急性心肌梗塞早期的心率变异性测定

目的 研究急性心肌梗塞（ＡＭＩ）较早期的心率变异性（ＨＲＶ）改变及其预后意义，探讨不同梗塞部位，心功能，溶栓与再通过ＨＲＶ的影响。方法 ＡＭＩ患５０例，Ｈｏｌｔｅｒ记录在胸痛发作２４小时之内开始进行，平均（１３．６±７．９）小时，健康对照组５０例。结果 （１）ＡＭＩ组ＨＲＶ各项指标均低于正常对照组，统计学达显意义，并且正常ＲＲ间期的标准差，低频等成分失去了昼夜间的差异。ＡＭＩ患２４小时ＨＲＶ     

性行为对急性心肌梗塞恢复期患者心肌缺血、心律失常及心率变异性的影响

】     

Heart rate versus heart rate variability in risk prediction after myocardial infarction

INTRODUCTION: The aim of this study was to evaluate and compare heart rate and heart rate variability (HRV) in risk prediction after acute myocardial infarction (MI) and to evaluate the effect of beta-blocker treatment on the prognostic performance of heart rate and HRV. METHODS AND RESULTS: Three hundred sixty-six patients underwent 24-hour Holter recording 1 to 6 days after an MI. HRV was expressed as the standard deviation of all normal-to-normal intervals. Left ventricular systolic function was evaluated using the wall motion index. Half of the patients were taking a beta-blocker at the time of Holter recording. Mean follow-up was 44 months (median 34) after MI. By the end of follow-up, 82 patients had died. Mortality at 1 and 3 years was 12.5% and 22.6%, respectively. HRV, heart rate, wall motion index, number of ventricular premature beats per hour, and ventricular tachycardia were all significantly (P < 0.05) associated with mortality in univariate analysis, independent of beta-blocker therapy. In multivariate Cox analysis, only heart rate, wall motion index, number of ventricular premature beats per hour, and age had independent prognostic value (P < 0.001). In any model, including heart rate, HRV had no predictive value. CONCLUSION: The prognostic information of HRV is contained completely in heart rate, which carries prognostic information further than that of HRV. This result was independent of beta-blocker treatment.     

急性心肌梗死患者血压变异性与心室重构的相关性研究

目的研究急性心肌梗死患者血压变异性（blood pressure variability,BPV）与心室重构的相关性及意义。方法根据24h收缩压BPV的总变异系数（coefficient variation,CV）将120例急性心肌梗死患者分为两组：高CV组（CV〉12.16%）和低CV组（CV≤12.16%）,记录两组BPV值。所有患者均于24h内及180d行超声心动图检查测定左室舒张末期内径（LVEDd）、左室舒张末期容积（LVEDV）、左室收缩末期容积（LVESV）及左室射血分数（LVEF）。比较两组患者的BPV与心室重构的相关性。另选30名体检健康者为正常对照组。结果与正常对照组比较,急性心肌梗死患者BPV值均增大（P〈0.05）,高CV组显著高于低CV组（P〈0.05～0.01）;在治疗180d时,高CV组LVEDV、LVESV及LVEF显著高于低CV组（P〈0.05）。LV-EDV、LVESV与24h收缩压BPV值呈正相关（r分别为0.7963、0.594,P均     

急性心肌梗塞患者尿儿茶酚胺变化及其与临床和心率变异性的关系

使用高效液相色谱分离技术连续测定２５例急性心肌梗塞（ＡＭＩ）患者发病初４周２４小时尿儿茶酚胺含量及变化。ＡＭＩ患者尿去甲肾上腺素（ＮＥ）和多巴胺含量明显升高，随病情恢复逐步下降，以发病后第一周下降幅度最大。ＮＥ含量与心率变异三项参数极低频成分、总成分和连续５分钟正常心率间期标准差均值相关（ｒ＝－０．７１２３、－０．６１５、－０．５２８，Ｐ＜０．０５）；与心肌酶相关（ｒ＝０．６３５，Ｐ＜０．０５）；与室早总数相关（ｒ＝０．５１５，Ｐ＜０．０５）。说明心率变异反映交感活性，尿ＮＥ水平可反映心肌坏死范围，儿茶酚胺增高有致心律失常作用。     

原发性高血压伴急性脑梗死患者心率变异性与血压变异性分析

目的：探讨原发性高血压伴急性脑梗死患者的心率变异性（heart rate variability, HRV）和血压变异性（blood pressure variability,BPV）。方法收集原发性高血压合并急性脑梗死患者82例、单纯原发性高血压患者108例,进行动态心电图和动态血压同步测量,计算机自动计算 HRV 和 BPV 各指标。结果脑梗死组 HRV 各指标均低于单纯高血压组,且差异有统计学意义（P ＜0．05）;夜间血压下降率脑梗死组均低于单纯高血压组,BPV 各指标脑梗死组均高于单纯高血压组,其中夜间舒张压下降率、24 h 平均收缩压（24 h SBP）和24 h 收缩压变异系数（24 h SCV）两组差异有统计学意义（P ＜0．05）。结论与单纯原发性高血压患者相比,原发性高血压合并急性脑梗死患者自主神经功能受损明显。随访观察 HRV 和 BPV 指标的变化对高血压及高血压合并急性脑梗死患者的病情评估及改善预后有一定的临床意义。     

急性心肌梗死心率变异性与临床背景的关系

分析８４例急性心肌梗死（ＡＭＩ）后两周患者的心率变异性（ＨＲＶ），旨在了解ＡＭＩ后ＨＲＶ与临床资料的关系。结果：１．ＨＲＶ各项指标与年龄呈负相关，女性患者的ＨＲＶ较男性低（Ｐ＜０．０５）。２．ＨＲＶ与左室射血分数、心肌梗死部位及是否合并高血压无明显关系，但糖尿病患者时域指标中的Ｓｔ．ｇｅｏｒｇｅｓ指数较无糖尿病患者显著下降（Ｐ＜０．０１）。３．心室晚电位阳性者的ＨＲＶ时域指标ＳＤ、Ｓｔ．ｇｅｏｒｇｅｓ指数较阴性者显著下降（Ｐ＜０．０５）。结论：年龄、性别、晚电位及糖尿病对ＨＲＶ有影响     

Heart rate variability: an important new risk factor in patients following myocardial infarction

After acute myocardial infarction, cardiac autonomic, and particularly parasympathetic, activity decreases, followed by a gradual return toward normal over the next few weeks and months. The easiest measurable index of autonomic activity is heart rate variability, which can be assessed in a number of different ways. Where heart rate variability is low after myocardial infarction, long-term survival is considerably reduced, independent of other known risk factors. This may be caused by patchy autonomic denervation, rendering the heart more susceptible to potentially fatal arrhythmias. Prophylactic drug therapy might reduce mortality in patients with low heart rate variability.     

QRS complex recovery during one year after acute myocardial infarction

The recovery of the ECG signs of anterior myocardial infarction has been studied in 70 patients. A significant increase in R-wave amplitude and decrease in Q-wave amplitude on 24-lead precordial mapping was observed during one year after infarction. Patients with lower initial heart rate showed a greater recovery of R- and Q-wave amplitudes, as did patients with smaller infarcts, as assessed by peak heat-stable lactate dehydrogenase (LDH).     

急性心肌梗塞患者的压力反射敏感性测定

目的探讨急性心肌梗塞（ＡＭＩ）后压力反射敏感性（ＢＲＳ）的临床意义。方法分析３１例ＡＭＩ患者和１７例正常对照组的ＢＲＳ、心率变异以及临床情况。结果ＡＭＩ患者３周ＢＲＳ明显小于１７例正常对照组（１０．７±７．２ｍｓ／ｍｍＨｇｖｓ．４．２±１．５ｍｓ／ｍｍＨｇ，Ｐ＜０．０５）；心肌梗塞患者随访中猝死２例，其ＢＲＳ降低最明显；心梗患者的ＢＲＳ与心率变异各项指标无相关性，与年龄、性别、超声射血分数、心肌酶谱等也无相关性；ＢＲＳ有较大个体差异。结论ＢＲＳ在心肌梗塞患者明显下降，并可作为患者的一项独立的预后指标；ＢＲＳ与心率变异是反映患者自主神经的二个不同方面。     

Relationships between heart rate variability, functional capacity, and left ventricular function following myocardial infarction: an evaluation after one week and six months

BACKGROUND: Relationships between heart rate (HR) variability and different prognostic markers such as ejection fraction, functional capacity, and patency of the infarct-related artery, as well as the comparison of their time courses are not fully elucidated. HYPOTHESIS: The aim of study was to assess prospectively the early postinfarction changes in HR variability and its evolution over a period of 6 months: the relationships between HR variability and functional capacity in exercise testing; left ventricular function in cardiac catheterization: status of the infarct-related artery; and the comparison of their time courses. METHODS: In 42 patients with anterior myocardial infarction, a study was made of the early changes in HR variability analyzed by the complex demodulation method, its evolution over a period of 6 months. and the relationships between HR variability and (1) functional capacity in exercise testing, (2) left ventricular function in cardiac catheterization, and (3) status of the infarct-related artery. RESULTS: At 1 week HR variability parameters correlated directly with functional capacity indicators such as METS, percent change in HR from rest to peak exercise (%deltaHR), difference between initial and peak HR (HR range), percent peak theoretical HR (% peak HR), left ventricular ejection fraction (EF), and, inversely, with end-systolic volume (ESV). Stepwise multiple regression analysis to establish HR variability parameters (recorded at 1 week) as related to functional capacity and left ventricular function at 1 week and 6 months postinfarction established the following variables: (1) At 1 week: standard deviation (SD) of the RR cycles in relation to %deltaHR (r = 0.60, p <0.0001), HR range (r = 0.43, p < 0.01), and EF (r = 0.79, p < 0.0001). (2) At 6 months, the sole accepted HR variability parameter was the SD in relation to %deltaHR (r = 0.38, p < 0.05) and HR range (r = 0.45, p < 0.01). No variability parameter was accepted in relation to METS, % peak HR, or ESV. Relationship between EF or ESV and HR variability parameters was not significant when both were evaluated at 6 months. At that time, there was a significant increase in all HR variability parameters among all surviving patients (n = 39), with the exception of the LF/HF ratio and mean RR cycle. The percent increase in HR variability between the first week and 6 months was greater among those patients with the lowest basal EF. No relation was established between HR variability and patency of the infarct-related artery. CONCLUSION: The decrease in HR variability observed following myocardial infarction is associated with a diminished functional capacity and an increased alteration of the EF. This does not affect the recovery of HR variability, which was observed in all surviving patients.     

索他洛尔(sotalol)对急性心肌梗死心率变异功率谱的影响及预后观察

２６例急性心肌梗死患者，应用索他洛尔治疗，并测定心率变异功率谱，发现用药后５天、１０天之功率谱较用药前有明显增加（Ｐ＜０．０５），与对照组相比亦有显著差异（Ｐ＜０．０５），应用索他洛尔组心肌梗死后心律失常发生率较对照组明显降低。     

经皮腔内冠脉成形术后心率变异性变化与心肌梗死部位的相关性分析

对６５例不同陈旧性心肌梗死部位患者采用频域和时域法分析经皮腔内冠脉成形术（ＰＴＣＡ）前、后的心率变异性（ＨＲＶ），旨在了解不同心肌梗死部位患者ＨＲＶ的变化及ＰＴＣＡ术对患者自主神经系统的影响。结果提示不同心肌梗死部位患者的ＨＲＶ无明显差异，而ＰＴＣＡ术后高频段（ＨＦ）、标准差（ＳＤＮＮ）均技术前增加，低频段（ＬＦ）及ＬＦ／ＨＦ较术前降低。说明ＰＴＣＡ术后交感神经活性降低迷走神经活性增加。提出ＰＴＣＡ术后可能改善冠心病患者的远期预后。     

Quality of life and circadian variation of heart rate and heart rate variability in short-term survivors and nonsurvivors after acute myocardial infarction

The purpose of this study was the simultaneous examination of the quality of life and changes in heart rate (HR) variables of patients immediately following acute myocardial infarction (AMI). Quality of life, estimated on a rating scale assessing the patients' well-being, as well as the circadian rhythm of their HR and HR variability, were determined within the first 3 days and at approximately 3 weeks after admission and the results were related to survival. The quality of life within the first 3 days post AMI was low in both the surviving (n = 42) and the nonsurviving (n = 5) patients but only the scores of the survivors increased significantly over the following three weeks. The HR of the survivors, initially lower than that of the nonsurvivors, decreased significantly at 3 weeks and a normal circadian pattern had developed. The HR variability of the survivors within the first 3 days was significantly higher than that of the nonsurvivors and had developed a clear circadian pattern after 3 weeks. It is concluded that in patients with AMI such diverse clinical aspects as quality of life and circadian patterns of HR and HR variability can be assessed meaningfully immediately post AMI and may find common expression in changes in sympathovagal balance.     

急性心梗患者心率减速力与心率变异性

目的:探讨急性心肌梗死(AMI)患者心率减速力(DC)与心率变异(HRV)、心率震荡(HRT)的相关性.方法62例窦性心律的AMI患者和51例非AMI对照组进行24h动态心电图检查,离线计算DC、HRV时域指标、HRT的两个参数震荡初始(TO)和震荡斜率(TS).结果:AMI患者的DC值、HRV降低;HRT减弱;且DC...     

老年陈旧性心肌梗死患者海水浴体疗的心率变异性分析

目的 :观察老年陈旧性心肌梗死 （OMI）患者海水浴前后的心率变异性 （HRV）。方法 :应用 2 4h动态心电图监测、分析 13例老年 OMI患者海水浴体疗前、4疗程结束后的 HRV时域指标 ;心脏超声获 LVEF值并设健康同龄对照组。结果 :1老年 OMI组海水浴前 HRV与 LVEF值均低于对照组 （P<0 .0 5或 P<0 .0 1） ;2老年 OMI组海水浴后 HRV与 LVEF值较对照组无明显差异 （P>0 .0 5 ）。 3老年 OMI组海水浴后 HRV与 L VEF值较海水浴前明显增高 ,差异非常显著 （P<0 .0 1）。结论 :海水浴体疗可使老年 OMI患者 HRV与 L VEF值增高 ,改善左室功能 ,可作为老年心血管疾病患者的一种康复途径     

老年急性心肌梗死患者二级预防干预前后脉搏波传导速度的变化

目的探讨老年急性心肌梗死(acute myocardial infarction,AMI)患者二级预防对臂踝脉搏波传导速度(Brachialankle pulse wave vclocity,BaPWV)的影响。方法选择老年AMI患者256例(AMI组)二级预防规范化治疗6个月后,重复测量患者血压、血脂、心率、血糖和BaPWV;另选择同期体检者272例为对照组。对比分析二级预防前后AMI患者血压、心率、血脂、血糖和RaPWV的变化。结果与对照组比较,AMI组患者血压、心率、TC、LDL-C和RaPWV明显升高,差异有统计学意义(P0.05);AMI组患者二级预防6个月后血压、心率、TC、LDL-C、左心室舒张末容积、左心室收缩末容积和BaPWV明显降低,LVEF明显升高,差异有统计学意义(P0.05)。结论规范的二级预防能够有效降低老年AMI患者的BaPWV,改善动脉顺应性。     

经皮腔内冠状动脉成形术对心肌梗死患者心率变异性和QT离散度的影响

目的　通过对 2 2例心肌梗死 (MI)病人经皮腔内冠状动脉成形术 (PTCA)术前 ,术后心率变异性 (HRV)和 QT离散度 (QTd)的变化及其之间相关分析 ,来了解 PTCA术对心脏自主神经功能和心肌电稳定性的影响。结果　 PTCA术后 HRV指标中 UL FP(193.4± 32 1.8;381.3± 6 35 .3) ,VL FP(35 2 .4± 40 4.5 ;6 82 .1± 5 72 .4) ,L FP(2 6 3.9± 2 30 .6 ;40 6 .7± 376 .4) ,TP(895 .6± 795 .8;1817.5±16 85 .3) ,HRm ean(6 8.1± 9.7;74.7± 11.6 ) ,HRmax(76 .4± 11.6 ;82 .6± 11.8) ;HRm in(6 2 .2± 9.5 ;6 8.3± 12 .1)明显升高 (P<0 .0 5 ) ,而 QTd(80 .5± 18.2 ;5 3.5± 13.9)和 QTcd(85 .5± 19.4;6 0 .2±14.5 )则明显减少 (P<0 .0 5 )。术前、术后 QTd、QTcd与 HRV指标之间有相关关系。说明心肌梗死病人PTCA术后心脏自主神经调节能力和心肌电稳定性明显提高 ,提示 PTCA术可能改善心梗病人的预后。