Blunted cyclic variation of heart rate predicts mortality risk in post-myocardial infarction, end-stage renal disease, and chronic heart failure patients.
Blunted cyclic variation of heart rate predicts mortality risk in post-myocardial infarction, end-stage renal disease, and chronic heart failure patients.
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DOI：
10.1093/europace/euw222
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发表时间：
2017-08-01
期刊：
影响因子：
--
通讯作者：
Kodama I
中科院分区：
文献类型：
--
作者：
Hayano J;Yasuma F;Watanabe E;Carney RM;Stein PK;Blumenthal JA;Arsenos P;Gatzoulis KA;Takahashi H;Ishii H;Kiyono K;Yamamoto Y;Yoshida Y;Yuda E;Kodama I
与睡眠呼吸障碍相关的心率周期性变化（CVHR）被认为反映了心脏对呼吸暂停/缺氧应激的自主反应。我们检查了动态心电图观察到的 CVHR 减弱是否可以预测死亡风险。通过自动算法检测夜间动态心电图的 CVHR，并检查 717 例心肌梗死后患者（MI 后 1 次，死亡率 6%，中位随访 25 个月）CVHR 频率 (FCV) 和振幅 (ACV) 的预后关系。预测能力在三个独立队列中进行了前瞻性验证：第二组由 220 名 MI 后患者组成（MI 2 后，死亡率为 25.5%，随访 45 个月）； 299 名接受慢性血液透析的终末期肾病患者（ESRD，死亡率 28.1%，随访 85 个月）；以及 100 名慢性心力衰竭患者（CHF，死亡率 35%，随访 38 个月）。尽管所有队列中 ≥96% 的患者都观察到了 CVHR，但 FCV 并不能预测任何队列中的死亡率。相比之下，ACV 下降是 MI 1 后队列中死亡率的有力预测因子（每减少 1 ln [ms]，风险比 [95% CI] 为 2.9 [2.2–3.7]，P < 0.001）。这种预后关系在 MI 后 2 (1.8 [1.4–2.2], P < 0.001)、ESRD (1.5 [1.3–1.8], P < 0.001) 和 CHF (1.4 [1.1–1.8], P = 0.02) 队列中得到验证。 ACV 的预后价值与年龄、性别、糖尿病、β 受体阻滞剂治疗、左心室射血分数、睡眠时间平均 R-R 间期和 FCV 无关。夜间动态心电图中 ACV 下降检测到的 CVHR 减弱可预测 MI 后、ESRD 和 CHF 患者的死亡风险增加。
Cyclic variation of heart rate (CVHR) associated with sleep-disordered breathing is thought to reflect cardiac autonomic responses to apnoeic/hypoxic stress. We examined whether blunted CVHR observed in ambulatory ECG could predict the mortality risk. CVHR in night-time Holter ECG was detected by an automated algorithm, and the prognostic relationships of the frequency (FCV) and amplitude (ACV) of CVHR were examined in 717 patients after myocardial infarction (post-MI 1, 6% mortality, median follow-up 25 months). The predictive power was prospectively validated in three independent cohorts: a second group of 220 post-MI patients (post-MI 2, 25.5% mortality, follow-up 45 months); 299 patients with end-stage renal disease on chronic haemodialysis (ESRD, 28.1% mortality, follow-up 85 months); and 100 patients with chronic heart failure (CHF, 35% mortality, follow-up 38 months). Although CVHR was observed in ≥96% of the patients in all cohorts, FCV did not predict mortality in any cohort. In contrast, decreased ACV was a powerful predictor of mortality in the post-MI 1 cohort (hazard ratio [95% CI] per 1 ln [ms] decrement, 2.9 [2.2–3.7], P < 0.001). This prognostic relationship was validated in the post-MI 2 (1.8 [1.4–2.2], P < 0.001), ESRD (1.5 [1.3–1.8], P < 0.001), and CHF (1.4 [1.1–1.8], P = 0.02) cohorts. The prognostic value of ACV was independent of age, gender, diabetes, β-blocker therapy, left ventricular ejection fraction, sleep-time mean R-R interval, and FCV. Blunted CVHR detected by decreased ACV in a night-time Holter ECG predicts increased mortality risk in post-MI, ESRD, and CHF patients.
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影响因子：
168.9
作者：
Bauer, Axel;Kantelhardt, Jan W.;Schmidt, Georg
通讯作者：
Schmidt, Georg
影响因子：
2.5
作者：
Hayano, Junichiro;Tsukahara, Teruomi;Watanabe, Eiichi;Sasaki, Fumihiko;Kawai, Kiyohiro;Sakakibara, Hiroki;Kodama, Itsuo;Nomiyama, Tetsuo;Fujimoto, Keisaku
通讯作者：
Fujimoto, Keisaku
DOI：
10.2215/cjn.09430911
发表时间：
2012-09-01
影响因子：
9.8
作者：
Suzuki, Mari;Hiroshi, Takahashi;Hayano, Junichiro
通讯作者：
Hayano, Junichiro
影响因子：
37.8
作者：
Carney, RM;Blumenthal, JA;Freedland, KE
通讯作者：
Freedland, KE
影响因子：
5.6
作者：
Guggisberg, Adrian G.;Hess, Christian W.;Mathis, Johannes
通讯作者：
Mathis, Johannes