女性急性心肌梗死患者心率变异性的特点
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摘要
目的探讨女性急性心肌梗死患者心率变异性(HRV)的特点。方法选择2016年7月至2017年7月于我院行冠状动脉造影并诊断为急性心肌梗死的152例患者,按性别分为女性组(n=52)和男性组(n=100)。回顾性分析两组患者的一般资料,并行24 h动态心电图检查,比较两组患者平均心率(HR)、HRV的时域和频域指标、随访半年内主要不良心血管事件(MACE)的发生率。结果与男性组相比,女性组患者合并高血压、糖尿病的占比较高,且吸烟率较低(P<0.01)。女性组的心率高于男性组(P<0.05)。时域指标中,女性组的SDNN、SDANN、SDNN Index、rMSSD、pNN50明显低于男性组(P<0.05)。频域指标中,女性组的HF、LF及LF/HF显著低于男性组(P<0.05)。随访半年内,女性组的MACE总发生率明显高于男性组(P=0.02)。结论女性急性心肌梗死患者较男性患者合并症多,女性心率更高,HRV明显更低,短期预后差,提示女性急性心肌梗死后会出现更严重的心脏自主功能障碍。
Objective To investigate the characteristics of h eart rate variability(HRV) in female patients with acute myocardial infarction. Methods A total of 152 patients with acute myocardial infarction diagnosed by coronary angiography in our hospital from July 2016 to July 2017 were divided into female group(n=52) and male group(n=100) according to gender.The general data of the two groups were retrospectively analyzed, and 24 hour dynamic electrocardiogram was performed. The average heart rate(HR), time-domain and frequency-domain indexes of HRV and incidences of major adverse cardiovascular events(MACE) followed up for half a year were compared between the two groups. Results Compared with the male group,the proportion of patients with hypertension and diabetes mellitus in the female group was higher, and the smoking rate was lower(P <0.01). The heart rate of the female group was higher than that of the male group(P <0.05). For time-domain indicators, the SDNN, SDANN, SDNN Index, rMSSD and pNN50 in the female group were significantly lower than those in the male group(P<0.05). For frequency-domain indicators, the HF, LF and LF/HF of the female group were significantly lower than those of the male group(P<0.05). During the follow-up period of half a year, the total incidence of MACE in the female group was significantly higher than that in the male group(P =0.02). Conclusion Female patients with acute myocardial infarction have more comorbidities, faster average heart rate and lower heart rate variability, poorer short-term prognosis, suggesting that women have more severe autonomic dysfunction after acute myocardial infarction.
Objective To investigate the characteristics of h eart rate variability(HRV) in female patients with acute myocardial infarction. Methods A total of 152 patients with acute myocardial infarction diagnosed by coronary angiography in our hospital from July 2016 to July 2017 were divided into female group(n=52) and male group(n=100) according to gender.The general data of the two groups were retrospectively analyzed, and 24 hour dynamic electrocardiogram was performed. The average heart rate(HR), time-domain and frequency-domain indexes of HRV and incidences of major adverse cardiovascular events(MACE) followed up for half a year were compared between the two groups. Results Compared with the male group,the proportion of patients with hypertension and diabetes mellitus in the female group was higher, and the smoking rate was lower(P <0.01). The heart rate of the female group was higher than that of the male group(P <0.05). For time-domain indicators, the SDNN, SDANN, SDNN Index, rMSSD and pNN50 in the female group were significantly lower than those in the male group(P<0.05). For frequency-domain indicators, the HF, LF and LF/HF of the female group were significantly lower than those of the male group(P<0.05). During the follow-up period of half a year, the total incidence of MACE in the female group was significantly higher than that in the male group(P =0.02). Conclusion Female patients with acute myocardial infarction have more comorbidities, faster average heart rate and lower heart rate variability, poorer short-term prognosis, suggesting that women have more severe autonomic dysfunction after acute myocardial infarction.
引文
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[7]VOSS A,SCHROEDER R,VALLVERD M,et al.Short-term vs.longterm heart rate variability in ischemic cardiomyopathy risk stratification[J].Front Physiol,2013,4:364.
[8]KIM CK,MCGORRAY SP,BARTHOLOMEW BA,et al.Depressive symptoms and heart rate variability in postmenopausal women[J].Arch Intern Med,2005,165(11):1239-1244.
[9]DE LUCA G,PARODI G,SCIAGR魥R,et al.Effect of diabetes on scintigraphic infarct size in STEMI patients undergoing primary angioplasty[J].Diabetes Metab Res Rev,2015,31(3):322-328.
[10]POKORNY J,STANEK V,VRANA M.Sudden cardiac death thirty years ago and at present.The role of autonomic disturbances in acute myocardial infarction revisited[J].Physiol Res,2011,60(5):715-728.
[11]PINHEIRO ADE O,PEREIRA VL JR,BALTATU OC,et al.Cardiac autonomic dysfunction in elderly women with myocardial infarction[J].Curr Med Res Opin,2015,31(10):1849-1854.
[12]高敏.心血管病患者心率变异性分析[J].中国临床保健杂志,2010,13(1):75-76.
[2]YU J,MEHRAN R,GRINFELD L,et al.Sex-based differences in bleeding and long term adverse events after percutaneous coronary intervention for acute myocardial infarction:three year results from the HORIZONS-AMI trial[J].Catheter Cardiovasc Interv,2015,85(3):359-368.
[3]THYGESEN K,ALPERT JS,JAFFE AS,et al.Third universal definition of myocardial infarction[J].Circulation,2012,126(16):2020-2035.
[4]BIONDI-ZOCCAI GG,ABBATE A,LIUZZO G,et al.Atherothrombosis,inflammation,and diabetes[J].J Am Coll Cardiol,2003,41(7):1071-1077.
[5]HSIA J,LARSON JC,OCKENE JK,et al.Resting heart rate as a low tech predictor of coronary events in women:prospective cohort study[J].BMJ,2009,338:b219.
[6]WONG TC,PIEHLER KM,KANG IA,et al.Myocardial extracellular volume fraction quantified by cardiovascular magnetic resonance is increased in diabetes and associated with mortality and incident heart failure admission[J].Eur Heart J,2014,35(10):657-664.
[7]VOSS A,SCHROEDER R,VALLVERD M,et al.Short-term vs.longterm heart rate variability in ischemic cardiomyopathy risk stratification[J].Front Physiol,2013,4:364.
[8]KIM CK,MCGORRAY SP,BARTHOLOMEW BA,et al.Depressive symptoms and heart rate variability in postmenopausal women[J].Arch Intern Med,2005,165(11):1239-1244.
[9]DE LUCA G,PARODI G,SCIAGR魥R,et al.Effect of diabetes on scintigraphic infarct size in STEMI patients undergoing primary angioplasty[J].Diabetes Metab Res Rev,2015,31(3):322-328.
[10]POKORNY J,STANEK V,VRANA M.Sudden cardiac death thirty years ago and at present.The role of autonomic disturbances in acute myocardial infarction revisited[J].Physiol Res,2011,60(5):715-728.
[11]PINHEIRO ADE O,PEREIRA VL JR,BALTATU OC,et al.Cardiac autonomic dysfunction in elderly women with myocardial infarction[J].Curr Med Res Opin,2015,31(10):1849-1854.
[12]高敏.心血管病患者心率变异性分析[J].中国临床保健杂志,2010,13(1):75-76.