists and a useful tool for the identification of patients with advanced PD by 81.5%. Proper identification of freezing of gait episodes and falls were frequent limitations reported.ConclusionSTAT-ON™ could be a useful device for using in PD patients in clinical practice.     

Risk assessment of post-myocardial infarction patients with preserved ejection fraction using 45-min short resting Holter electrocardiographic recordings

Background

Risk stratification for sudden cardiac death in post-myocardial infarction (post-MI) patients remains a challenging task. Several electrocardiographic noninvasive risk factors (NIRFs) have been associated with adverse outcomes and were used to refine risk assessment. This study aimed to evaluate the performance of NIRFs extracted from 45-min short resting Holter ECG recordings (SHR), in predicting ventricular tachycardia inducibility with programmed ventricular stimulation (PVS) in post-MI patients with preserved left ventricular ejection fraction (LVEF).

Methods

We studied 99 post-MI ischemia-free patients (mean age: 60.5 ± 9.5 years, 86.9% men) with LVEF ≥40%, at least 40 days after revascularization. All the patients underwent PVS and a high-resolution SHR. The following parameters were evaluated: mean heart rate, ventricular arrhythmias (premature ventricular complexes, couplets, tachycardias), QTc duration, heart rate variability (HRV), deceleration capacity, heart rate turbulence, late potentials, and T-wave alternans.

Results

PVS was positive in 24 patients (24.2%). HRV, assessed by the standard deviation of normal-to-normal R–R intervals (SDNN), was significantly decreased in the positive PVS group (42 ms vs. 51 ms, p = .039). SDNN values <50 ms were also associated with PVS inducibility (OR 3.081, p = .032 in univariate analysis, and 4.588, p = .013 in multivariate analysis). No significant differences were identified for the other NIRFs. The presence of diabetes, history of ST-elevation MI (STEMI) and LVEF <50% were also important predictors of positive PVS.

Conclusions

HRV assessed from SHR, combined with other noninvasive clinical and echocardiographic variables (diabetes, STEMI history, LVEF), can provide an initial, practical, and rapid screening tool for arrhythmic risk assessment in post-MI patients with preserved LVEF.