RR VARIABILITY IN HEALTHY, MIDDLE-AGED PERSONS COMPARED WITH PATIENTS WITH CHRONIC CORONARY HEART-DISEASE OR RECENT ACUTE MYOCARDIAL-INFARCTION
RR VARIABILITY IN HEALTHY, MIDDLE-AGED PERSONS COMPARED WITH PATIENTS WITH CHRONIC CORONARY HEART-DISEASE OR RECENT ACUTE MYOCARDIAL-INFARCTION
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DOI：
10.1161/01.cir.91.7.1936
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发表时间：
1995-04-01
期刊：
影响因子：
37.8
通讯作者：
STEIN, PK
中科院分区：
文献类型：
--
作者：
BIGGER, JT;FLEISS, JL;STEIN, PK
背景：本研究的目的是建立中年人RR变异性的正常值，并将其与心肌梗死后早期和晚期患者的正常值进行比较。我们假设有或没有冠心病、年龄和性别(按重要性顺序)都与RR变异性相关。方法和结果为了确定中年人RR变异性的正常值，我们招募了274名40至69岁的健康人作为样本。为了确定急性心肌梗死RR变异性的影响，我们比较了心肌梗死后2周的RR变异性测量(n=684)和年龄和性别匹配的没有心血管疾病病史的中年受试者(n=274)的测量结果。为了确定心肌梗死后RR变异性恢复的程度，我们将健康中年人的RR变异性测量结果与278例心肌梗塞后1年患者的测量结果进行比较。我们对连续24小时的心电记录进行功率谱分析，以量化总功率、超低频(ULF)功率、甚低频(VLF)功率、低频(LF)功率、高频(HF)功率以及低频/高频(LF/HF)功率的比率。还计算了时间域测量结果。慢性或亚急性冠状动脉疾病患者的RR变异性的所有测量指标均显著低于健康受试者。心肌梗死后2周与正常值的差异明显大于心肌梗死后1年，但三组总功率在其四个分量带中的分数分布相似。在健康受试者中，超低频功率随年龄增长变化不明显，VLF、LF和HF功率随年龄增长而显著降低。慢性冠心病患者的RR变异性功率谱指标与年龄关系不大。新发心肌梗死患者的VLF、LF、HF功率与年龄呈强负相关，ULF功率与年龄呈弱负相关。ULF POWER最好地将健康组与两个冠心病组中的任何一个区分开来。男性和女性之间RR变异性的差异很小，且三组之间不一致。结论健康人RR变异性的所有指标均显著高于慢性或亚急性冠心病组。健康中年人与冠心病组在心肌梗死后2周的差异明显大于梗死后1年的差异，但健康组和两组冠心病组的总功率在其四个分量带中的分数分布相似。先前报道的预测已知慢性冠心病患者死亡的RR变异性的值在健康的中年人中很少发现(接近1%)。因此，当使用RR变异性的测量来筛查中年人群体以识别有大量冠状动脉死亡或心律失常事件风险的个体时，对健康的中年人的错误分类应该是罕见的。
Background The purpose of this investigation was to establish normal values of RR variability for middle-aged persons and compare them with values found in patients early and late after myocardial infarction. We hypothesized that presence or absence of coronary heart disease, age, and sex (in this order of importance) are all correlated with RR variability.Methods and Results To determine normal values for RR variability in middle-aged persons, we recruited a sample of 274 healthy persons 40 to 69 years old. To determine the effect of acute myocardial infarction RR variability, we compared measurements of RR variability made 2 weeks after myocardial infarction (n=684) with measurements made on age- and sex-matched middle-aged subjects with no history of cardiovascular disease (n=274). To determine the extent of recovery of RR variability after myocardial infarction, we compared measurements of RR variability made in the group of healthy middle-aged persons with measurements made in 278 patients studied 1 year after myocardial infarction. We performed power spectral analyses on continuous 24-hour ECG recordings to quantify total power, ultralow-frequency (ULF) power, very-low-frequency (VLF) power, low-frequency (LF) power, high-frequency (HF) power, and the ratio of LF to HF (LF/HF) power. Time-domain measures also were calculated. All measures of RR variability were significantly and substantially lower in patients with chronic or subacute coronary heart disease than in healthy subjects. The difference from normal values was much greater 2 weeks after myocardial infarction than 1 year after infarction, but the fractional distribution of total power into its four component bands was similar for the three groups. In healthy subjects, ULF power did not change significantly with age; VLF, LF, and HF power decreased significantly as age increased. Patients with chronic coronary heart disease showed little relation between power spectral measures of RR variability and age. Patients with a recent myocardial infarction showed a strong inverse relation between VLF, LF, and HF power and age and a weak inverse relation between ULF power and age. ULF power best separates the healthy group from either of the two coronary heart disease groups. Differences in RR variability between men and women were small and inconsistent among the three groups.Conclusions All measures of RR variability were significantly and substantially higher in healthy subjects than in patients with chronic or subacute coronary heart disease. The difference between healthy middle-aged persons and these with coronary heart disease was much greater 2 weeks after myocardial infarction than 1 year after infarction, but the fractional distribution of total power into its four component bands was similar for the healthy group and the two coronary heart disease groups. Values of RR variability previously reported to predict death in patients with known chronic coronary heart disease are rarely (approximate to 1%) found in healthy middle-aged individuals. Thus, when measures of RR variability are used to screen groups of middle-aged persons to identify individuals who have substantial risk of coronary deaths or arrhythmic events, misclassification of healthy middle-aged persons should be rare.