心房颤动患者高敏C反应蛋白的变化及与心房重构的关系

目的:探讨心房颤动(房颤)患者血清高敏C反应蛋白(hs-CRP)的变化,及与左房内径(LAD)的相关性。方法:选取房颤患者120例(持续性房颤组56例,阵发性房颤组64例),窦性心律者60例为对照组,采用超声心动图测量2组的LAD,免疫速率散射比浊法测定hs-CRP含量,并对结果进行相关分析。结果:持续性房颤组血清hs-CRP的水平显著高于阵发性房颤组和对照组,差异有统计学意义。而阵发性房颤组患者血清hs-CRP水平虽高于对照组,但差异无统计学意义。房颤组患者血清hs-CRP水平与LAD存在正相关关系。结论:持续性房颤患者hs-CRP增高,与LAD呈正相关。     

高敏C-反应蛋白在冠心病患者诊治中的临床意义

高敏C-反应蛋白(hs-CRP)是一种急性时相反应蛋白,常作为炎症相关疾病的检测指标。冠心病存在慢性炎症过程,检测hs-CRP有助于预测急性冠状动脉事件、评估冠心病的严重程度和观察演变情况,对冠心病患者的临床危险分层有重要参考价值。     

70例持续性房颤患者心率变异性临床分析

目的 探讨持续性房颤患者心率变异性（HRV）变化,分析其在基础心脏疾病伴房颤疾病中的临床意义.方法 70例持续性心房颤动患者作为房颤组,70例为正常对照组.行24h动态心电图检查,检测心率变异性时域指标.进一步将70例房颤患者分为孤立性房颤10例,冠心病伴房颤21例,高血压性心脏病伴房颤25例,心衰伴房颤14例.所有房颤患者均进行24h动态心电图监测,观察24h HRV时域分析指标.结果 房颤患者HRV时域分析较正常对照组下降（P＜0.01）.冠心病、高血压性心脏病、慢性心衰伴房颤患者HRV时域分析指标较孤立性房颤患者明显降低（P＜0.01）.结论 冠心病、高血压性心脏病、慢性心衰、伴房颤患者HRV降低,即自主神经对心脏的调节能力减弱.HRV可作为冠心病、高血压性心脏病、心衰伴房颤患者的无创性预测指标.     

心房颤动患者血清高敏C-反应蛋白的测定及意义

近年来,大量的研究显示炎症反应在心血管疾病的发生中有重要作用。高敏C-反应蛋白(hs-CRP)是敏感的炎症标志物。2004年1月~2006年6月,我测定了256例心房颤动患者的血清hs-CRP水平,现探讨其临床意义。临床资料:同期收治心房颤动患者256例,男162例,女94例;年龄32~79(58.6±11.7)岁。其中单纯性心房颤动22例,伴高血压病102例、心脏瓣膜病29例、冠心病103例。随机分为慢性心房颤动组(慢性组)147例,心房颤动持续6个月以上;阵发性心房颤动组(阵发组)109例;另选择窦性心律患者67例作为对照组。下列情况均予以排除:肝、肾功能异常及其他器官功能…     

高敏C-反应蛋白及其在心血管疾病中的临床意义

C反应蛋白作为一种传统的检测因子,已在临床应用多年。目前,对高敏C-反应蛋白在心血管疾病危险度预测方面又有了新的认识。现对高敏C-反应蛋白的结构及生物学特性、作用、来源及调控、变化特点及检测方法和临床上高敏C-反应蛋白在心血管疾病方面的应用等作一综述。     

持续性心房颤动患者高敏C反应蛋白水平的临床观察

目的 探讨炎症反应在持续性心房颤动的发展与维持中的作用.为应用通过干预炎症的方法治疗或预防持续性房颤提供依据.方法 选取持续性心房颤动患者50例为观察组,对照组为同期住院的窦性心律患者50例.24 -48 h测定两组hs-CRP水平、LAD,并对结果进行比较.结果 持续性房颤组hs-CRP和LAD显著高于对照组(P＜0.01).持续性房颤患者的LAD与hs-CRP呈正相关,相关系数(r=0.65,P＜0.01).结论 炎症反应可能在房颤维持中起重要作用,并可能促进心房结构重构,推测通过干预炎症的措施降低hs-CRP水平可能对房颤的治疗有益.     

C-反应蛋白与心房颤动

心房颤动(房颤)是临床上常见的一种室上性快速性心律失常.心房蓖构是房颤发生和维持的核心环节,心房重构主要包括电重构和解剖重构.研究报告显示,炎症与心房重构的发生、发展有着密切的关系,而C-反应蛋白(CRP)作为一种典型的急性期反应蛋白被认为是一种非特异性炎症反应指标,与房颤的心房重构密切相关,本文就这一方面的研究进展作一综述.     

代谢综合征与高敏C-反应蛋白、游离脂肪酸的关系

代谢综合征（MS）作为一组以糖代谢异常或胰岛素抵抗（IR）、高血压、肥胖、脂代谢异常为主要表现的征候群.西方人群MS患病率约为20%,中国MS患病率也高达16.5%,其发病机制尚未明确,认为其发生的主要基础为IR及肥胖,它是一种低滴度全身性炎症.目前对高敏C-反应蛋白（hsCRP）与MS关系的研究多在普通人群中进行,而本研究是在2型糖尿病（T2DM）患者中探讨炎症标志物hsCRP及游离脂肪酸（FFA）与MS的关系,以期为MS的防治提供理论依据.     

高敏C-反应蛋白在心血管疾病中的临床意义

目的探讨高敏C-反应蛋白(hs-CRP)在心血管疾病中的临床意义。方法回顾性分析于2012年1月~2013年4月入我院治疗的63例心血管疾病患者的临床资料,按疾病类型分为A组(稳定型心绞痛组)、B组(不稳定型心绞痛组)和C组(急性心肌梗死组),三组均有21例患者,另选择同期进行体检的21例健康人员进行对照。对各组hs-CRP浓度进行比较。结果 A、B、C三组的hs-CRP浓度与对照组比较均差异显著,具有统计学意义(P0.01)。C组明显高于A、B两组,B组明显高于A组,差异均具有统计学意义(P0.01)。其中A组hs-CRP浓度≥5mg/L的患者占该组总数的71.43%,B组hs-CRP浓度≥5mg/L的患者占该组总数的90.48%,C组患者hs-CRP浓度均≥5mg/L,达100%。A组hs-CRP浓度异常例数明显少于B组和C组,B组hs-CRP浓度异常例数则明显少于C组,均具有统计学意义(P0.05)。结论 hs-CRP的检测对于心血管疾病的诊断和预后均具有重要的价值和意义。     

慢性充血性心力衰竭者C-反应蛋白、心率变异性的检测意义

目的分析慢性充血性心力衰竭（CHF）者C反应蛋白（CRP）、心率变异性（HRV）变化的意义,了解CHF者自主神经功能损害、心功能和CRP的关系。方法用24h动态心电图（DCG）分析40例CHF者（A组）,22例心功能代偿的心血管病者（B组）,20例健康体检者（C组）的HRV时域指标和CRP。比较三组间HRV指标和CRP的差异,分析A组24hHRV指标变化、CRP与心功能NYHA分级的相互关系。结果B组24hHRV时域指标SDNN、SDANN和较C组显著下降（P〈0．01、0．05）,rMSSD和pNN50与c组比较差异无显著性（P〉0．05）;A组的HRV各指标均显著低于C组（P〈0．01）,将A组分为心功能Ⅱ级组（n=21）和心功能≥Ⅲ级（n：19）两亚组,结果发现心功能≥Ⅲ级的HRV各指标明显低于心功能Ⅱ级组（P〈0．01）。同时,A组CRP明显高于C组,且与心衰程度成正相关。结论心血管病患者在心功能代偿期时自主神经的平衡可能受到损害。当出现CHF时交感活性增强,迷走神经张力进一步下降,HRV指标的下降与心功能损害程度相关。因此HRV时域指标可作为评价CHF预后指标之一,而CRP可能是HRV指标的下降原因之一。     

持续性心房颤动患者心率变异性与脑钠尿肽的关系

目的:探讨持续性心房颤动患者心率变异性与脑钠尿肽（BNP）的相关性。方法: 入选45例持续性心房颤动患者,20例正常对照组。行24小时动态心电图检查,检测心率变异性时域指标,并行BNP测定,再分析以上两者的相关性。结果: 持续性房颤患者与对照组比较,心率增快,心率变异性时域指标SDNN、RMSSD、PNN50显著增加（P<0.01）;平均RR间期（RINNT）实测值与BNP呈负相关;以平均心率矫正后的有关心率变异时域指标RMSSDDdiff和PNN50Ddiff与BNP呈正相关。结论: 持续性心房颤动患者心率变异性时域参数增加,BNP受心率和心率变异性改变的影响。     

自主神经在阵发性心房颤动发生中的作用

目的 探讨自主神经在阵发性心房颤动发生中的作用。方法 分析31例阵发性房颤患者47次房颤（〉30s）发作前动态心电图心率变异性时域和频域指标。患者分为器质性心脏病组（19例）和非器质性心脏病组（12例）。根据房颤发作前频域指标变化，将阵发性房颤分为3组：房颤发作前心率变异性频域指标低频（LF）成分增加，LFIHF比例增加为交感神经介导房颤，房颤发作前心率变异性频域指标高频（HF）成分增加，LF／HF比例减小为迷走神经介导房颤，其余的为未分类房颤。结果 器质性心脏病组房颤发作28次，其中交感神经介导房颤17次（60．7％），非器质性心脏病组房颤发作19次，迷走神经介导房颤12次（63．2％）。结论 自主神经在房颤的发作中起着重要的作用，器质性心脏病中的阵发性房颤多为交感神经介导房颤。非器质性心脏病中的阵发性房颤多为迷走神经介导房颤。     

血清高敏C反应蛋白与心房颤动

目的探讨炎症与心房颤动的发生和持续的关系。方法心房颤动患者124例,分为两组,慢性心房颤动组53例,阵发性心房颤动组71例,对照组(窦性心律)54例。采用免疫速率散射比浊法测定各组患者血清高敏C-反应蛋白(highsensitivityC-reactiveprotein,hs-CRP)的含量,同时测量各患者左心房前后径。结果慢性心房颤动组患者血清hs-CRP水平高于阵发性心房颤动组(P<0.05)及正常对照组(P<0.01);阵发性心房颤动组患者血清hs-CRP水平高于正常对照组(P<0.05);慢性心房颤动组左心房前后径,与窦性心律组比较差异有统计学意义(P<0.05);阵发性心房颤动组与窦性心律组比较,左心房前后径虽有增大,但差异无统计学意义(P>0.05)。结论hs-CRP水平升高可能参与心房颤动的发生,提示炎症反应具有促进心房颤动的发生和持续的作用。     

Persistent atrial fibrillation worsens heart rate variability, activity and heart rate, as shown by a continuous monitoring by implantable biventricular pacemakers in heart failure patients

Background: Atrial fibrillation (AF) induces loss of atrial contribution, heart rate irregularity, and fast ventricular rate.
Objectives: The objectives of the study were to accurately measure AF incidence and to investigate the mutual temporal patterns of AF and heart failure (HF) in patients indicated to cardiac resynchronization therapy.
Methods: Four hundred ten consecutive patients (70% male, age 69 ± 11) with advanced HF (NYHA = 3.0 ± 0.6), low ejection fraction (EF = 27 ± 9%), and ventricular conduction delay (QRS = 165 ± 29 ms) received a biventricular pacemaker. Enrolled patients were divided into two groups: G1 = 249 patients with no AF history, G2 = 161 patients with history of paroxysmal/persistent AF.
Results: In a median follow-up of 13 months, AF episodes longer than 5 minutes occurred in 105 of 249 (42.2%) G1 patients and 76 of 161 (47.2%) G2 patients, while AF episodes longer than one day occurred in 14 of 249 (5.6%) G1 patients and in 36 of 161 (22.4%) G2 patients. Device diagnostics monitored daily values of patient activity, night heart rate (NHR), and heart rate variability (HRV). Comparing 30-day periods before AF onset and during persistent AF, significant (P < 0.0001) changes were observed in patient activity, which decreased from 221 ± 13 to 162 ± 12 minutes, and in NHR, which increased from 68 ± 3 to 94 ± 7 bpm. HRV significantly decreased (from 75 ± 5 ms before AF onset to 60 ± 6 ms after AF termination). NHR during AF was significantly (P < 0.01) and inversely correlated (R²= 0.73) with activity, with a significant lower activity associated with NHR ≥ 88 bpm.
Conclusion: AF is frequent in HF patients. Persistent AF is associated with statistically significant decrease in patient activity and HRV and NHR increase.     

比索洛尔对持续性非瓣膜性心房颤动患者心房结构重构的影响

目的观察比索洛尔对持续性非瓣膜性心房颤动患者心房结构重构及C反应蛋白(CRP)的影响,并探讨其可能关系。方法将85例持续性非瓣膜性心房颤动患者,分为比索洛尔组(48例)和地高辛组(37例),随访观察(9.8±1.3)个月,治疗前后检测CRP和超声心动图观察左心房结构变化。结果比索洛尔组治疗后左心房内径(41.8±4.2)mmvs(39.7±5.3)mm,CRP 3.9 mg/Lvs3.5 mg/L,均较治疗前明显下降,差异有统计学意义(P<0.01),而地高辛组治疗前后左心房内径(41.8±4.6)mmvs(42.3±5.2)mm,CRP 3.8 mg/Lvs3.5 mg/L,差异无统计学意义(P>0.05)。比索洛尔组的左心房内径和CRP下降幅度与地高辛组比较,差异有统计学意义(P<0.01)。相关分析显示,左心房内径变化与CRP变化呈显著正相关(r=0.218,P=0.045)。结论比索洛尔可改善持续性非瓣膜性心房颤动患者的心房结构重构,并减轻炎性反应。     

Predictive value of heart rate variability for the recurrence of chronic atrial fibrillation after electrical cardioversion

BACKGROUND: The relation between heart rate variability (HRV) and occurrence of atrial fibrillation (AF) in paroxysmal AF has been well studied, but there are controversial observations regarding the relation of HRV parameters to the recurrence of chronic AF after cardioversion. HYPOTHESIS: The present study compared HRV parameters of patients with chronic AF on the second day of cardioversion with a healthy control group and investigated their predictive value for AF recurrence. METHODS: Forty-one patients with chronic AF (> 3 months), who had various underlying cardiovascular disorders, were enrolled to the study. Of these, 31 patients were successfully cardioverted by external direct current shock, but 27 patients fulfilled the entry criteria. Twenty healthy subjects served as a control group. On the second day of restoration of sinus rhythm, 24-h Holter recording was obtained and the following time-domain indices of HRV were measured: SDNN (the standard deviation of the mean RR interval expressed in ms), SDANN (the SD of the averages of RR intervals in all 5-min segments of the 24-h recording), rMSSD (the root mean square of differences of successive RR intervals), and pNN50 (the percentage of adjacent RR intervals that differed by more than 50 ms). Patients were followed-up for 6 weeks for recurrence of AF. RESULTS: After cardioversion, SDNN and SDANN were found to be significantly lower in the AF group than in the control group (86.4 +/- 31.7 ms vs. 142.1 +/- 40.2 ms, and 57 +/- 17.4 ms vs. 124.4 +/- 37.7 ms, p < 0.001 and p < 0.001, respectively). The indices of vagal modulation of heart rate (rMSS and pNN50) were not different between the AF group and the control group. Recurrence of AF was observed in 15 patients. In these patients, all HRV parameters were significantly depressed compared with those with maintained sinus rhythm. Logistic regression analysis revealed that only decreased pNN50 was an independent predictor of AF relapse (relative risk = 1.5, p = 0.02, 95% confidence interval 1.1-2.2). There was also a trend toward a shortened SDNN as a predictor of AF recurrences. CONCLUSION: Suppressed HRV parameters and decreased vagal tone are probably a risk factor for AF recurrences after cardioversion to sinus rhythm in a specific subset of patients with chronic AF.     

The effect of head‐up tilt upon markers of heart rate variability in patients with atrial fibrillation

Background

Heart rate variability (HRV) analysis is uncommonly undertaken in patients with atrial fibrillation (AF) due to an assumption that ventricular response is random. We sought to determine the effects of head‐up tilt (HUT), a stimulus known to elicit an autonomic response, on HRV in patients with AF; we contrasted the findings with those of patients in sinus rhythm (SR).

Methods

Consecutive, clinically indicated tilt tests were examined for 207 patients: 176 in SR, 31 in AF. Patients in AF were compared to an age‐matched SR cohort (n = 69). Five minute windows immediately before and after tilting were analyzed using time‐domain, frequency‐domain and nonlinear HRV parameters. Continuous, noninvasive assessment of blood pressure, heart rate and stroke volume were available in the majority of patients.

Results

There were significant differences at baseline in all HRV parameters between AF and age matched SR. HUT produced significant hemodynamic changes, regardless of cardiac rhythm. Coincident with these hemodynamic changes, patients in AF had a significant increase in median [quartile 1, 2] DFA‐α2 (+0.14 [?0.03, 0.32], p < .005) and a decrease in sample entropy (?0.17 [?0.50, ?0.01], p < .005).

Conclusion

In the SR cohort, increasing age was associated with fewer HRV changes on tilting. Patients with AF had blunted HRV responses to tilting, mirroring those seen in an age matched SR group. It is feasible to measure HRV in patients with AF and the changes observed on HUT are comparable to those seen in patients in sinus rhythm.

     

Determinants of a reduced heart rate variability in chronic atrial fibrillation

Background: We aimed to evaluate whether clinical factors, which influence heart rate variability (HRV) in the presence of undisturbed sinus rhythm, have any associations with HRV in patients with permanent atrial fibrillation (AF). Methods: One hundred ninety‐seven consecutive patients with permanent AF were included (122 males, 75 females, aged 64 ± 11 years, range 25–85). In each patient a 24‐hour electrocardiographic recording was performed and an HRV fraction (HRVF)—the index based on scatter plot numerical processing—was calculated. Additionally, standard HRV measures were analyzed. Reduced HRVF was defined as its value lower than lower normal limit. Demographic and clinical factors were examined for their association with a reduced HRVF by means of a univariate and multivariate logistic regression analysis. Results: The reduced HRVF was associated with advanced age, clinical diagnosis of a previous MI or dilated cardiomyopathy, presence of diabetes, depressed left ventricular function, NYHA class > II, treatment regimen, use of digoxin, diuretics or antiarrhythmic agents, nonuse of beta‐blockers, and increased heart rate. The independent determinants that sustained after multivariate analysis were: heart rate (per 10 bpm increase, odds ratio 2.77 [1.88–4.07]), age (per 5 years increase 1.43 [1.1–1.85]), depressed left ventricular EF (<30% vs higher 2.26 [1.19–4.31]), and presence of diabetes (3.45 [1.1–10.85]). The HRVF correlated moderately with standard HRV measures. This index showed also the strongest correlation with left ventricular ejection fraction. Conclusion: We concluded that advanced age, left ventricular systolic dysfunction, increased heart rate, and presence of diabetes are cofactors of a reduced HRV in AF patients. Thus, the determinants of heart rate variability in the presence of atrial fibrillation are the same as those in sinus rhythm. Ann Noninvasive Electrocardiol 2011;16(4):321–326