超高龄持续性心房颤动患者心率变异性与基础临床特征的关系分析

王小艳; 许健; 钱进; 姜苏蓉; 王森

doi:10.7619/jcmp.20234217

超高龄持续性心房颤动患者心率变异性与基础临床特征的关系分析

Relationship between heart rate variability and baseline clinical characteristics in super-aged patients with persistent atrial fibrillation

摘要

摘要:
目的探讨超高龄(≥ 80岁)持续性心房颤动(简称房颤)患者的心率变异性(HRV)与基础临床特征的关系。
方法选取108例超高龄持续性房颤患者纳入房颤组, 另选取127例超高龄窦性心律老人纳入对照组, 监测24 h动态心电图, 比较2组心率、HRV时域指标正常RR间期标准差(SDNN)、全程每5 min RR间期平均值的标准差(SDANN)、相邻NN间期差值的均方根(RMSSD)、全程记录中5 min NN间期标准差平均值(SDNN index)、心率变异指数(HRV index)和相邻NN间期差值>50 ms的心搏数占NN间期总搏数的百分比(PNN50)。收集房颤患者的基础临床特征, 采用多元线性回归分析探讨HRV时域指标与心率、基础临床特征的相关性。
结果房颤组的SDNN、RMSSD、HRV index、PNN50、SDNN index均高于对照组, 差异有统计学意义(P < 0.01)。多元线性回归分析结果显示, SDNN升高与高血压(P=0.001)、服用β受体阻滞剂(P=0.003)、心率慢(P < 0.001)显著相关, RMSSD升高与高血压(P=0.040)、服用β受体阻滞剂(P=0.002)、心率慢(P < 0.001)显著相关, HRV index升高与心力衰竭(P=0.003)、心率慢(P < 0.001)显著相关, PNN50升高与心率慢(P=0.004)显著相关; SDNN index升高与服用β受体阻滞剂(P=0.002)、心率慢(P < 0.001)显著相关, SDANN升高与高血压(P=0.006)、心率慢(P < 0.001)、服用达比加群(P=0.021)显著相关。
结论超高龄持续性房颤患者的HRV与基础临床特征存在相关性, 该现象可能源于自主神经系统的活动状态。

Abstract:
Objective To investigate the relationship between heart rate variability (HRV) and baseline clinical characteristics in super-aged (≥ 80 years old) patients with persistent atrial fibrillation (AF).
Methods A total of 108 super-aged patients with persistent AF were included in AF group, and 127 super-aged patients with sinus rhythm were included in control group. 24-hour ambulatory electrocardiogram monitoring was conducted to compare heart rate and HRV time-domain indicatorsstandard deviation of normal RR intervals (SDNN), standard deviation of the average of normal to normal intervals (SDANN) every 5 minutes throughout the recording, mean of the sum of the squares of differences between adjacent N-N intervals (RMSSD), average value of standard deviation of 5-minute NN intervals throughout the recording (SDNN index), heart rate variability (HRV) index, and percentage of NN intervals with differences greater than 50 ms accounting for the total number of NN intervals (PNN50). Clinical characteristics of AF patients were collected, and multiple linear regression analysis was used to explore the correlation between HRV time-domain indicators and heart rate and baseline clinical characteristics.
Results SDNN, RMSSD, HRV index, PNN50, and SDNN index were higher in the AF group than in the control group (P < 0.01). Multiple linear regression analysis showed that increased SDNN was significantly associated with hypertension (P=0.001), use of β-blockers (P=0.003), and slow heart rate (P < 0.001). Increased RMSSD wassignificantly associated with hypertension (P=0.040), use of β-blockers (P=0.002), and slow heart rate (P < 0.001). Increased HRV index was significantly associated with heart failure (P=0.003) and slow heart rate (P < 0.001). Increased PNN50 was significantly associated with slow heart rate (P=0.004). Increased SDNN index was significantly associated with the use of β-blockers (P=0.002) and slow heart rate (P < 0.001). Increased SDANN was significantly associated with hypertension (P=0.006), slow heart rate (P < 0.001), and use of dabigatran (P=0.021).
Conclusion There is a correlation between HRV and baseline clinical characteristics in super-aged patients with persistent AF, which may be due to the activity status of the autonomic nervous system.

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