老年冠心病患者心率变异性减低与心血管事件的关系

目的　评价一般老年冠心病 (CAD)患者心率变异性 (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中有CAD者 2 4h动态心电图 (DCG)HRV资料与心血管事件的关系 ,共 2 38例。HRV分析包括时域分析和频域分析。比较查体者有和无心血管事件组各时域和频域参数有无差别。结果　有 2 7例老年人发生心血管事件 (有心血管事件组 ) ,2 11例未发生心血管事件 (无心血管事件组 ) ,有心血管事件组与无心血管事件组比较 ,HRV各参数均明显降低 (P <0 .0 1)。结论　一般老年CAD患者如HRV明显降低 ,则易于发生心血管事件。     

原发性高血压患者血压与心率变异性的关系探讨

目的;探讨原发性高血压(EH)患者血压与心率变异性(HRV)的关系。方法:45例原发性高血压患者药物治疗1年(血管紧张素转换酶抑制剂,钙离子拮抗剂),治疗前、后测血压与24小时动态心电图,进行HRV时域和频域分析,并与63例正常人对照。结果:(1)EH组患者治疗后血压明显降低(P<0.05);(2)与正常组比较,EH组治疗前时域分析与频域分析各项参数均减低,差异显著(P<0.05);(3)HE患者经治疗后HRV各项参数,特别是SDNN、SDANN、LF、HF有显著改善(P<0.05)。结论:降压治疗可以改善心血管自主神经功能。     

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±     

高龄老年人心率变异性减低与心脏性猝死的关系

目的　研究高龄老年人心率变异性 (Heart Rate Variability,HRV)减低与心脏性猝死的关系。方法　回顾性分析 36例 75岁以上心脏性猝死患者的临床资料及其死亡前 6个月之内 2 4小时动态心电图 HRV资料 ,HRV分析包括时域分析和频域分析。比较猝死组与对照组各时域与频域参数有无差别。结果　高龄老年人心脏性猝死组HRV各参数均明显降低 (P<0 .0 1)。结论　 HRV减低是预测高龄老年人心脏性猝死的有价值的指标。多种因素导致心脏性猝死患者 HRV减低     

老年衰弱患者心率变异性改变及与衰弱程度的关系

目的观察老年患者中衰弱程度与心率变异性(HRV)的关系。方法选择130例年龄≥65岁的老年患者,排除有器质性心脏病患者,依据衰弱表型评估方法将入选患者分为衰弱组(67例)、衰弱前期组(30例)、非衰弱组(33例),三组均给予24 h动态心电图行HRV检测,观察时域和频域参数。时域参数包括:平均正常R-R间期标准差(SDNN)、相邻R-R间期的均方根(RMSSD)、大于50 ms相邻R-R间期占窦性心搏总数的百分比(pNN50)。频域参数包括:总功率(TP)、低频功率(LF)、高频功率(HF)。比较三组HRV的差异,分析老年衰弱程度与HRV的关系。结果随老年衰弱程度加重,患者HRV逐渐下降,各组间SDNN、RMMSD、pNN50、TP、LF、HF指标均有统计学差异(P0.05)。结论老年衰弱患者普遍存在HRV下降,且下降程度与衰弱严重程度相关。     

各型冠心病心率变异的特点和临床意义

目的　探讨不同类型冠心病 (CHD )者对心率变异性 (HRV)的影响及其相互之间的差异。方法　对CHD者 1 6 5例 (A组 ) ,按国际心脏病学会 (ISFC)和WHO临床命名标准分为 5型 ,对照组 (B组 ) 1 5 0例。均记录2 4hDCG ,进行HRV时域和频域分析。结果　①A组HRV时域和频域指标较正常人明显降低有显著差异性 ,P<0 0 5。②A组各型HRV组间比较无统计学意义 ,P >0 0 5。结论　CHD者HRV降低 ;不同类型CHD者之间HRV降低无显著差异性。     

并发不同常见慢性疾病的老年体位性低血压患者心率变异性的特点

目的 探讨并发不同常见慢性疾病的老年体位性低血压患者心率变异性（HRV）的特点。方法 将完善24小时动态心电图检查的267名60岁以上老年人分为体位性低血压组(OH组)和非体位性低血压组(非OH组),对两组患者HRV的时域和频域分别进行比较;同时,对这两组患者中并发不同的单一疾病患者的HRV指标分别进行分析比较。结果 在非OH组,从时域性指标来看,高血压病最高,冠心病次之,糖尿病最低;从频域性指标来看,高血压病最高,糖尿病次之,冠心病最低。在OH组,从时域性指标来看,也是高血压病最高,冠心病次之,糖尿病最低;从频域性指标高频(HF)来看,也是高血压病最高,糖尿病次之,冠心病最低,但从低频(LF)来看,高血压病最高,冠心病和糖尿病差异不显著。与非OH组同病名同指标比较,OH组并发糖尿病的患者,时域性指标下降最为显著;OH组3种常见慢性病的频域性指标下降均很显著(P<0.05,P<0.01)。结论 老年体位性低血压患者中,并发糖尿病患者时域性指标下降显著,并发冠心病患者频域性指标下降显著。     

冠心病患者心率变异性分析及临床意义

目的探讨冠心病患者心率变异性变化及临床意义。方法冠心病组102例,对照组(无冠心病的健康人80例),通过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均明显的低于健康组,p0.01,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,反应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。     

慢性失眠对老年糖尿病患者静息心率及心率变异性的影响

目的探讨慢性失眠对老年糖尿病患者静息心率(RHR)及心率变异性(HRV)的影响。方法入选老年患者236例,分为健康对照组62例,单纯糖尿病组64例,糖尿病合并失眠组110例,其中糖尿病合并失眠组按失眠病程分为<5年组(40例),5⁹年组(38例)和≥10年组(32例)。所有患者行常规心电图及24 h心电图检查,并对RHR,HRV时域指标窦性R-R间标准差(SDNN)、窦性R-R间期标准差(SDANN)、窦性R-R间期标准差均值(SDNN index)、窦性R-R间期差值>50 ms(r MSSD)和R-R连质差异均值的平方根(PNN50),频域指标低频(LF)、高频(HF)及LF/FH进行对比分析。结果与健康对照组相比,单纯糖尿病组和糖尿病合并失眠组HRV各时域指标及频域指标LF、HF降低,RHR及LF/HF增高(P<0.05)。与单纯糖尿病组相比,糖尿病合并失眠组HRV各时域指标及频域指标LF、HF降低明显,LF/HF增高明显(P<0.05)。糖尿病合并失眠组中失眠病程59年组(38例)和≥10年组(32例)。所有患者行常规心电图及24 h心电图检查,并对RHR,HRV时域指标窦性R-R间标准差(SDNN)、窦性R-R间期标准差(SDANN)、窦性R-R间期标准差均值(SDNN index)、窦性R-R间期差值>50 ms(r MSSD)和R-R连质差异均值的平方根(PNN50),频域指标低频(LF)、高频(HF)及LF/FH进行对比分析。结果与健康对照组相比,单纯糖尿病组和糖尿病合并失眠组HRV各时域指标及频域指标LF、HF降低,RHR及LF/HF增高(P<0.05)。与单纯糖尿病组相比,糖尿病合并失眠组HRV各时域指标及频域指标LF、HF降低明显,LF/HF增高明显(P<0.05)。糖尿病合并失眠组中失眠病程5⁹年组和≥10年组的HRV各时域指标及频域指标LF、HF降低,RHR及LF/HF增高(P<0.05);失眠病程≥10年组的HRV各时域指标及频域指标LF、HF较59年组和≥10年组的HRV各时域指标及频域指标LF、HF降低,RHR及LF/HF增高(P<0.05);失眠病程≥10年组的HRV各时域指标及频域指标LF、HF较5⁹年组进一步降低,RHR及LF/HF进一步增高(P<0.05)。结论慢性失眠可加重老年糖尿病患者自主神经功能紊乱,其中失眠病程越长,糖尿病患者自主神经功能紊乱程度更明显。     

监测心率变异性及QT间期离散度对介入术后患者发生心血管事件的预测价值

目的:探讨心率变异性(HRV)和QT间期离散度(QTd)对冠心病患者行经皮冠状动脉介入术(PCI)后发生心血管事件的预测价值。方法:对我院80例行PCI的冠心病患者进行手术前后的动态心电图及体表心电图检查,根据术后1年主要心血管事件随访结果将患者分为事件组和非事件组,分析患者手术前后HRV和QTd的变化情况。结果:事件组SDNN、SDANN、rMSSD和QTd均比非事件组小,差异具有显著性。所有患者PCI术后HRV与术前比较无显著差异,QTd与术前比较均有显著改善。结论:HRV和QTd是PCI术后1年预后的预测指标,对术后心血管事件的发生有较好的预测价值。     

心率变异性与冠状动脉病变的关系

目的探讨心率变异性(heartratevariability,HRV)与冠状动脉病变范围和程度的关系。方法回顾性分析我院冠心病患者186例的冠状动脉病变范围程度和HRV指标。用Logistic回归筛选冠状动脉病变的HRV预测指标。结果HRV时域指标和频域指标均随冠状动脉病变范围和程度的加重而降低,时域指标,包括正常窦性心搏间期标准差(standarddeviationofnormalnumberofintervals,SDNN),每5分钟平均正常窦性心搏间期标准差(standarddeviationofper5minaveragesnormalnumberofintervals,SDANN),正常窦性心搏间期标准差平均值(averageofstandarddeviationofnormalnumberofintervals,ASDNN),相邻正常窦性心搏间期差的平方根值(rootmeansquarevaluesofthestandarddeviationbetweenadjacentnormalnumberofintervals,rMSSD),相邻正常窦性心搏间期差超过50ms的个数占总窦性心搏数的百分率(percentageofdifferencesexceeding50msbetweenadjacentnormalnumberofintervalsPNN50),PNN50包括PNN50a(大于相邻心搏间期50ms)和PNN50b(小于相邻心搏间期50ms),频域指标包括低频带(lowfrequency,LF),极低频带(verylowfrequency,VLF),高频带(highfrequency,HF)都与冠状动脉病变范围和程度呈负相关(P<0.01或P<0.05);Logistic回归结果表明SDANN、LF/HF为冠状动脉病变范围和程度的保护因素。结论有冠状动脉病变的患者HRV降低,存在自主神经功能紊乱;HRV与冠状动脉病变范围和程度呈负相关。     

Clinical features of coronary artery ectasia

OBJECTIVES: To investigate the clinical significance of coronary artery ectasia in Japanese patients. METHODS: Coronary artery ectasia was found in 54 of 3,778 (1.4%) consecutive patients who underwent coronary angiography. The clinical characteristics and the coronary angiographic findings of these patients were studied. Follow-up data were obtained for 49 patients, who were separated into two groups: Group A subsequently suffered a follow-up major cardiac event, and Group B did not develop such an event. RESULTS: Among the coronary artery ectasia patients, 65% had myocardial infarction, 91% had coronary artery disease, and 48% had single-vessel disease. Seventy-six percent had single-vessel involvement with coronary artery ectasia. Eighteen patients (37%) suffered 22 follow-up major events. Seventy-two percent of the first follow-up event cases occurred within 4 years after the first cardiac event. The follow-up event in 78% of cases was acute coronary syndrome. There were no significant differences in age and prevalence of each coronary artery risk factor between Groups A and B. There were no significant differences in the incidence of follow-up event between the patients with single-vessel disease and the patients with multi-vessel disease, nor between the patients with single-vessel involvement with coronary artery ectasia and the patients with multi-vessel involvement with coronary artery ectasia. There was no significant difference in the percentage of patients in whom the culprit vessel of the cardiac event was the same as the ectatic vessel between the first cardiac event and follow-up cardiac events (41% vs 62%). CONCLUSIONS: Coronary artery ectasia is not benign and must be carefully monitored. Coronary atherosclerosis may contribute to the occurrence of subsequent cardiac events.     

心率变异性与冠状动脉病变的关系

本研究对８８例行冠状动脉动脉造影检查的患者，于造影前１周进行心率变异性检查，以了解自主神经功能与冠状动脉病变的关系。结果；１。冠状动脉单支病变，双支病变有三支病变之间ＨＲＶ时域及频域指标有下降趋势，但无统计学意义；２．ＨＲＶ与冠状动脉病变部位，病变程度不相关；３．心率与左室     

Different cut-off points of decreased heart rate variability for different groups of cardiac patients

BACKGROUND: Heart rate variability (HRV) differs by the type and stage of the disease, by age, by environment, and so on. Criteria for normal, moderately changed and pathologic values of HRV lack for routine clinical work with different groups of cardiac patients. METHODS: Twelve time and frequency domain HRV variables were analysed from 24-h Holter ECG monitoring in 2578 consecutive patients of both sexes (57% male) aged 15-91 (mean 54 +/- 13) years. Fifty-nine per cent of the patients were hospital out-patients, 15% came from the cardiac unit of an internal medicine department and 26% were undergoing stationary cardiac rehabilitation. Arrhythmias of aetiology other than coronary artery disease predominate in out-patients and coronary artery disease in in-patients. Limits of moderately and pathologically changed values were determined according to biostatistical principles. RESULTS: HRV differed by the age, sex and type of patients (MANOVA P < 0.001). Heart rate and all HRV measures decreased with age. Females had a higher heart rate but more pronounced vagally modulated activity than males. Out-patients had better HRV than in-patients. The cut-off level for a pathologic standard deviation of the normal R-R interval (a measure of overall HRV) ranged from 75 ms in female out-patients to 44 ms in male patients from the cardiac unit. Different cut-points for 12 HRV measures were obtained for 12 sub-groups of patients. CONCLUSION: In view of the HRV differences between different cardiac patients, different limits of normal and decreased HRV are proposed for daily practice.     

Influence of Balloon Angioplasty on Heart Rate Variability in Patients with Coronary Artery Disease

We assessed the influence of elective balloon angioplasty on heart rate variability (HRV) in patients with coronary artery disease. In 62 patients (41 men and 21 women, aged 33 to 69), two 6-minute electrocardiographic recordings were performed 2 hours apart. Patients were divided into three groups: group A (26 patients) underwent balloon angioplasty; group B (14 patients) underwent coronary angiography alone, and group C (22 patients) served as controls. There was a statistically significant decrease in time and frequency domain measurements in group A patients after successful balloon angioplasty (P < 0.05). The logarithm of the high frequency decreased in group B patients after coronary angiography alone (P < 0.05). HRV did not change in group C. There was no correlation with lesion location. We conclude that in patients with coronary arterial disease, successful balloon angioplasty is associated with an immediate decrease in HRV in time and frequency domains regardless of the artery involved. Coronary angiography alone is associated with an early decrease in the logarithm of the high frequency domain measurement of HRV. These changes may be due to procedure-related factors, patient characteristics, and microvascular derangements. A delayed improvement in HRV after balloon angioplasty is not addressed by the present study and warrants further evaluation.     

老年急性心肌梗死患者直接冠状动脉介入治疗的特点及疗效

目的分析老年急性心肌梗死（AMI）患者行直接冠状动脉介入治疗（PCI）的可行性及近远期疗效。方法196例AMI患者分为老年组（108例）和非老年组（88例），分析两组患者临床特征、冠脉病变特点、是否进行球囊预扩张、支架植入情况、近远期疗效。结果老年组患者多有冠心病史（44．4％vs23．9％，P=0．003）；老年组梗死相关动脉（IRA）以LAD（50．9％）和RCA（44．4％）为主，非老年组IRA以LAD（59．1％）为主（P=0．005）；两组IRA狭窄程度、病变形态无差异性（P均〉0．05）；老年组常有2支或3支冠脉病变（80．6％），非老年组患者以单支病变为主（46．6％，P=0．001）；与非老年组相比，老年组支架植入前常需进行球囊预扩张（89．2％vs72．3％，P=0．004），但植入支架直径、长度及血运重建程度无差异性。住院及随访期间老年组靶血管血运重建率及死亡率均较非老年组偏高，但未达到统计学意义。结论老年AMI患者进行直接PCI安全有效，但与非老年患者相比，支架植入前常需进行球囊预扩张。     

Dysfunction of pre- and post-operative cardiac autonomic nervous system in elderly patients with diabetes mellitus

The pre- and post-operative cardiac autonomic nervous functions were compared in elderly, non-cardiac surgery patients with diabetes mellitus (DM) and without diabetes mellitus (NDM). A group of 30 unpremedicated elderly patients scheduled to undergo elective non-cardiac surgery were studied, including 15 DM patients and 15 NDM patients. Each component of heart rate variability (HRV) analysis in the frequency domain was monitored with Holter during the nights of the day before and on 1st and 2nd day after operation. After surgery, total power (TP), high frequency (HF), low frequency (LF) and very low frequency (VLF) significantly decreased as compared to the baseline values before operation in both groups (p < 0.05). The LF/HF ratio was significantly changed in DM group but did not change in NDM group. On the 2nd postoperative day, TP, HF, LF and VLF in DM group were further decreased as compared to those on the 1st postoperative day and were significantly lower than those in NDM group (p < 0.01 or 0.05), but these indices in NDM group did not show significant decreases. Surgery induced the cardiac autonomic nervous dysfunction in elderly patients not only with DM but also without diabetes. On the 2nd postoperative day, the disturbances of cardiac autonomic nervous activity were more sever in DM patients, compared to the 1st postoperative day, but was not significantly more sever than in the NDM patients.