389例冠心病患者心率变异性时域指标的分析

目的探讨心率变异性(HRV)时域指标与冠心病(coronary artery disease,CAD)严重程度之间的关系。方法选取2012年5月至2013年3月期间,在我国伊犁哈萨克自治州友谊医院因疑似或已知冠心病而行冠脉造影的389例患者,纳入本研究。分别行动态心电图和冠状动脉造影检查,依据冠脉造影结果,将患者分为冠心病组和非冠心病组(对照组),比较两组间的心率变异时域指标的差异。随后由冠脉造影结果计算出Gensini评分,依据评分的中位数将冠心病组分为高分组和低分组,对两组间心率变异性指标进行比较,并分别与对照组比较。结果心率变异性时域指标中SDANN和HRV三角指数(TRIA)在冠心病组中较非冠心病组显著降低,两者差异有统计学意义(p0.05)。SDANN和TRIA在高分组较低分组亦显著降低(p0.05)。结论心率变异性指标中SDNN和TRIA与CAD的严重程度呈负相关,提示迷走神经功能受损与冠状动脉病变的严重程度呈正相关。     

Heart rate variability in coronary artery disease

Abstract. Heart rate variability (HRV) reflects the modulation of cardiac function by autonomic and other physiological systems, and its measurement from ambulatory electrocardiograph (ECG) recordings is a useful method for both clinical and scientific purposes. Heart rate variability can be measured by several linear and non-linear methods, and various methods can give different information on neural and other physiological influences on the heart. Heart rate variability is abnormal in various settings of ischaemic heart disease, and the most important current application of HRV analysis in clinical cardiology is its measurement in postinfarction patients, in whom abnormal HRV indicates an increased risk of cardiac mortality. Future research may expand the clinical utility of HRV measurement to other clinical situations.     

Low-dose aspirin increases aspirin resistance in patients with coronary artery disease

PURPOSE: We sought to investigate the association of aspirin dose and aspirin resistance in stable coronary artery disease patients measured by a point-of-care assay. METHODS: We studied 468 consecutive stable coronary artery disease patients in a referral cardiac center who were taking aspirin 80 to 325 mg daily for > or =4 weeks. The VerifyNow Aspirin (Ultegra RPFA-ASA, Accumetrics Inc, San Diego, Calif) was used to determine aspirin responsiveness. An aspirin reaction unit (ARU) > or =550 indicates the absence of aspirin-induced platelet dysfunction, based on correlation with epinephrine-induced light transmission aggregometry. Demographic and clinical data were collected to analyze the predictors of aspirin resistance. RESULTS: Aspirin resistance was noted in 128 (27.4%) patients. Univariate predictors of aspirin resistance include elderly (P = 0.002), women (P <0.001), anemia (P <0.001), renal insufficiency (P = 0.009) and aspirin dose < or =100 mg (P = 0.004). Multivariate analysis revealed hemoglobin (odds ratio [OR] 0.6; 95% confidence interval [CI] 0.51 to 0.69; P <0.001) and aspirin dose < or =100 mg (OR 2.23; 95% CI 1.12 to 4.44; P = 0.022) to be independent predictors of aspirin resistance. Daily aspirin dose < or = 100 mg was associated with increased prevalence of aspirin resistance compared with 150 mg and 300 mg daily (30.2% vs 16.7% vs 0%, P = 0.0062). CONCLUSION: A 100 mg or less daily dose of aspirin, which may have lower side effects, is associated with a higher incidence of aspirin resistance in patients with coronary artery disease. Prospective randomized studies are warranted to elucidate the optimal aspirin dosage for preventing ischemic complications of atherothrombotic disease.     

Response variability to aspirin and one-year prediction of vascular events in patients with stable coronary artery disease

The aim of this study was to assess the association between “aspirin non responsiveness” in patients with coronary artery diseases (CAD) and the risk of major adverse cardiovascular events (MACE). 204 patients with CAD receiving aspirin (250 mg/d) were included. Both Collagen/Epinephrine Closure Time (CEPI-CT) and urinary Thromboxane B2 (uTxB2) concentration was used to determine the patients aspirin responsiveness. The clinical primary endpoint was the occurrence of MACE including: cardiovascular death, MI, stroke or transient ischemic attack. The secondary endpoint was the occurrence of Recurrent Acute Vascular Event (RAVE: MI, stroke or transient ischemic attack). After 1-year follow-up, no responders diagnosed by CEPI-CT had a trend for higher risk of MACE (13% vs 7.4%; P = 0.22) and significant higher risk of RAVE (OR = 2.1; 95%CI: 1.7–2.4; P = 0.01) when compared to good responders. Multivariate analysis showed that CEPI-CT < 143 s was the only independent predictor of RAVE (OR = 6.3; 95% CI: 1.2–32.2; P = 0.026). Aspirin non-responsiveness, diagnosed by the uTxB2, was not associated with an increased risk of either MACE or RAVE. Our results, reinforce the importance of being able to diagnose laboratory “aspirin non responsiveness”, and extend the evidence that aspirin non responsiveness may explain in part the occurrence of RAVE.     

Heart rate variability is associated with haptoglobin phenotype in patients with coronary artery disease.

BACKGROUND: Three haptoglobin phenotypes exist called Hp 1-1, Hp 2-2, and Hp 2-1. Patients carrying the haptoglobin 1 allele seem to be partly protected against coronary artery disease. An attenuated heart rate variability is associated with a poor outcome in patients with coronary artery disease. Therefore, we hypothesized that the presence of the haptoglobin 1 allele would be associated with a favourable heart rate variability. DESIGN: A cross-sectional study. METHODS: We included 255 patients who were referred for elective coronary angiography as a result of suspected coronary artery disease, and all underwent 24-h electrocardiogram recordings to assess heart rate variability in the time domain. The haptoglobin phenotype was also determined in each patient. RESULTS: There were 159 patients in the Hp 1-1 and Hp 2-1 groups and 98 patients in the Hp 2-2 group. The two groups were comparable with respect to clinical parameters. However, the Hp 2-2 group had significantly lower 24-h heart rate variability values compared with the other group (RR 882 versus 921 ms, P=0.02; RMSSD 26 versus 30 ms, P<0.01; pNN50 6 versus 9%, P=0.01). Furthermore, Hp 2-2 was independently and negatively associated with heart rate variability (P=0.02). CONCLUSION: Hp 2-2 was associated with an attenuated heart rate variability in patients with coronary artery disease that may help to explain other results reporting a poor prognosis in Hp 2-2 patients.     

Comparison of heart rate variability and treadmill exercise score in patients with stable coronary artery disease

Depressed heart rate variability (HRV) is associated with increased mortality and morbidity with various forms of heart disease, and the Duke treadmill score (DTS) provides diagnostic and prognostic information for the evaluation of patients with coronary artery disease (CAD). Our study was aimed at assessing any possible correlation between HRV and DTS in stable CAD. We evaluated the correlation between the HRV assessed by using 24 hour ambulatory ECG monitoring, and treadmill exercise score in 37 patients with angiographically proven and clinically stable CAD. In univariate analysis, DTS showed a significant negative correlation with age (r=–0.89, p<0.01) and a significant positive correlation with the square root of the mean of the sum of the squares of differences between adjacent R-R intervals (RMSSD) (r=0.67, P<0.05), percent difference between adjacent normal R-R intervals >50 ms (PNN50) (r=0.69, P<0.05), and mean of the standard deviation of all R-R intervals in all the 5-minute intervals (HRVM) (r=0.63, P<0.05). There is no significant correlation between DTS and standard deviation of all R-R intervals (SDNN), standard deviation of the averages of R-R intervals in all 5-minute segments of the entire recordings (SDANN) and standard deviation of the SDNN in all the 5-minute intervals (HRVSD). In multiple regression analysis, age was the only independent significant predictor of DTS (p<0.01). DTS decreased with advancing age. SDNN, SDANN, RMSSD, HRVM and HRVSD were not apparent predictors for detecting of DTS. Age was an independent predictor of DTS. Although DTS was correlated with RMSSD, PNN50 and HRVM in patients with stable CAD, time domain parameters of HRV were not appearent predictor for DTS.     

Heart rate variability before and after coronary artery bypass surgery in patients with ischemic heart disease

Short term heart rate variability (HRV) was studied in 44 patients before, in 2 weeks and 2 months after coronary artery bypass grafting (CABG). Prior to surgery the patients were divided into 2 groups: with normal and substantially lowered HRV parameters. In 2 weeks after CABG lowering of HRV was registered in all patients. In 2 months parameters of HRV returned to preoperative level almost in all patients but did not exceed it despite restoration of coronary blood flow and improvement of myocardial contractility. Intergroup differences of characteristics of HRV remained the same as before CABG.     

冠心病患者冠状动脉病变与心率变异性的关系

目的了解冠心病患者冠状动脉病变与心率变异性（HRV）的关系。方法回顾性分析111例患者冠状动脉造影及24小时动态心电图检查资料,按冠状动脉造影结果分为3组:冠状动脉造影完全正常（正常组）、至少有一支冠状动脉狭窄>50%（狭窄组）、至少有一支冠状动脉完全阻塞（闭塞组）;通过动态心电图检查分析HRV的时域指标:SDNN、SDANNind、SDNNind、rMSSD、PNN50。结果①随冠状动脉狭窄程度加重,SDNN、SDANNind、SDNNind逐渐下降,完全阻塞组这些指标下降最显著;②随冠状动脉病变支数增加,SDNN、SDANNind、SDNNind、rMSSD、PNN50有进一步下降趋势,但只有3支病变HRV下降才有统计学意义;③左冠状动脉病变SDNN、SDAN-Nind显著下降,而右冠状动脉病变下降不显著。结论冠心病患者HRV显著下降提示冠状动脉狭窄程度重、病变范围广、病变在左冠状动脉。     

Heart rate variability after long-term treatment with atorvastatin in hypercholesterolaemic patients with or without coronary artery disease

Low heart rate variability (HRV) level, indicative of impaired autonomic function, is associated with an increased risk of cardiovascular morbidity and mortality and is negatively affected by hypercholesterolaemia. In order to test the hypothesis that significant low density lipoprotein (LDL) cholesterol reduction after treatment with a statin will have a beneficial effect on HRV level in hypercholesterolaemic patients with or without coronary artery disease (CAD), forty consecutive patients (28 men and 12 women) with a median age of 61, range (17--70) years were studied. Twenty had stable CAD and 20 were free of CAD at baseline. Twenty healthy volunteers, of similar age and gender as the patients, were used as controls. Patients were treated with atorvastatin (20 mg/day) for 2 years. Changes in lipid parameters and HRV indices were assessed at baseline and 2 years later in all subjects. In both patient subgroups a significant beneficial change in all lipid parameters (more pronounced in the CAD+ subgroup) and a significant beneficial modification in HRV time and frequency domain indices was recorded (more pronounced in the CAD- subgroup), while lipid parameters and HRV indices remained unchanged in the control group. A correlation between LDL concentrations and most of the HRV indices was found at baseline in both patient subgroups, while no such correlation was found between values or their percent changes after hypolipidaemic treatment. These data suggest that treatment with atorvastatin improves autonomic function, as reflected by an increase in HRV level, and this may be a likely mechanism, at least in part, for the reduction in clinical events reported by the landmark survival studies with statins in primary and secondary CAD prevention. Perhaps, if this finding is confirmed by larger studies, HRV level may prove to be a useful tool for risk-stratification and treatment guide in high-risk patients with hypercholesterolaemia, regardless of CAD.     

冠心病患者的心率变异性分析

目的探讨冠心病患者心率变异性的变化。方法选择冠心病患者70例,作为冠心病组,选择无冠心病的健康人50例,作为对照组,进行动态心电图检查,分别测定时域指标（SDNN、SDANN、RMSSD、PNN50）和频域指标（TP、LF、HF）,进行心率变异性变化的参数分析。结果冠心病组的指标SDNN、RMSSD、PNN50、TP、LF、HF均显著低于健康组,P〈0．01,有统计学意义。结论冠心病患者的心率变异性时域和频域指标均明显减低,反映自主神经调节心脏平衡的功能减低,易发生严重的心血管事件。     

冠心病患者冠状动脉病变与心率变异性的关系

目的了解冠心病患者冠状动脉病变与心率变异性的关系，探讨心率变异性在评估冠心病病情方面的作用及意义。方法所有111例病人均行冠状动脉造影及24h动态心电图检查，按冠状动脉造影结果分为至少有一支冠状动脉完全阻塞、至少有一支冠状动脉有不同程度狭窄病变、冠状动脉造影完全正常3组；通过动态心电图检查计算心率变异性的时域指标：SDNN、SDANNind、SDNNind、rMSSD、PNN50，用SPSS12．0统计软件包对比不同冠状动脉病变之间心率变异性的差异。结果①随冠状动脉狭窄程度加重，心率变异性指标：SDNN、SDANNind、SDNNind渐下降，完全阻塞组这些指标下降最显著；②随冠状动脉病变支数增加，心率变异性指标：SDNN、SDANNind、SDNNind、rMSSD、PNN50有进一步下降趋势，但只有三支病变心率变异性下降才有统计学意义；③左冠状动脉病变心率变异性指标：SDNN、SDANNind明显下降，而右冠状动脉病变下降不明显。结论冠心病患者心率变异性明显下降提示冠状动脉狭窄程度重、病变范围广、病变在左冠状动脉，这对冠心病患者病情评估有一定意义。     

冠心病患者阿司匹林抵抗及其影响因素

目的探讨冠心病患者阿司匹林抵抗（Aspirin resistance,AR）现象及其影响因素。方法入选1 731例入院诊断为冠心病（急性冠状动脉综合征和稳定型心绞痛）的患者。采用血小板聚集仪分别测定花生四烯酸（AA）、腺苷二磷酸（二磷酸腺苷,ADP）诱导的血小板聚集率。AR定义为0.5 mmol/L花生四烯酸时血小板平均聚集率≥20%,用10μmol/L ADP时血小板平均聚集率≥70%。阿司匹林半抵抗（Aspirin semiresistance,ASR）即符合上述两个条件之一者。均不符合者为阿司匹林敏感（Aspirin sensitive,AS）。用统计学方法分析各组间各项临床特征差异及影响AR与ASR的危险因素。结果1 731例患者中AR的发生率3.58%（62/1 731）,ASR的发生率20.34%（352/1 731）。与AS相比,AR＋ASR中以女性、高龄、高脂血症患者较多,吸烟者较少。而且AS患者的血小板计数偏高,总胆固醇水平偏低。Logistic回归分析表明,女性[相对比值比（OR）=1.377,95%可信区间（CI）1.084～1.751,P=0.009〗、老年（OR=1.504,95%CI1.005～2.253,P=0.047）、总胆固醇（TCHO）（OR=1.249,95%CI1.114～1.401,P=0.000）升高是发生AR与ASR的危险因素。结论服用阿司匹林的冠心病患者中AR发生率为3.58%,ASR发生率为20.34%。发生AR与ASR危险因素有女性、高龄、高血脂。     

Profile and prevalence of aspirin resistance in Indian patients with coronary artery disease

BACKGROUND: Aspirin resistance is considered to be an enigma and the data available on aspirin resistance is scarce. This study was initiated to prospectively evaluate the prevalence of aspirin resistance in patients with stable coronary artery disease by using an established method of optical platelet aggregation. METHODS AND RESULTS: We studied 50 patients who were on 150 mg of aspirin for the previous 7 days. Fasting blood samples were assessed using optical platelet aggregation (Chronolog Corp, USA). The mean platelet aggregation with 10 microm of adenosine diphosphate in our patient group was 49.42 +/- 23.29% and with 0.5 mg/ ml of arachidonic acid it was 13.58 +/- 21.40%. Aspirin resistance was defined as a mean aggregation of > or =70% with 10 microm of adenosine diphosphate and a mean aggregation of > or =20% with 0.5 mg/ml of arachidonic acid. Aspirin semi responders were defined as those meeting only one of the criteria. Based on these criteria, 2.08% patients were found to be aspirin-resistant, 39.58% were aspirin semi responders and 58.33% were aspirin responders. Females tended to be more aspirin semi responsive (p = 0.08). All other parameters tested, namely, age, smoking, diabetes mellitus, hypertension, obesity, lipids, hemoglobin, platelet count, ejection fraction and drug intake did not show any statistically significant difference among the groups. Thus, in our group 41.66% patients showed inadequate response to aspirin. Conclusions: This study shows that aspirin resistance and aspirin semi responsiveness do occur in the Indian patients and there are no reliable clinical predictors for this condition. The diagnosis therefore relies primarily on laboratory tests.     

老年冠心病患者阿司匹林抵抗的临床研究

目的：探讨老年冠心病患者阿可匹林抵抗（AR）的发生率及其临床特征,评价AR的相关危险因素。方法：对135例患老年冠心病,口服阿司匹林≥100mg超过7d的患者,采用血小板聚集仪分别测定花生四烯酸、二磷酸腺苷（ADP）诱导的血小板聚集率（PAR）。AR的定义：用0．5mmol／L花生四烯酸诱导,平均PAR≥20％,用10μmol／L的ADP诱导,平均PAR≥70％。阿司匹林半抵抗（ASR）即符合上述AR两条件之一者,均不满足者为阿司匹林敏感（AS）。用统计学方法分析各组间各项临床特征差异及影响AR与ASR的独立危险因素。结果：AR、ASR及AS发生率分别为13．3%（18／135）、28．9％（39／135）及57．8％（78／135）。与AS者相比,AR组中糖尿病患者明显增多,且该组患者纤维蛋白原（Fb）水平明显高于AS组[（4．21±1．09）g／L：（3．58±0．80）g／L,P〈0．05]。Logistic回归分析表明,糖尿病[相对比值比（OR）=7．402,95％可信区间（CI）3．110～17．620,P〈0．01]是发生AR与ASR的独立危险因素。结论：研究人群中阿司匹林抵抗的发生率为13．3％,发生AR与ASR可能与糖尿病有关,高Fb患者发生AR的危险性升高。     

老年冠心病患者阿司匹林抵抗及危险因素研究

目的分析老年冠心病（CAD）患者阿司匹林抵抗（AR）的患病率及临床特征,评价AR的相关危险因素。方法129例住院老年CAD患者包括急性冠状动脉综合征（ACS）106例、稳定型心绞痛患者（SAP）23例。应用二磷酸腺苷（ADP）、花生四烯酸（AA）诱导的血小板聚集率评价AR。测定血液生化指标,记录心血管疾病危险因素,伴随临床疾病,超声心动图、冠状动脉造影结果及介入治疗措施等。结果老年CAD患者AR的患病率为51．9％,ACS组AR患病率（57．5％）明显高于SAP组（26．1％）。多因素logistic回归分析结果显示,AR与合并糖尿病、高敏C反应蛋白（hsCRP）及低密度质蛋白胆固醇（LDL-C）水平升高相关（P〈0．05）。结论老年CAD患者AR患病率ACS组明显高于SAP组,合并糖尿病、hsCRP和LDL—C升高是AR的危险因素。