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…

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）均较术前增加，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ＰＴＣ     

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。     

间隔部射频消融对自主神经张力的非一过性影响

本文将间隔部射频消融（ＲＦＣＡ）患者２２例（含１８例改良慢径消融）和游离壁ＲＦＣＡ患者２０例作术后４８至７２小时的心率变慢性（ＨＲＶ）研究。结果表明，两组ＲＦＣＡ的功率及时间无显著性差异，间隔部ＲＦＣＡ组ＬＦＰ／ＨＦＰ比值较术前显著增加，提示ＨＲＶ减低，而游离壁组术前、术后无显著性差异。     

长程与短程心率变异性的结合对于急性心肌梗死患者预后的意义

目的 比较长程与短程心率变异性（ＨＲＶ）分析对于急性心肌梗死（ＡＭＩ）患者预后的不同预测价值。方法 选择１９９５年１０月至１９９６年１２月入我院的ＡＭＩ患者５０例，结合时域与频域的方法，分别进行长程（２４小时），短程（１－３小时）分析。结果 长程短程ＨＲＶ分析相关性很强，相关系数在０．７４～０．９８之间。 长程分析还是短程分析ＨＲＶ，在６个月随访死亡病例中均降低，除高频（ＨＦ）低高频比值（ＬＦ／Ｈ     

REGULATION OF GI MOTOR FUNCTION：ROLEOFBRAINPEPTIDES．

ＲＥＧＵＬＡＴＩＯＮＯＦＧＩＭＯＴＯＲＦＵＮＣＴＩＯＮ：ＲＯＬＥＯＦＢＲＡＩＮＰＥＰＴＩＤＥＳ．Ｖ．ＭａｒｔｉｎｅｚａｎｄＹ．Ｔａｃｈｅ，ＣＵＲＥ：ＤｉｓｅａｅｓＲｅｓｅｒｃｈＣｅｎｔｅｒ，ＷｅｓｔＬｏｓＡｎｇｅｌｅｓＶＡＭｅｄｉｃａｌＣｅｎｔｅｒ．...     

风湿性心脏病慢性心房颤动迷宫和二尖瓣手术围术期的血液动力学监测

采用Ｓｗａｎ－Ｇａｎｚ漂浮导管，对１４例同时行迷宫和二尖瓣手术的风湿性心脏病慢性心房颤动（简称房颤）患者在术前和术后２４ｈ、４８ｈ及１个月进行血液动力学监测。结果：①术后２４ｈ、４８ｈ、１个月的心输出量（ＣＯ）、心脏指数（ＣＩ）、每搏指数（ＳＩ）、体循环阻力指数（ＳＶＲＩ）、左室每搏作功指数（ＬＶＳＷＩ）和右室每搏作功指数（ＲＶＳＷＩ）与术前比较差异有显著性（Ｐ＜０．０５～０．０００１）。②心率（ＨＲ）、平均动脉压（ＭＡＰ）、平均肺动脉压（ＭＰＡＰ）、肺动脉毛楔压（ＰＡＷＰ）、中心静脉压（ＣＶＰ）、左心作功指数（ＬＣＷＩ）、肺循环阻力指数（ＰＶＲＩ）、右心作功指数（ＲＣＷＩ）等，术后与术前以及不同时间之间比较均无统计学意义，Ｐ＞０．０５。③ＭＰＡＰ、ＰＡＷＰ、ＣＯ、ＣＩ、ＳＩ、ＳＶＲＩ、ＬＶＳＷＩ的异常发生率术后１个月与术前比较有显著性差异，Ｐ＜０．０５、＜０．０１或＜０．０００１。迷宫术后ＣＯ较术前明显提高，左房压力恢复正常，肺血管压力降低。以上表明风湿性心脏病慢性房颤迷宫和二尖瓣术后ＣＯ、左心功能均有明显改善，无围术期死亡和严重并发症，提示血液动力学监测对及时了解泵功能状态、指导治疗和评价手术疗效是非常?     

应用心率功率谱分析心肌梗塞后心率变异性改变

应用心率功率谱（ＨＲＰＳ）分析２６例急性心肌梗塞（ＡＭＩ）、１７例陈旧性心肌梗塞（ＯＭＩ）及１９例健康人的心率变异性（ＨＲＶ）改变，探讨心肌梗塞后心脏植物神经活性的变化。结果：ＡＭＩ组与ＯＭＩ组的高频（ＨＦ）及总功率（ＴＰ）面积均明显低于对照组，分别为１２１．９４±１３９．６５，１２４．７９±８７．６７（ｂｐｍ）２／ＨｚＶＳ６４４．６１±５３９．０９（ｂｐｍ）２／Ｈｚ（Ｐ＜０．０１）；８１８．７２±６９９．４２，８９２．３５±５７３．９６（ｂｐｍ）２／ＨｚＶＳ１８６４．５０±１４９９．４０（ｂｐｍ）２／Ｈｚ（Ｐ＜Ｏ．０５）；ＬＦ／ＨＦ比值明显高于对照组（２．０３±１．４９，１．９９±１．３２ＶＳ０．６１±０．２６，Ｐ＜０．０１）；ＡＭＩ组与ＯＭＩ组相比ＨＲＰＳ所有成分无显著性差异。提示心肌梗塞早期就有迷走神经活性降低，交感神经活性相对占优势，这种改变在一定时间内（平均２．１年）不易恢复。     

慢性充血性心力衰竭患者心率变异性初步分析

对４８例正常人、５２例充血性心力衰竭（ＣＨＦ）患者的心率变异性（ＨＲＶ）进行分析，发现ＣＨＦ患者２４小时ＳＤＡＮＮ、ｒＭＳＳＤ及ｐＮＮ５０等时域指标明显低于正常人；ＬＦ、ＭＦ、ＨＦ和ＴＰ等频域指标也明显低于正常人，ＬＦ／ＨＦ比值略高于正常人。揭示ＣＨＦ患者存在自主神经功能损害，交感神经相对占优势     

冠状动脉成形术TNF的活性及临床意义

为探讨肿瘤坏死因子（ＴＮＦ）在冠状动脉成形术（ＰＴＣＡ），对冠状动脉内膜损伤及再狭窄的相互关系，自１９９５年４月～１９９６年４月，采用Ｌ９２９细胞系测定了３２例ＰＴＣＡ患者ＴＮＦ的活性。观察ＰＴＣＡ术前和术后１、４、８、２４小时周围静脉血ＴＮＦ的动态变化。结果：术前ＴＮＦ活性低，术后４～８小时明显增高（Ｐ＜０．０１），２４小时基本降至术前水平。显示ＴＮＦ活性增高与ＰＴＣＡ术中冠脉内膜损伤有密切关系，可能是参与ＰＴＣＡ后术冠状动脉急性闭塞及迟发性再狭窄的重要因素之一。     

冠心病患者红细胞变形能力与红细胞膜脂质成分和PAF－AH活性关系的研究

本文检测了１１２例冠心病（ＣＨＤ）患者红细胞变形能力（ＥＤ）和膜脂质成分及血小板激活因子乙酰水解酶（ＰＡＦ－ＡＨ）活性变化。结果显示，ＣＨＤ病人红细胞滤过指数（ＩＦ）较对照组明显增高（Ｐ＜０．００１）；膜胆固醇（Ｃｈ）、脂质过氧化物（ＭＤＡ）和Ｃｈ／磷脂（Ｃｈ／ＰＬ）明显增高，而膜ＰＬ和ＰＡＦ－ＡＨ活性明显降低，与对照组相比差异有显著性意义（Ｐ＜０．００１）。ＣＨＤ患者ＩＦ与膜Ｃｈ、ＭＤＡ和ＣＵＰＬ呈正相关，与膜ＰＬ和ＰＡＦ－ＡＨ呈负相关。提示ＣＨＤ患者ＥＤ降低与红细胞膜脂质成分异常和ＰＡＦ－ＡＨ活性降低有关。     

The Relationship between Heart Rate Variability and Heart Rate Turbulence Dynamics after Primary Coronary Angioplasty

Background: The application of heart rate turbulence (HRT) analysis for risk assessment after pharmacologically treated myocardial infarction (MI) was described in 1999. The aim of the present study was to evaluate the dynamics of HRT changes in long‐term observation after MI treated with primary coronary angioplasty (PTCA). Moreover, the usefulness was assessed of early postinfarction heart rate variability (HRV) analysis for predicting HRT dynamics. Methods: The study group consisted of 96 patients with MI treated with primary PTCA. Holter monitoring with HRV and HRT analysis was performed 3 days after the procedure and 1 year later. Results: Twelve months after primary PTCA, an improvement (Type I HRT dynamics) was noted in 51 patients, and the worsening of both the HRT parameters (Type II HRT dynamics) in 34 patients. Fourteen patients showed the worsening of only one HRT parameter (Type III HRT dynamics). The following HRV parameters recorded in early postinfarction Holter monitoring had a significant influence on the risk of Type II HRT dynamics: SDNN, RMSSD, Triangle Index and Δ LF/HF (mean day‐time LF/HF – mean night‐time LF/HF). Only the latter was found in the multivariate analysis as significantly connected with worsened HRT. During the follow‐up, SDNN and Triangular Index improved in all the patients. Conclusions: HRT after myocardial infarction treated with primary PTCA presents a significant dynamics, which is different than dynamics of HRV. An abnormal circadian pattern of autonomic activity is a finding that helps identify patients who need to have HRT analysis repeated during a long‐term follow‐up, due to the tendency for HRT to change with time toward the prognostically unfavorable values.     

T‐Wave Alternans and Heart Rate Variability: A Comparison in Patients with Myocardial Infarction with or without Diabetes Mellitus

Background : The aim of this study was to investigate the differences in T‐wave alternans (TWA) and heart rate variability (HRV) among patients with myocardial infarction with or without diabetes mellitus and the relationship between TWA and HRV. Methods: The study population included 133 patients: 59 patients with myocardial infarction (MI) (group post‐MI without diabetes); 40 myocardial infarction with diabetes (group post‐MI with diabetes); and 34 controls (group control). Cardiac autonomic neuropathy assessment was made using frequency domain (low‐frequency [LF] power, high‐frequency [HF] power, LF/HF) and time domain (SDNN, standard deviation of the averaged normal sinus RR intervals for all 5‐minute segments [SDANN]) of HRV indexes. Both TWA and HRV were measured on the Holter monitor, and TWA was calculated automatically using the time‐domain modified moving average method. Results: TWA values differed significantly between controls (40 ± 16 μV) and group post‐MI with (62 ± 17 μV, P < 0.05) or without (60 ± 15 μV, P < 0.05) diabetes. In addition, group post‐MI with diabetes had lower standard deviation of all normal sinus RR intervals (SDNN), standard deviation of the averaged normal sinus RR intervals for all 5‐minute segments (SDANN), and HF, indicating depressed vagus nerve activity, and higher LF/HF ratio, indicating elevated sympathetic nerve activity, than controls and group post‐MI without diabetes (P < 0.05). TWA correlated with SDNN and SDANN (r = 0.29, 0.31; P < 0.001). Conclusions: TWA was elevated in patients following myocardial infarction, both in those with or without diabetes. Myocardial infarction patients had a lower time domain, HF, and a higher LF/HF ratio HRV, especially in those with diabetes. The analysis of modified moving agerage (MMA)‐based TWA and HRV can be a useful tool for identifying post–myocardial infarction patients at high risk of arrhythmic events. Ann Noninvasive Electrocardiol 2011;16(3):232–238     

Effect of percutaneous transluminal coronary angioplasty on QT dispersion and heart rate variability parameters

Background

The aim of the study was to analyse parameters reflecting the sympathovagal control of ventricular depolarisation and repolarisation [heart rate variability (HRV) and QT interval dispersion (QTd)] in patients undergoing elective percutaneous transluminal coronary angioplasty (PTCA), and determine whether HRV correlates with QT dispersion parameters.

Methods

The study consisted of 26 consecutive patients (16 men, 10 women) with single-vessel coronary artery disease (CAD) who underwent elective coronary angioplasty. HRV analyses of all subjects were obtained with the time- and frequency-domain methods. For frequency-domain analysis, low-frequency HRV (LF), high-frequency HRV (HF) and the LF:HF ratio were measured. For time-domain analysis, standard deviations of the normal-to-normal QRS intervals (SDNN) and square roots of the mean squared differences of successive N–N intervals (rMSSD) were obtained. QT intervals were also corrected for heart rate using the Bazett’s formula, and the corrected QT interval dispersion (QTcd) was then calculated. All measurements (HRV parameters and QTcd) were made before and immediately after PTCA.

Results

QTcd was significantly decreased after PTCA (52.2 ± 3.5 vs 42 ± 3.9 ms). SDNN (94.1 ± 22 vs 123.9 ± 35.2 ms), rMSSD (43.7 ± 20.1 vs 73.4 ± 14.5 ms) and HF (51.1 ± 48.8 vs 64.2 ± 28.6 ms²) were significantly higher after PTCA, whereas LF (142 ± 41.5 vs 157.2 ± 25.9 ms²) and the ratio of LF:HF (3.3 ± 1.9 vs 2.1 ± 1.2) were significantly decreased after PTCA. We observed a significant negative correlation after PTCA between QTcd and LF (r = −0.87, p = 0.01) and between QTcd and the ratio of LF:HF (r = −056, p < 0.05).

Conclusion

Among the patients with CAD undergoing PTCA, QTcd significantly decreased after PTCA, and negatively correlated with LF, the parameter reflecting the sympathetic system.     

Reduced heart rate variability in ischemic heart disease is only partially caused by ischemia. An HRV study before and after PTCA

BACKGROUND: Reduced heart rate variability (HRV) after acute myocardial infarction (AMI) indicates poor prognosis. HRV in patients with uncomplicated coronary artery disease is reduced, and an association with poor prognosis has been suggested. The mechanism of the HRV reduction is not known, but ischemia is a possibility. AIM: To evaluate, in angina patients with no prior AMI, no other disease and drug-free, if complete revascularization and thus important reduction of ischemia by means of PTCA influences HRV. PATIENTS AND METHODS: Twenty-four-hour Holter recordings were performed at baseline prior to PTCA in 48 patients with angina and in 41 age-matched healthy control subjects. The recording was repeated 1 and 6 months after complete revascularization. In addition, HRV was registered during controlled respiration in the supine and standing positions and during cold pressure test at baseline in all angina patients and controls and in 17 consecutive angina patients 6 months after PTCA. RESULTS: Compared to controls, angina patients had a significantly reduced mean RR interval (p = 0.02), SD (p = 0.003), rMSSD (p = 0.03), pNN50 (p = 0.03), total power (p = 0.003), low- (p = 0.004) and high-frequency peak (p = 0.04), but normal SDNN, SDANN and LF/HF. One and 6 months after PTCA, 42/46 and 32/40 follow-up patients, respectively, were free of angina. Six months after PTCA, there was a significant recovery of vagal modulation seen in the frequency domain during controlled respiration, but only nonsignificant trends in HRV parameters analyzed over 24 h. CONCLUSION: Patients with uncomplicated angina had reduced HRV, mainly affecting vagal activity, but normal low frequency variability associated with mortality. Complete revascularization caused a partial normalization of vagal modulation indicating that ischemia may be one of but not the only mechanism of the HRV reduction in uncomplicated chronic coronary artery disease.     

Effects of propranolol on recovery of heart rate variability following acute myocardial infarction and relation to outcome in the Beta-Blocker Heart Attack Trial

This study evaluated the effects of propranolol on recovery of heart rate variability (HRV) after acute myocardial infarction and its relation to outcome in the Beta-blocker Heart Attack Trial (BHAT). Beta blockers improve mortality after acute myocardial infarction, but through an unknown mechanism. Depressed HRV, a measure of autonomic tone, predicts mortality after acute myocardial infarction. Whether beta blockers influence recovery of HRV after acute myocardial infarction, and thereby improve outcome, is unknown. We compared 24-hour HRV parameters at 1 week after acute myocardial infarction and after 6 weeks of treatment with propanolol (n = 88) or placebo (n = 96). The relation between 25-month outcome (death/acute myocardial infarction/congestive heart failure), propranolol treatment, and HRV was further analyzed. After 6 weeks, high-frequency (HF) power (log-normalized), an index of vagal tone, increased more in propranolol-treated patients (4.28 +/- 0.1 to 5.17 +/- 0.09 ms(2)) than in placebo-treated patients (4.26 +/- 0.09 to 4.77 +/- 0.1 ms(2), p <0.05). Sympathovagal balance measured by the low-frequency (LF) to HF ratio increased in placebo-treated patients (3.55 +/- 0.24 to 3.86 +/- 0.24) but decreased in those treated with propranolol (3.76 +/- 0.29 to 3.17 +/- 0.23, p <0.01). Other frequency-domain parameters increased over time but were not affected by propranolol. Propranolol blunted the morning increase in the LF/HF ratio. Recovery of HF, the strongest HRV predictor of outcome, and propranolol therapy independently predicted outcome. In summary, after acute myocardial infarction, propranolol therapy improves recovery of parasympathetic tone, which correlates with improved outcome, and decreases morning sympathetic predominance. These findings may elucidate the mechanisms by which beta blockers decrease mortality and reduce the early morning risk of sudden death after acute myocardial infarction.     

冠心病患者短暂心肌缺血时心率变异性变化

目的 :观察冠心病患者心肌缺血时的心率变异性 （HRV）变化。方法 :监测 38例冠心病患者 2 4h动态心电图中的 72次短暂心肌缺血发作事件 ,分析心肌缺血发作前、发作时、发作停止后的 HRV。结果 :在心肌缺血发作时 ,HRV降低。时域指标 SDANN ,r MSSD,PNN50 显著降低 ,频域指标 HF也降低 ,L F未见增加 ,L F/ HF无显著差异。结论 :在日常生活中发生的短暂缺血、迷走神经减弱可能起重要作用。     

Prognostic Significance of Heart Rate Variability During the First 24 Hours of Acute Myocardial Infarction: A 5‐Year Follow‐up Study

Background: The prognostic value of heart rate variability (HRV) measured within the first 24 hours of acute myocardial infarction was assessed in 94 consecutive patients. Methods: The mean of standard deviation of normal R‐R intervals for all 5‐minute segments (SDNN index), the width of the R‐R interval histogram at 10% and 50% of the peak, and three frequency‐domain measures of HRV (low frequency [LF], high frequency [HF], and LF/HF ratio) were calculated from a continuous ECG recording taken within the first hours of admission and their prognostic value for long‐term events was studied. Results: During the follow‐up period (56.7 ± 5.9 months) 6 sudden and 7 nonsudden cardiac deaths occurred. Time‐domain measurements of HRV were lower in patients with sudden death (SDNN index: 27.0 ± 20.2 vs 47.5 ± 20.7 ms in survivors, P < 0.001). LF and HF power, but not the LF/HF ratio, were also inversely associated with sudden death. No significant differences were found between survivors and patients with nonsudden cardiac death. After adjustment for other clinical covariates, LF and HF power remained significantly associated with sudden death. Conclusion: We conclude that heart rate variability measured within the first 24 hours of myocardial infarction is a strong predictor of sudden death during subsequent follow‐up.     

苯那普利对高血压病患者心率变异性及其昼夜节律的影响

目的　观察苯那普利对高血压病患者动态血压、心率变异性及其心率变异性昼夜节律的影响。方法　 3 6例高血压病人 ,服用苯那普利 ( 10～ 2 0 mg/ d) 8周 ,用药前后做动态血压和 2 4h动态心电图分析。结果　治疗后动态血压各指标均下降 ( P<0 .0 5或 <0 .0 1) ;HRV(心率变异性 )时域指标 RMSSD(全部相邻 RR间期之差的均方根值 )升高 ( P<0 .0 5 ) ,其他指标虽均有升高 ,但无统计学意义 ( P>0 .0 5 ) ;频域指标中 HF(高频功率 )增加 ,L F(低频功率 )、L F/ HF下降 ;5分钟 HRV中治疗后白昼段和夜间段 HF均升高 ,L F/ HF均下降 ,且白昼段 L F较夜间段高 ,HF比夜间段低。结论　苯那普利可以很好控制全天血压 ,同时降低交感神经活性 ,提高迷走神经张力 ,且不干扰心率变异性的昼夜节律     

骶神经刺激对慢性功能性便秘自主神经功能影响观察

目的评价骶神经刺激治疗（SNS）对慢性功能性便秘患者自主神经功能的影响。 方法搜集西京消化病医院和西安马应龙肛肠医院2016年9月至2017年11月收治的86例慢性功能性便秘患者,随机分为治疗组与对照组,治疗组42例,对照组44例。治疗组采用非植入性骶神经刺激治疗,对照组采用电针八髎穴治疗。比较两组间及各组内治疗前后便秘症状评分和心率变异性（HRV）测定值。 结果组内比较症状评分均降低（P<0.05）;治疗组内HRV各指标的变化差异具有统计学意义（HF：u=-2.269,P=0.023;LF：u=-5.183,P=0.000;LF/HF：u=-4.359,P=0.000）,对照组无影响。组间比较,治疗前后的症状评分和HRV各指标差异无统计学意义（P>0.05）,伴随症状差值（t=4.040,P=0.000）和HRV各值差值（ΔHF：u=-2.583,P=0.010;ΔLF：u=-5.089,P=0.000;ΔLF/HF：u=-3.299,P=0.001）差异具有统计学意义。 结论SNS可能具有通过影响自主神经功能改善慢性功能性便秘的作用。