心率变异性在冠心病患者中的应用
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摘要
冠心病的发病率及病死率不断上升,有效评估病情并实施诊疗对改善预后至关重要。冠心病患者心肌缺血与自主神经功能异常有关,而心率变异性可方便、无创、有效地评价自主神经功能。本文对心率变异性在冠心病患者中应用的价值、现状、局限性及前景进行综述。
Against the background of rising morbidity and mortality of coronary heart disease,effective disease evaluation,and diagnosis and treatment are crucial for the improvement of prognosis. Among the patients with coronary heart disease,myocardial ischemia has been proved to be associated with dysfunction of autonomic nerve.Heart rate variability could be convenient,noninvasive and effective in evaluating autonomic nervous functions.This paper reviews on the value,current situation,limitations and prospect of the application of heart rate variability on the patients with coronary heart disease.
Against the background of rising morbidity and mortality of coronary heart disease,effective disease evaluation,and diagnosis and treatment are crucial for the improvement of prognosis. Among the patients with coronary heart disease,myocardial ischemia has been proved to be associated with dysfunction of autonomic nerve.Heart rate variability could be convenient,noninvasive and effective in evaluating autonomic nervous functions.This paper reviews on the value,current situation,limitations and prospect of the application of heart rate variability on the patients with coronary heart disease.
引文
[1]陈尔冬,周菁.心率变异性的研究及应用进展[J].心血管病学进展,2014,35(4):435-439.
[2]Kleiger RE,Stein PK,Bigger JT Jr.Heart rate variability:measurement and clinical utility[J].Ann Noninvasive Electrocardiol,2005,10(1):88-101.
[3]Thayer JF,Yamamoto SS,Brosschot JF.The relationship of autonomic imbalance,heart rate variability and cardiovascular disease risk factors[J].Int J Cardiol,2010,141(2):122-131.
[4]Liao D,Cai J,Brancati FL,et al.Association of vagal tone with serum insulin,glucose,and diabetes mellitus-the ARIC Study[J].Diabetes Res Clin Pract,1995,30(3):211-221.
[5]郭晓琳.心率变异性分析临床应用研究近况[J].心血管病防治知识(学术版),2017,7(7):143-144.
[6]Muhadi,Nasution SA,Putranto R,et al.The ability of detecting heart rate variability with the photoplethysmography to predict major adverse cardiac event in acute coronary syndrome[J].Acta Med Indones,2016,48(1):48-53.
[7]Schmidt G,Malik M,Barthel P,et al.Heart-rate turbulence after ventricular premature beats as a predictor of mortality after acute myocardial infarction[J].Lancet,1999,353(9162):1390-1396.
[8]Grad C.Heart rate variability and heart rate recovery as prognostic factors[J].Clujul Med,2015,88(3):304-309.
[9]Kotecha D,New G,Flather MD,et al.Five-minute heart rate variability can predict obstructive angiographic coronary disease[J].Heart,2012,98(5):395-401.
[10]Goldkorn R,Naimushin A,Shlomo N,et al.Comparison of the usefulness of heart rate variability versus exercise stress testing for the detection of myocardial ischemia in patients without known coronary artery disease[J].Am JCardiol,2015,115(11):1518-1522.
[11]黄祖坚.心率变异性与慢性稳定性心绞痛分级的关系及β-受体阻滞剂的干预作用[J].中国当代医药,2018,25(4):50-53.
[12]Task Force of the European Society of Cardiology,the North American Society of Pacing and Electrophysiology.Heart rate variability:standards of measurement,physiological interpretation and clinical use[J].Circulation,1996,93(5):1043-1065.
[13]Crawford MH,Bernstein SJ,Deedwania PC,et al.ACC/AHA guidelines for ambulatory electrocardiography:executive summary and recommendations.A report of the A-merican College of Cardiology/American Heart Association task force on practice guidelines(committee to revise the guidelines for ambulatory electrocardiography)[J].Circulation,1999,100(8):886-893.
[14]Singh N,Mironov D,Armstrong PW,et al.Heart rate variability assessment early after acute myocardial infarction.Pathophysiological and prognostic correlates.GUS-TO ECG Substudy Investigators.Global Utilization of Streptokinase and TPA for Occluded Arteries[J].Circulation,1996,93(7):1388-1395.
[15]Hohnloser SH,Kuck KH,Dorian P,et al.Prophylactic use of an implantable cardioverter-defibrillator after acute myocardial infarction[J].N Engl J Med,2004,351(24):2481-2488.
[16]Gillis AM.Prophylactic implantable cardioverter-defibrillators after myocardial infarction-not for everyone[J].N Engl JMed,2004,351(24):2540-2542.
[17]Bigger JT Jr,Fleiss JL,Steinman RC,et al.RR variability in healthy,middle-aged persons compared with patients with chronic coronary heart disease or recent acute myocardial infarction[J].Circulation,1995,91(7):1936-1943.
[18]Stein PK,Domitrovich PP,Kleiger RE,et al.Including patients with diabetes mellitus or coronary artery bypass grafting decreases the association between heart rate variability and mortality after myocardial infarction[J].Am Heart J,2004,147(2):309-316.
[19]Whang W,Bigger JT Jr.Comparison of the prognostic value of RR-interval variability after acute myocardial infarction in patients with versus those without diabetes mellitus[J].Am J Cardiol,2003,92(3):247-251.
[20]Janszky I,Ericson M,Mittleman MA,et al.Heart rate variability in long-term risk assessment in middle-aged women with coronary heart disease:The Stockholm Female Coronary Risk Study[J].J Intern Med,2004,255(1):13-21.
[21]La Rovere MT,Bigger JT Jr,Marcus FI,et al.Baroreflex sensitivity and heart-rate variability in prediction of total cardiac mortality after myocardial infarction.ATRAMI(Autonomic Tone and Reflexes After Myocardial Infarction)Investigators[J].Lancet,1998,351(2):478-483.
[22]Camm AJ,Pratt CM,Schwartz PJ,et al.Mortality in patients after a recent myocardial infarction:a randomized,placebo-controlled trial of azimilide using heart rate variability for risk stratification[J].Circulation,2004,109(8):990-996.
[23]Fang SC,Cassidy A,Christiani DC.A systematic review of occupational exposure to particulate matter and cardiovascular disease[J].Int J Environ Res Public Health,2010,7(4):1773-1806.
[24]Routledge FS,Campbell TS,McFetridge-Durdle JA,et al.Improvements in heart rate variability with exercise therapy[J].Can J Cardiol,2010,26(6):303-312.
[25]Emren V,Aldemir M.SYNTAX score predicts postoperative atrial fibrillation in patients undergoing on-pump isolated coronary artery bypass grafting surgery[J].Anatol JCardiol,2016,16(11):892-893.
[26]Lakusic N,Mahovic D,Kruzliak P,et al.Changes in heart rate variability after coronary artery bypass grafting and clinical importance of these findings[J].Biomed Res Int,2015,2014(3):1-7.
[27]Hossen A,Jaju D,Al-Abri M,et al.Investigation of heart rate variability of patients undergoing coronary artery bypass grafting(CABG)[J].Technol Health Care,2017,25(2):197-210.
[28]Antman EM,Anbe DT,Armstrong PW,et al.ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction-executive summary:a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines(Writing Committee to Revise the 1999 Guidelines for the Management of Patients With Acute Myocardial Infarction)[J].Circulation,2004,110(5):588-636.
[29]Goldberger JJ,Cain ME,Hohnloser SH,et al.American Heart Association/American College of Cardiology Foundation/Heart Rhythm Society scientific statement on noninvasive risk stratification techniques for identifying patients at risk for sudden cardiac death:a scientific statement from the American Heart Association Council on Clinical Cardiology Committee on Electrocardiography and Arrhythmias and Council on Epidemiology and Prevention[J].Circulation,2008,118(14):1497-1518.
[30]Bailey JJ,Berson AS,Handelsman H,et al.Utility of current risk stratification tests for predicting major arrhythmic events after myocardial infarction[J].J Am Coll Cardiol,2001,38(7):1902-1911.
[31]Malik M,Camm AJ,Janse MJ,et al.Depressed heart rate variability identifies post infarction patients who might benefit from prophylactic treatment with amiodarone:a substudy of EMIAT(The European Myocardial Infarct Amiodarone Trial)[J].J Am Coll Cardiol,2000,35(5):1263-1275.
[2]Kleiger RE,Stein PK,Bigger JT Jr.Heart rate variability:measurement and clinical utility[J].Ann Noninvasive Electrocardiol,2005,10(1):88-101.
[3]Thayer JF,Yamamoto SS,Brosschot JF.The relationship of autonomic imbalance,heart rate variability and cardiovascular disease risk factors[J].Int J Cardiol,2010,141(2):122-131.
[4]Liao D,Cai J,Brancati FL,et al.Association of vagal tone with serum insulin,glucose,and diabetes mellitus-the ARIC Study[J].Diabetes Res Clin Pract,1995,30(3):211-221.
[5]郭晓琳.心率变异性分析临床应用研究近况[J].心血管病防治知识(学术版),2017,7(7):143-144.
[6]Muhadi,Nasution SA,Putranto R,et al.The ability of detecting heart rate variability with the photoplethysmography to predict major adverse cardiac event in acute coronary syndrome[J].Acta Med Indones,2016,48(1):48-53.
[7]Schmidt G,Malik M,Barthel P,et al.Heart-rate turbulence after ventricular premature beats as a predictor of mortality after acute myocardial infarction[J].Lancet,1999,353(9162):1390-1396.
[8]Grad C.Heart rate variability and heart rate recovery as prognostic factors[J].Clujul Med,2015,88(3):304-309.
[9]Kotecha D,New G,Flather MD,et al.Five-minute heart rate variability can predict obstructive angiographic coronary disease[J].Heart,2012,98(5):395-401.
[10]Goldkorn R,Naimushin A,Shlomo N,et al.Comparison of the usefulness of heart rate variability versus exercise stress testing for the detection of myocardial ischemia in patients without known coronary artery disease[J].Am JCardiol,2015,115(11):1518-1522.
[11]黄祖坚.心率变异性与慢性稳定性心绞痛分级的关系及β-受体阻滞剂的干预作用[J].中国当代医药,2018,25(4):50-53.
[12]Task Force of the European Society of Cardiology,the North American Society of Pacing and Electrophysiology.Heart rate variability:standards of measurement,physiological interpretation and clinical use[J].Circulation,1996,93(5):1043-1065.
[13]Crawford MH,Bernstein SJ,Deedwania PC,et al.ACC/AHA guidelines for ambulatory electrocardiography:executive summary and recommendations.A report of the A-merican College of Cardiology/American Heart Association task force on practice guidelines(committee to revise the guidelines for ambulatory electrocardiography)[J].Circulation,1999,100(8):886-893.
[14]Singh N,Mironov D,Armstrong PW,et al.Heart rate variability assessment early after acute myocardial infarction.Pathophysiological and prognostic correlates.GUS-TO ECG Substudy Investigators.Global Utilization of Streptokinase and TPA for Occluded Arteries[J].Circulation,1996,93(7):1388-1395.
[15]Hohnloser SH,Kuck KH,Dorian P,et al.Prophylactic use of an implantable cardioverter-defibrillator after acute myocardial infarction[J].N Engl J Med,2004,351(24):2481-2488.
[16]Gillis AM.Prophylactic implantable cardioverter-defibrillators after myocardial infarction-not for everyone[J].N Engl JMed,2004,351(24):2540-2542.
[17]Bigger JT Jr,Fleiss JL,Steinman RC,et al.RR variability in healthy,middle-aged persons compared with patients with chronic coronary heart disease or recent acute myocardial infarction[J].Circulation,1995,91(7):1936-1943.
[18]Stein PK,Domitrovich PP,Kleiger RE,et al.Including patients with diabetes mellitus or coronary artery bypass grafting decreases the association between heart rate variability and mortality after myocardial infarction[J].Am Heart J,2004,147(2):309-316.
[19]Whang W,Bigger JT Jr.Comparison of the prognostic value of RR-interval variability after acute myocardial infarction in patients with versus those without diabetes mellitus[J].Am J Cardiol,2003,92(3):247-251.
[20]Janszky I,Ericson M,Mittleman MA,et al.Heart rate variability in long-term risk assessment in middle-aged women with coronary heart disease:The Stockholm Female Coronary Risk Study[J].J Intern Med,2004,255(1):13-21.
[21]La Rovere MT,Bigger JT Jr,Marcus FI,et al.Baroreflex sensitivity and heart-rate variability in prediction of total cardiac mortality after myocardial infarction.ATRAMI(Autonomic Tone and Reflexes After Myocardial Infarction)Investigators[J].Lancet,1998,351(2):478-483.
[22]Camm AJ,Pratt CM,Schwartz PJ,et al.Mortality in patients after a recent myocardial infarction:a randomized,placebo-controlled trial of azimilide using heart rate variability for risk stratification[J].Circulation,2004,109(8):990-996.
[23]Fang SC,Cassidy A,Christiani DC.A systematic review of occupational exposure to particulate matter and cardiovascular disease[J].Int J Environ Res Public Health,2010,7(4):1773-1806.
[24]Routledge FS,Campbell TS,McFetridge-Durdle JA,et al.Improvements in heart rate variability with exercise therapy[J].Can J Cardiol,2010,26(6):303-312.
[25]Emren V,Aldemir M.SYNTAX score predicts postoperative atrial fibrillation in patients undergoing on-pump isolated coronary artery bypass grafting surgery[J].Anatol JCardiol,2016,16(11):892-893.
[26]Lakusic N,Mahovic D,Kruzliak P,et al.Changes in heart rate variability after coronary artery bypass grafting and clinical importance of these findings[J].Biomed Res Int,2015,2014(3):1-7.
[27]Hossen A,Jaju D,Al-Abri M,et al.Investigation of heart rate variability of patients undergoing coronary artery bypass grafting(CABG)[J].Technol Health Care,2017,25(2):197-210.
[28]Antman EM,Anbe DT,Armstrong PW,et al.ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction-executive summary:a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines(Writing Committee to Revise the 1999 Guidelines for the Management of Patients With Acute Myocardial Infarction)[J].Circulation,2004,110(5):588-636.
[29]Goldberger JJ,Cain ME,Hohnloser SH,et al.American Heart Association/American College of Cardiology Foundation/Heart Rhythm Society scientific statement on noninvasive risk stratification techniques for identifying patients at risk for sudden cardiac death:a scientific statement from the American Heart Association Council on Clinical Cardiology Committee on Electrocardiography and Arrhythmias and Council on Epidemiology and Prevention[J].Circulation,2008,118(14):1497-1518.
[30]Bailey JJ,Berson AS,Handelsman H,et al.Utility of current risk stratification tests for predicting major arrhythmic events after myocardial infarction[J].J Am Coll Cardiol,2001,38(7):1902-1911.
[31]Malik M,Camm AJ,Janse MJ,et al.Depressed heart rate variability identifies post infarction patients who might benefit from prophylactic treatment with amiodarone:a substudy of EMIAT(The European Myocardial Infarct Amiodarone Trial)[J].J Am Coll Cardiol,2000,35(5):1263-1275.