慢性阻塞性肺部疾病的心率变异性分析

为探讨慢性阻塞性肺部疾病与心率变异性的关系,对２４例慢性阻塞性肺部疾病和２４例对照组进行心率变异性分析,并观察其与第ｌｓ用力呼气量的相关性。结果显示：慢性阻塞性肺部疾病患者的ＳＤＮＮ、ＳＤＡＮＮ、ＳＤＮＮＩｎｄｅｘ、ｒＭＳＳＤ、ＰＮＮ５０均明显低于对照组（Ｐ〈０．００５）,且第ｌｓ用力呼气量与上述时域指标呈高度正相关（ｒ＝０．６１～０．８９,Ｐ〈０．０１）。提示心率变异时域指标反映慢性阻塞性肺部疾     

老年慢性阻塞性肺病患者窦性心率震荡及心率变异性的研究

目的 探讨慢性阻塞性肺病(COPD)患者窦性心率震荡(HRT)及心率变异性(HRV)变化及临床意义.方法 临床诊断为COPD老年患者59例,选择同期健康老年人30例为对照组.24 h动态心电图检测各组HRT参数:震荡初始(TO)和震荡斜率(TS)及HRV各项指标,肺功能检测,同时超声心动图测量左心室射血分数(LVEF)、右心房内径(RAD)、右心室内径(RVD)、右心室壁厚度(RVWT)等指标;组间比较且对HRT与HRV指标进行相关性分析.结果 与对照组比较,COPD患者TO值显著增高[(-0.2±1.1)%与(-3.8±2.8)%,t=6.830,P＜0.01],TS值显著下降[(7.0±3.6)与(11.7±6.1)ms/RR,t=3.866,P＜0.01];HRV指标正常R-R间期的标准差(SDNN)、正常R-R间期的标准差的平均值(SDNNI)、SDNNI的标准差(SDANN)、相邻R-R间期之差的均方根值(rMSSD)和正常R-R间期标准差≥50 ms的百分数(PNN50)增加,且随肺动脉压力的增高而恶化.TO与SDANN,rMSDD呈负相关(r=-0.369,P＜0.05;r=-0.472,P＜0.01),TS和SDNN,SDANN,PNN50呈正相关(P＜0.05),与rMSDD无相关性(P＞0.05).结论 COPD患者HRT现象减弱,HRT和HRV变化随患者肺动脉压力的增加而恶化,联合检测对评价COPD患者自主神经功能状态及预后有较高临床价值.

Abstract：

Objective To explore the clinical significance of sinus heart rate turbulence (HRT)and heart rate variability (HRV) in patients with chronic obstructive pulmonary disease(COPD).Methods The 59 moderate to severe COPD patients and 30 healthy subjects were enrolled in this study. The 24-hour holter monitor was used to screen the HRT onset (TO), turbulence slope (TS)and HRV. Pulmonary function tests and echocardiographic examination were performed for measuring left ventricular ejection fraction (LVEF), right atrial dimension (RAD), right ventricular dimension (RVD), right ventricular wall thickness (RVWT). Then all the parameters were compared between NC group and COPD group, and the relationship between HRT and HRV was investigated. Results Compared with control group, TO was significantly increased [(-0.2±1.1) % vs.(-3.8±2.8) %, t=6. 830,P＜0.01] and TS was decreased [(7.0±3.6) ms/RR vs. (11.7±6.1) ms/RR, t =3. 866, P＜0.01] in COPD group. In time domain HRV parameters, normal RR intervallerinin standart deviation(SDNN), standard deviation of normal-to-normal beats index (SDNNi), standard deviation of the averages of normal sinus to normal sinus (SDANN), mean squared differences of the successive RR intervals (rMSDD), fraction of consecutive normal sinus intervals that differ by more than 50 ms (PNN50) were significantly lower in COPD group than in control group(P＜0. 05). TO was negatively correlated with SDANN and rMSDD (r=-0. 369, P＜0. 05; r=-0.472, P＜0.01).TS was positively correlated with SDNN, SDANN and PNN50 (all P＜0.05), but had no correlation with rMSDD (P＞0. 05). Conclusions HRT and HRV are dramatically blunted in COPD patients.Combination of HRV and prognosis. and HRT may be simple and elegant ways for evaluating cardiac autonomic functions.     

Noninvasive ventilation acutely modifies heart rate variability in chronic obstructive pulmonary disease patients

OBJECTIVE: The purpose of present study was to evaluate the acute effects of bi-level positive airway pressure (BiPAP) on heart rate variability (HRV) of stable chronic obstructive pulmonary disease patients (COPD). METHODS: Nineteen males with COPD (69+/-8 years and with forced expiratory volume in 1s <50% of predicted) and eight healthy sedentary age-matched (69 years) males in the control group (CG) were evaluated during two conditions of controlled respiratory rate: spontaneous breathing (SB) and BiPAP (inspiratory and expiratory levels between 12-14 cmH(2)O and 4-6 cmH(2)O, respectively). Peripheral oxygen saturation (SpO(2)), end-tidal of carbon dioxide (ETCO(2)), systolic blood pressure (SBP) and R-R interval were obtained. HRV was analyzed by time (RMSSD and SDNN index) and frequency domains (high frequency - HF, low frequency - LF and HF/LF ratio). RESULTS: Significant reduction of ETCO(2) and SBP in both groups and increase of SpO(2) in COPD group was observed during BiPAP ventilation (p<0.05). During spontaneous breathing, patients with COPD presented lower values of LF, LF/HF and higher values of HF when compared to CG (p<0.05). However, HF was significantly reduced and LF increased during BiPAP ventilation (58+/-19-48+/-15 and 41+/-19-52+/-15 un, respectively) in COPD group. Significant correlations between delta BiPAP-SB (Delta) ETCO(2) and DeltaHF were found (r=0.89). CONCLUSIONS: Sympathetic and parasympathetic neural control of heart rate is altered in COPD patients and that BiPAP acutely improves ventilation, enhances sympathetic response and decreases vagal tonus. The improvement of ventilation caused by BiPAP was associated with reduced cardiac vagal activity in stable moderate-to-severe COPD patients.     

The role of heart rate variability in assessing the evolution of patients with chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (CPOD) is an important cause of morbidity and mortality. Cardiovascular involvement is the most common complication of the disease. Abnormalities of autonomic system, caused by this involvement, can lead to cardiac arrhythmias and sudden death. An important tool in assessing the dysfunction of the autonomic nervous system is the measurement of heart rate variability (HRV). In this article we systematically review the literature that addresses the role of heart rate variability as a maker of clinical evolution in patients with COPD. We focused on correlations between heart rate variability and pulmonary, muscular, cognitive and functional impairment. Heart rate variability has proven an important tool in assessing the cardiac function, the respiratory function, the muscular force, the cognitive capacity and the life quality of these patients. Until recently the problem of the cardiac autonomic dysfunction in patients with COPD could be identified only by invasive measures. At present the simple measuring of HRV is used as a noninvasive method in assessing the cardiac problems of these patients. HRV can be correlated with the severity of the disease, knowing that a dysfunction in autonomic nervous system can lead to potential fatal arrhythmias. Understanding the role of HRV in the evolution of COPD could be important in clinical practice and should be used more frequently.     

慢性肺源性心脏病患者24小时心率变异性的研究

目的 :研究男性慢性肺源性心脏病患者的心率变异性。方法 :46例健康男性 ,34例男性慢性肺源性心脏病患者 ,行 2 4h动态心电图记录 ,作时域和频域分析。结果 :慢性肺源性心脏病病人的高频 (HF)、低频 (LF)、NN5 0计数占总R -R间期的百分比 (pNN5 0 )、每 5min正常R -R间期标准差的平均值 (SDANN)均下降 ,其中严重的慢性肺源性心脏病患者下降更为显著。结论 :男性慢性肺源性心脏病患者存在植物神经功能紊乱 ,病情严重程度也与植物神经功能相关。     

Effects of aerobic exercise training and irbesartan on blood pressure and heart rate variability in patients with chronic obstructive pulmonary disease

BACKGROUND AND OBJECTIVES:

The present pilot study was undertaken to evaluate the efficacy of an aerobic exercise training (AET) program alone or combined with an antihypertensive agent (irbesartan) to reduce blood pressure (BP) and enhance heart rate variability (HRV) in chronic obstructive pulmonary disease patients.

METHODS:

Twenty-one patients were randomly assigned to a double-blind treatment with exercise and placebo (n=11) or exercise and irbesartan (n=10). Subjects underwent 24 h BP monitoring and 24 h electrocardiographic recording before and after the 12-week AET. HRV was investigated using three indexes from the power spectral analysis and three indexes calculated from the time domain. The AET program consisted of exercising on a calibrated ergocycle for 30 min three times per week. Five patients in the placebo group were excluded during follow-up because they were not compliant.

RESULTS:

There was no change in 24 h systolic and diastolic BP before (130±14 mmHg and 70±3 mmHg, respectively) and after (128±8 mmHg and 70±8 mmHg, respectively) exercise training in the placebo group, whereas in the irbesartan group systolic and diastolic BP decreased from 135±9 mmHg and 76±9 mmHg to 126±12 mmHg and 72±8 mmHg, respectively (P<0.02). There were no changes in HRV parameters in either group.

CONCLUSIONS:

The present study suggests that a 12-week AET program is not associated with a significant reduction in BP or enhancement in HRV, whereas an AET program combined with irbe-sartan is associated with a reduction in 24 h BP.     

Augmented heart rate response to hypoxia in patients with chronic obstructive pulmonary disease.

Effects of acute, progressive isocapnic hypoxia on heart rate (HR) and ventilation were determined in 31 patients with chronic obstructive pulmonary disease (COPD) and in 24 normal control subjects. There was an inverse linear relationship between heart rate and SaO2 in each subject. The slope factor (delta HR/delta SaO2) obtained from the regression line was significantly higher in the patients with COPD than in the normal control subjects (0.888 +/- 0.309 SD beats/min/% fall in SaO2 versus 0.693 +/- 0.287; p less than 0.05), whereas the ventilatory response (delta VE/delta SaO2) was not significantly different between the two groups. To elucidate factors responsible for the augmented heart rate response to hypoxia in the patients with COPD, we examined the relationships of delta HR/delta SaO2 with age, physical characteristics, pulmonary function data, and arterial blood gas data in all the subjects. A weak but significant relationship was found only between delta HR/delta SaO2 and FEV1/VC, %FEV1, RV/TLC, and %RV. Because the HR response to hypoxia correlates only with parameters that reflect the grade of airway obstruction, we believe that the enhanced HR response seen in patients with COPD is a result of the disease process in the airway and tissue, although the precise mechanism was not specified in this study.     

Association of parameters of heart rate variability with severity of bronchial obstruction and presence of pulmonary hypertension in patients with chronic obstructive pulmonary disease

With the aim of assessing parameters of heart rate variability (HRV) and heart rhythm turbulence (HRT) in patients with chronic obstructive pulmonary disease (COPD) in dependence on severity of the course of this disease and presence of pulmonary hypertension (PH) we examined 73 patients (28 with COPD and 45 healthy subjects). Invasive measurement of central hemodynamics was conducted. Compared with the control group in patients with COPD we revealed lowering of temporal as well as frequency HRV parameters. No significant changes of HRV parameters depended on severity of COPD course. However a tendency to maximal lowering of HRV parameters was noted in the group of patients with COPD with first sec forced expiratory volume <50%. Comparison of patients with and without PH with controls revealed tendency to maximal lowering of HRV parameters in the PH group. Thus measurement of HRV can be used for supplementary assessment of severity of the disease and detection of PH.     

Effect of mibefradil on heart rate variability in patients with chronic heart failure

BACKGROUND: Mibefradil was recently withdrawn from the market because of an unfavorable clinical profile in patients with chronic heart failure. Although drug interactions appear to play a role, other mechanisms such as proarrhythmia and autonomic deterioration could also be relevant. Chronic heart failure is accompanied by autonomic impairment and analysis of heart rate variability can be used to examine autonomic modulation of heart rate. METHODS: We studied 18 heart failure patients (age 63.2+/-10.1 years (mean+/-S.D. ), ejection fraction 0.21+/-0.07) treated with mibefradil or placebo, who participated in the MACH-I (Mortality Assessment in Chronic Heart failure) trial in our center, and compared them with 18 healthy matched controls. Heart rate variability analysis was performed at baseline and after 7 months of treatment. RESULTS: At baseline, heart rate variability parameters were impaired in patients with heart failure compared to healthy controls (P<0.05). After 7 months of treatment a reduction in (24-h) heart rate was observed (P=0.02, versus placebo). Apart from the effect on mean NN, no significant differences were observed for the remaining heart rate variability parameters. CONCLUSIONS: Mibefradil does not impair autonomic balance and in fact reduces heart rate in patients with heart failure. These findings suggest that autonomic activation did not contribute to the adverse effects of mibefradil.     

Effects of protriptyline on diurnal and nocturnal oxygenation in patients with chronic obstructive pulmonary disease

OBJECTIVE: To determine the effects of a nonsedating tricyclic antidepressant (protriptyline) on pulmonary function (lung volume, expiratory flow), arterial blood gases, sleep architecture, and sleep-induced breathing abnormalities in patients with chronic obstructive pulmonary disease. DESIGN: A before-and-after trial in which patients, blinded to treatment, were given a placebo for 2 weeks, followed by 2 and 10 weeks of protriptyline treatment. SETTING: Referral-based pulmonology clinic in a public institution. PATIENTS: Sixteen outpatients were enrolled in the trial. Complete results for 11 patients and partial results for 3 patients are presented. INTERVENTIONS: Patients were evaluated at baseline, after receiving placebo for 2 weeks, and after 2 and 10 weeks of protriptyline therapy (20 mg/d, taken at bedtime). MEASUREMENTS AND MAIN RESULTS: At baseline, for the whole group, forced expiratory volume in 1 second (FEV1) was 1.0 +/- 0.08 L (mean +/- SE); the partial pressure of O2 in arterial blood (PaO2) was 59 +/- 1.2 mm Hg; and the partial pressure of CO2 in arterial blood (PaCO2) was 48.9 +/- 1.2 mm Hg. These variables remained stable after placebo. Pulmonary function test results were unchanged with protriptyline therapy. Arterial blood gas levels improved with such therapy: PaO2 levels increased by 5.1 +/- 1.4 mm Hg after 2 weeks and 6.7 +/- 2.4 mm Hg after 10 weeks (P less than 0.01); PaCO2 levels decreased by 4.2 +/- 0.9 mm Hg after 2 weeks and 2.2 +/- 1.1 mm Hg after 10 weeks (P less than 0.01). Total sleep times were similar at these visits. The only change in sleep architecture was a significant decrease in rapid eye movement (REM) sleep. The lowest value for the saturation of hemoglobin with O2 in arterial blood (SaO2) seen during sleep was 72.0% +/- 2.0% at baseline. After 2 and 10 weeks of protriptyline therapy, SaO2 values increased by 7.1% +/- 1.6% and 5.0% +/- 2.1%, respectively (P less than 0.01). With protriptyline therapy, the cumulative SaO2 curve, derived from data obtained during sleep, shifted down and to the right. CONCLUSIONS: Protriptyline improves diurnal and nocturnal hypoxemia in patients with chronic obstructive pulmonary disease. These changes are not related to changes in pulmonary mechanics.     

慢性阻塞性肺疾病对冠状动脉粥样硬化性心脏病患者的影响

目的探讨慢性阻塞性肺疾病(COPD)对冠状动脉粥样硬化性心脏病(CHD)患者的影响。方法收集2012年8月至2018年3月于首都医科大学附属北京同仁医院内科住院的CHD患者共121例,其中61例合并COPD,进行横断面分析,比较两组之间冠状动脉造影结果、Gensini评分和高敏C反应蛋白(hs-CRP)的差异。结果 CHD合并COPD组患者的Gensini评分较单纯CHD组升高(120.90±90.68比65.27±50.38,t=4.162,P=0.000);CHD合并COPD组发生一支及以上心外膜血管完全或次全闭塞的比例较单纯CHD组高(44.3%比21.7%,χ~2=6.979,P=0.008),两组发生左主干+三支心外膜血管或三支心外膜血管病变的比例相当。CHD合并COPD组的hs-CRP较单纯CHD组高,但差异无统计学意义[(6.95±9.52)mg/L比(5.03±4.90)mg/L,t=1.392,P=0.166]。多因素logistic回归分析显示,COPD与一支及以上心外膜血管完全或次全闭塞独立相关(OR:2.838,95%CI:1.251～6.437,P=0.013)。结论 CHD合并COPD患者的冠状动脉狭窄程度更重,出现一支及以上血管完全或次全闭塞的比例更高。COPD对CHD的影响机制可能是全身炎症反应。     

慢性阻塞性肺病并发心律失常特点及处理分析

目的 研究慢性阻塞性肺病(COPD)合并心律失常特点及处理.方法 对95例COPD同时合并心律失常患者临床资料进行分析.结果 本组COPD并发心律失常率达57％(95例),其中室上性心律失常最为多见,共75例次,室性心律失常及传导阻滞或多种心律失常并存情况也可见.经过控制感染、输氧、纠正酸碱平衡紊乱等支持治疗后,93.4％患者的心律失常症状消失.结论 COPD并发心律失常患者治疗时针对原发病及并发症的治疗是控制抗心律失常的关键所在.     

心率变异性和心律失常对急性肺栓塞预后的评估价值

目的 探讨心率变异性(heart rate variability,HRV)和心律失常发生率对急性肺栓塞(acute pulmonary embolism,APE)危险分层及预后评估的临床价值.方法 回顾性分析100例经影像学检查确诊APE患者的临床资料.根据临床表现、简化肺栓塞严重指数、右心室功能不全和心肌损伤标志物...     

Effect of biventricular pacing on heart rate variability in patients with chronic heart failure

BACKGROUND: Biventricular pacing is emerging as a long-term therapy for symptomatic heart failure. Analysis of heart rate variability (HRV) has become an important predictive tool in this syndrome. AIM OF THE STUDY: To assess whether chronic resynchronization therapy can affect HRV in patients with heart failure. METHODS AND RESULTS: Thirteen patients with heart failure were studied (mean age+/-1 S.E. 65+/-2.2 years, QRS 195+/-5.3 ms, NYHA class 3.2+/-0.1, LVEF 21+/-1.7%). The protocol included a preliminary no pacing period for 1 month following device implantation. Twenty-four hour Holter ECG recordings were performed at the end of this period (baseline) and after 3 months of biventricular stimulation (VDD mode). Prior to and following pacing patients underwent NYHA class evaluation, 6-min walk test, Quality of Life Assessment and a cardiopulmonary exercise test. Biventricular pacing improved functional class (P<0.0001) and Quality of life (P<0.0001), increased 6-min walk distance, (P=0.008) and exercise duration (P<0.0001) but had no significant effect on peak exercise VO(2). Resynchronization therapy increased mean 24-h RR (922+/-58 vs. 809+/-41 ms at baseline, P=0.006), SDNN (111+/-11 vs. 83+/-8 ms, P=0.003), SDNN-I (56+/-10 vs. 40+/-5 ms, P=0.02), rMSSD (66+/-14 vs. 41+/-8 ms, P=0.003), Total Power (5724+/-1875 vs. 2074+/-553 ms(2), P=0.03), Ultra Low Frequency Power (1969+/-789 vs. 653+/-405 ms(2), P=0.03) and Very Low Frequency Power (2407+/-561 vs. 902+/-155 ms(2), P=0.004). CONCLUSION: Biventricular pacing in heart failure improves autonomic function by increasing HRV. This may have important prognostic implications.     

肺心病患者心率变异性改变的临床意义

目的分析慢性肺源性心脏病患者的心率变异性改变的临床意义。方法经动态心电图、血气分析检查,选取肺心病缓解期、急性期与正常受试者各42例,采用时域法分析其HRV的改变。结果肺心病组HRV均较对照组降低,且重症肺心病随血氧分压下降、二氧化碳分压升高,各参数下降更明显。结论肺心病患者HRV的改变在预测其心电变化指导临床治疗提供了重要的指标。     

Post-exercise heart rate recovery and mortality in chronic obstructive pulmonary disease

Abnormal heart rate recovery (HRR) after exercise, a marker of cardiac autonomic dysfunction, is associated with poor prognosis in various populations. As chronic obstructive pulmonary disease (COPD) is associated with cardiac autonomic dysfunction, we tested the hypothesis that patients with COPD have a lower HRR than healthy people, and evaluated whether a delay in HRR is associated with an increased risk of mortality in COPD. The records of 147 COPD patients were reviewed (65.1+/-9.1 years, mean+/-sd, 42 women/105 men, forced expiratory volume in 1s (FEV1): 42+/-15% predicted) and compared to 25 healthy subjects (61.6+/-4.5 years, 5 women/20 men, FEV1: 100+/-14% predicted) during recovery after an exercise test. Heart rate was measured at peak exercise and at 1-min recovery, the difference between the two being defined as HRR (11+/-9 beats in COPD patients vs. 20+/-9 beats in healthy subjects, P < 0.0001). During a mean follow-up of 43.1+/-22.0 months, 32 patients died. Abnormal HRR (14 beats) was a strong predictor of mortality in COPD patients (adjusted hazard ratio: 5.12, 95% CI [1.54-17.00]). In conclusion, COPD patients have a lower HRR than healthy subjects, and have a worse prognosis when presenting abnormal HRR.     

慢性阻塞性肺疾病昼夜血氧变化及其临床意义

已有研究表明慢性阻塞性肺疾病(COPD)患者血氧的波动在氧化应激、炎症反应中均起重要作用[1]。由于COPD患者白天可能已有低氧血症,因此单纯夜间血氧饱和度水平不能真正反映昼夜血氧变化情况,而目前关于血氧的昼夜变化幅度对病情影响的研究较少。因此,本研究将从COPD患者昼夜血氧变化幅度的角度探讨其临床意义。