Relation of heart rate variability to serum levels of C-reactive protein in patients with unstable angina pectoris
Relation of heart rate variability to serum levels of C-reactive protein in patients with unstable angina pectoris
复制标题
DOI：
10.1016/j.amjcard.2006.01.029
复制
发表时间：
2006-06-15
影响因子：
2.8
通讯作者：
Maseri, A
中科院分区：
文献类型：
--
作者：
Lanza, GA;Sgueglia, GA;Maseri, A
心率变异性（HRV）和全身炎症指标对不稳定型心绞痛（UAP）患者具有预后价值。然而，在这种临床情况下，HRV参数与炎症指标之间是否存在关系尚不清楚。我们对531名UAP患者（65 +/- 10岁；347名男性）纳入前瞻性多中心研究Stratificazione预后不稳定性心绞痛（SPAI），通过入院24小时内进行的24小时心电图动态心电图记录评估HRV，并在入院时通过高灵敏度测定血清c反应蛋白（CRP）水平。CRP水平与所有HRV参数之间存在显著的负相关，在所有RR区间的SD （r = -0.23, p < 0.001）在时域中r系数最高，在频域中r值非常低（r = -0.22, p < 0.001）。根据CRP四分位数水平将患者分为4组，CRP四分位数高的患者HRV值较低，差异有统计学意义。在单独的多元回归分析中，包括最重要的临床和实验室变量，所有RR区间的SD和极低频振幅是CRP水平升高的最显著预测因子（2个比较的p < 0.001）。相反，在所有RR区间的SD和非常低的频率幅度作为因变量的模型中，CRP是心脏自主神经功能受损的一个强有力的预测因子（2个比较的p < 0.001）。因此，我们的数据显示，在UAP患者中，高水平的血清CRP水平与HRV降低显著相关，提示心脏自主神经功能障碍与炎症活动之间可能存在病理生理联系。(c) 2006爱思唯尔公司版权所有。
Heart rate variability (HRV) and systemic markers of inflammation have prognostic value in patients with unstable angina pectoris (UAP). However, it is unknown whether any relation exists between HRV parameters and indexes of inflammation in this clinical context. We assessed HRV on 24-hour electrocardiographic Holter recordings, performed within 24 hours of admission, and measured C-reactive protein (CRP) serum levels by a high-sensitivity assay on admission, in 531 patients with UAP (65 +/- 10 years of age; 347 men) who were enrolled in the prospective multicenter study Stratificazione Prognostica dell'Angina Instabile (SPAI). A significant inverse correlation was found between CRP levels and all HRV parameters, with the highest r coefficient shown with SD of all RR intervals (r = -0.23; p < 0.001) in the time domain and with very low-frequency amplitude (r = -0.22; p < 0.001) in the frequency domain. When patients were categorized into 4 groups according to CRP quartile levels, statistically significant lower HRV values were observed in the upper CRP quartile. On separate multiple regression analyses, including the most important clinical and laboratory variables, SD of all RR intervals and very low-frequency amplitude were the most significant predictors of increasing CRP levels (p < 0.001 for the 2 comparisons). In contrast, in models with SD of all RR intervals and very low-frequency amplitude as dependent variables, CRP was a strong predictor of impaired cardiac autonomic function (p < 0.001 for the 2 comparisons). Thus, our data show that, in patients with UAP, high levels of serum CRP levels are significantly associated with decreased HRV, suggesting a possible pathophysiologic link between cardiac autonomic dysfunction and inflammatory activity. (c) 2006 Elsevier Inc. All rights reserved.