心率变异性临床应用分析

二十多年前就发现,人的心率总在变动,生理机制与自主神经张力有关。心率变异性(HeartRateVariabilityHRV)是评价人体内植物神经功能的一项指标。HRV分析在九十年代后期临床研究得到普遍重视,成为心血管临床及心脏电生理的一个热点。为进一步探讨HRV的临床应用价值,将我院检测24h动态心电图(Holter)同时观察HRV结果作一回顾性总结。资料与方法收集1999年1月-12月所有检测Holter的患者102例,男66例、女36例,年龄19～77岁,平均年龄48岁。其中:冠心病18例,心律失常21例,高血压病7例,心肌炎7例,晕厥5例,糖尿病3例,安装起搏器2例,神经官能…     

正常人群的心率变异性分析

将１００４例正常人分三个年龄组进行短程心率变异性分析。时域法的参数为平均心率标准差，连续５ｍｉｎ节段平均正常ＲＲ间期标准差，相邻ＲＲ间期差的均方根，相邻ＲＲ间期差异≥５０ｍｓ的百分数；频域法的参数为极低频、低频、高频成分，总功率及ＬＦ／ＨＦ比值。     

老年糖尿病患者心率变异性分析

心率变异性 (HRV)分析作为反映自主神经系统对心脏和血管调节动态平衡的无创指标 ,已越来越得到国内外学者的注意〔1 ,2〕。自主神经的病变普遍存在于糖尿病患者中 ,成为糖尿病发生无痛性心肌梗死、猝死、体位性低血压的主要原因 〔3〕。本文对 36例老年糖尿病患者及 2 7例正常老年人 HRV的分析 ,旨在探讨糖尿病对心脏自主神经的影响。1　对象及方法1.1　 对象　 36例糖尿病患者 (DM组 )为本院门诊及住院病人 ,男 2 6例 ,女 10例 ;年龄 6 0～ 78岁 ,平均 (6 6 .3± 5 .6 )岁 ,病程 1～ 2 5年 ,符合 1985年 WHO糖尿病诊断标准 ,并排除高…     

短暂心肌缺血的心率变异性分析

目的：评价自主神经活动在短暂心肌缺血中的调节作用。方法：检测25例冠心病患者24小时动态心电图中的47次短暂心肌缺血发作事件,分析心肌缺血发作前、发作期间及发作停止后的心率变异性。结果：在心肌缺血发作期间,心率变异性降低,时域参数SDANN、RMSSD、PNN50显著降低,频域参数HF亦下降,LF未见增加,LF／HF无显著差异。结论：在日常活动发生的短暂心肌缺血中,副交感神经活动减弱可能起重要作用。     

心率变异性分析的研究进展

心率变异性（HRV）分析研究的是心率快慢变化差异及变化规律,即逐次心动周期之间的时间变异数,从而反映出植物神经系统对心血管活动的影响。HRV降低是心脏病患者死亡预测的独立危险因素,也是判断是否伴有自主神经系统损害的糖尿病患者最敏感、最准确的指标。现将HRV的研究现状综述如下。     

心率变异性的测定及其临床意义

心率变异性的测定及其临床意义陈灏珠心率变异性的概念心率变异指逐次心动周期之间的时间变异数。心律并不绝对规则，两次心搏之间有微小的时间差别，通过测量连续出现正常心搏间期之间的变异数，即可了解心率变异性（ｈｅａｒｔｒａｔｅｖａｒｉａｂｉｌｉｔｙ，ＨＲＶ）...     

Heart rate variability during hypoglycaemia

A diabetic patient with parasympathetic neuropathy underwent 24-h ECG monitoring. During the 24 hours the patient had a hypoglycaemic event. Heart rate variability was greatly increased during this time, though heart rate was unaltered. The reasons for the sudden increase are unknown but may indicate a fruitful line for further research.     

脑梗死患者心率变异性分析(附50例报告)

目的　研究脑梗死患者的自主神经功能状态。方法　应用时域法对 5 0例脑梗死患者进行心率变异性分析。结果　脑梗死组与正常对照组相比所有 R- R间期均值的标准差 (SDNN)明显降低 (10 2 .0 6± 2 8.5 1,137.0 6± 2 9.0 8) ms,P<0 .0 1,HRV三角指数明显降低 (2 5 .86± 9.18,37.5 7± 14 .88;P<0 .0 5 )。相邻 R- R间期之差的均方根值 (RMSSD)、爱丁堡指数 (p NN5 0 )较正常对照组低 ,但无统计学意义。脑梗死患者心率变异昼夜比较RMSSD夜间高于日间 (18.70± 7.30 ,2 6 .2 3± 8.85 ) m s,P<0 .0 5。余指标昼夜有所变化但无统计学意义。脑梗死首次发作组与非首次发作组相比 SDNN、RMSSD、p NN5 0、HRV三角指数等指标无明显差别。结论　脑梗死患者的自主神经功能以交感神经活性占优势 ,心率变异程度降低 ,且失去了正常的昼夜规律。脑梗死后自主神经功能的改变主要与本次发作有关     

Heart rate variability in sarcoidosis: a frequency domain analysis

BACKGROUND: Little is known about autonomic dysfunction in patients with sarcoidosis. Heart rate variability (HRV) studies provide information regarding sympathetic and vagal tone and are both noninvasive and relatively simple to perform. The objective of this study was to compare HRV in sarcoidosis patients and in healthy controls. METHODS: We prospectively analyzed data from 12 sarcoidosis patients and 12 healthy volunteers. Electrocardiographic (ECG) data were recorded from all study participants, and HRV analysis was performed in the frequency domain. The sarcoidosis patients underwent echocardiography as well. RESULTS: Mean values for HRV in the high-frequency (HF) domain were significantly reduced in sarcoidosis patients (182+/-102 ms(2) vs. 758+/-457 in controls, p=0.001). We also observed a trend (p=0.055) towards an increased ratio of low-frequency (LF) to high-frequency power in sarcoidosis patients. CONCLUSIONS: Our findings indicate the possibility of altered sympathovagal balance in sarcoidosis. Since 5 of these 12 sarcoidosis patients had mild echocardiographic abnormalities, possibly related to sarcoidosis, we were unable to conclude whether the HRV findings were attributable solely to an autonomic dysfunction in sarcoidosis or whether they were related to a structural myocardial involvement of the disease.     

Heart rate versus heart rate variability in risk prediction after myocardial infarction

INTRODUCTION: The aim of this study was to evaluate and compare heart rate and heart rate variability (HRV) in risk prediction after acute myocardial infarction (MI) and to evaluate the effect of beta-blocker treatment on the prognostic performance of heart rate and HRV. METHODS AND RESULTS: Three hundred sixty-six patients underwent 24-hour Holter recording 1 to 6 days after an MI. HRV was expressed as the standard deviation of all normal-to-normal intervals. Left ventricular systolic function was evaluated using the wall motion index. Half of the patients were taking a beta-blocker at the time of Holter recording. Mean follow-up was 44 months (median 34) after MI. By the end of follow-up, 82 patients had died. Mortality at 1 and 3 years was 12.5% and 22.6%, respectively. HRV, heart rate, wall motion index, number of ventricular premature beats per hour, and ventricular tachycardia were all significantly (P < 0.05) associated with mortality in univariate analysis, independent of beta-blocker therapy. In multivariate Cox analysis, only heart rate, wall motion index, number of ventricular premature beats per hour, and age had independent prognostic value (P < 0.001). In any model, including heart rate, HRV had no predictive value. CONCLUSION: The prognostic information of HRV is contained completely in heart rate, which carries prognostic information further than that of HRV. This result was independent of beta-blocker treatment.     

急性心肌梗塞早期的心率变异性测定

目的 研究急性心肌梗塞（ＡＭＩ）较早期的心率变异性（ＨＲＶ）改变及其预后意义，探讨不同梗塞部位，心功能，溶栓与再通过ＨＲＶ的影响。方法 ＡＭＩ患５０例，Ｈｏｌｔｅｒ记录在胸痛发作２４小时之内开始进行，平均（１３．６±７．９）小时，健康对照组５０例。结果 （１）ＡＭＩ组ＨＲＶ各项指标均低于正常对照组，统计学达显意义，并且正常ＲＲ间期的标准差，低频等成分失去了昼夜间的差异。ＡＭＩ患２４小时ＨＲＶ     

Heart rate variability in patients with rheumatoid arthritis

Heart rate variability (HRV) is a useful tool for the detection of sympathetic-parasympathetic balance in the autonomic nervous system. Autonomic nervous system involvement in patients with rheumatoid arthritis (RA) has rarely been studied and has shown conflicting results. Our purpose was to determine if HRV showed changes in patients with RA in comparison with the normal population. Short-term analysis of HRV was performed for time-domain frequency in 42 patients with RA and 44 matched controls. In this analysis, patients displayed lower standard deviation of the mean than healthy subjects ( P<0.0001). Patients tended to display higher pNN50 and root-mean-square of successive difference values than did healthy subjects, but these differences were not statistically significant (P >0.05). In frequency domain analysis, the spectral measures of HRV showed reduced high-frequency (HF) values and an higher low-frequency (LF) values; as a result, the ratio between low and high frequencies (LF/HF), representative of sympathovagal modulation, was significantly increased (P=0.001, P=0.012, and P=0.003, respectively). Our data suggest an increase in sympathetic control of the heart rate in patients with RA. This increased sympathetic activity could play a key role in the development of ventricular tachyarrhythmias in RA and may be related to the higher incidence of sudden death in this disorder.     

Heart rate variability in beta‐thalassemia patients

Background: Cardiac failure remains the major cause of death in beta‐thalassemia major (TM). Reduced heart rate variability (HRV) is associated with a higher risk of arrhythmias after myocardial infarction and heart failure. We evaluated HRV in TM patients and its relationship with hemodynamics and echocardiographic parameters during a 6‐month follow‐up. Methods: Thirty‐four TM patients (19 ± 10 yr) and 20 healthy subjects (17 ± 6 yr) were evaluated. Hematologic, biochemical, echocardiographic and HRV parameters were determined at entry and at 6‐month follow‐up. Time and frequency domain HRV parameters were analyzed from 24‐h recorded electrocardiograms. All TM patients received blood transfusion and chelation therapy. Results: Both time and frequency domain HRV parameters were markedly reduced in TM patients, compared to the control. The significantly improved HRV was seen in correlation with higher hemoglobin (Hb) level when compared within TM group at different time point. No correlation was seen between HRV and serum ferritin, reactive oxygen species (ROS) and non‐transferrin bound iron (NTBI). Conclusion: HRV is depressed in TM patients. HRV was significantly correlated with Hb level, suggesting that anemia greatly influences the cardiac autonomic balance.     

Heart rate variability and heart rate turbulence in hypothyroidism before and after treatment

Background: Cardiac autonomic dysfunction may develop in patients with clinical or subclinical thyroid hormone deficiency. Heart rate variability (HRV) and heart rate turbulence (HRT) are used for evaluating changes in cardiac autonomic functions and also used to provide risk stratification in cardiac and noncardiac diseases. The aim of this study is to evaluate cardiac autonomic functions before and 6 months after thyroid replacement therapy in patients with thyroid hormone deficiency. Methods: Forty hypothyroid patients (mean age 48 ± 13, four male) and 31 healthy controls (mean age 51 ± 12, three male) were included in the study. Twenty‐four hour ambulatory electrocardiogram recordings were taken using Pathfinder Software Version V8.255 (Reynolds Medical). The time domain parameters of HRV analysis were performed using the Heart Rate Variability Software (version 4.2.0, Norav Medical Ltd, Israel). HRT parameters, Turbulence Onset (TO), and Turbulence Slope (TS) were calculated with HRT! View Version 0.60‐0.1 software. Results: HRV and HRT parameters were decreased in the patient group (SDNN; P < 0.001, SDANN; P < 0.009, RMSSD; P = 0.049, TO; P = 0.035, TS; P < 0.001). After 6 months of thyroid replacement therapy, there were no significant changes observed in either HRV or HRT. Conclusions: Hypothyroidism may cause cardiac autonomic dysfunction. Treating hypothyroidism with L‐thyroxine therapy does not effectively restore cardiac autonomic function. HRV and HRT can be used as to help monitor cardiovascular‐related risk in this population. Ann Noninvasive Electrocardiol 2011;16(4):344–350     

Heart rate variability in patients with atrial septal defect and healthy children

ObjectiveHeart rate variability (HRV) measures are altered in various cardiac and non-cardiac situations in children. The autonomic nervous system is assumed to have a role in the pathophysiology of atrial septal defect (ASD). In this study, we evaluated the autonomic system by measuring HRV in children with ASD.MethodsTwenty-eight patients with ASD and 32 healthy children (mean ages: 6.6 ± 2.1 years and 6.4 ± 2.2 years, respectively) were enrolled in the study. Twenty-four-hour ambulatory electrocardiographic recordings were obtained and the seven time-domain (SDNN, SDANN, rMSSD, SD, SDNN index, PNN50, and mean RR) and four frequency-domain (VLF, LF, HF, and LF/HF ratio) indices of HRV were analyzed.ResultsA significant decrease in calculated HRV variables was observed in children with ASD as compared to controls. The HRV alteration was found in both time-domain and frequency-domain parameters.ConclusionsOur results indicate that HRV is decreased in children with ASD, which implies parasympathetic withdrawal and sympathetic predominance.     

扩张型心肌病的心率变异性分析

为了解扩张型心肌病患者自主神经功能,通过22例扩张型心肌病患者和22例健康人的动态心电图检查,进行线性和非线性心率变异性分析.结果显示:患者R-R间期、SDNN、SDNN_(Index)、PNN_(50)、RMSSD等线性时域指标均低于正常人:非线性分析的散点图健康人多呈彗星状.扩张型心肌病患者多呈非彗星状.提示:扩张型心肌病患者心率变异性下降,反映自主神经功能减退.