A phenomenon of heart-rate turbulence, its evaluation, and prognostic value.
A phenomenon of heart-rate turbulence, its evaluation, and prognostic value.
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DOI：
10.1023/a:1016333109829
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发表时间：
2002-09-01
期刊：
影响因子：
--
通讯作者：
Schmidt, Georg
中科院分区：
文献类型：
--
作者：
Guzik, Przemyslaw;Schmidt, Georg
识别高危心脏病患者对于分层策略和预防心血管事件（包括死亡）至关重要。在健康受试者和低风险的缺血性心脏病和/或心力衰竭患者中，单室早搏可引起心脏周期持续时间的振荡（周期间隔缩短后又延长）。这种现象被称为心率波动（HRT）。回顾性和前瞻性研究表明，缺乏激素替代疗法与心脏病患者随后死亡的风险增加有关。HRT可以通过两个变量来量化：湍流发作（TO），描述早期加速阶段，湍流斜率（TS），描述室性早搏后心率的后期减速阶段。TO和TS都是相互独立的，也不依赖于其他传统的风险预测指标。TO和TS联合使用似乎是最强的基于霍尔特的风险预测因子，并且对左室射血分数、心率变异性、平均日心率和气压反射敏感性具有一定的成瘾预测价值。此外，激素替代疗法对接受受体阻滞剂和胺碘酮治疗的患者具有预测价值。此外，HRT被认为是由气压反射介导的，因此可以作为其敏感性和自主神经系统功能的非侵入性测量。在伴有自主神经功能障碍的糖尿病患者和阿托品阻断迷走神经活动的患者中可以观察到HRT的钝化。此外，HRT的昼夜变化似乎是存在的，因为它在睡眠中表达得更好。然而，HRT的使用仅限于有优势窦性心律和单心室搏动的患者。然而，HRT的评估是一种廉价和简单的方法，可以通过常规的24小时动态心电图记录来进行。
Identification of high-risk cardiac patients is crucial for stratification strategies and prevention of cardiovascular events, including death. Single ventricular premature beat triggers some oscillations in cardiac cycle duration (the shortening followed by the lengthening of the cycle intervals) in healthy subjects and low-risk patients with ischaemic heart disease and/or heart failure. This phenomenon is called heart-rate turbulence (HRT). It was shown in retrospective and prospective studies that the absence of HRT is associated with increased risk of subsequent mortality in cardiac patients. HRT can be quantified by two variables: turbulence onset (TO), describing an early acceleration phase, and turbulence slope (TS), describing a late deceleration phase of heart rate after ventricular premature beat. Both TO and TS are independent one from another and from other conventional risk predictors. The combination of TO and TS seems to be the strongest Holter-based risk predictor and has some addictive predictive value to left ventricular ejection fraction, heart rate variability, and the averaged diurnal heart rate and baroreflex sensitivity. In addition, HRT has a predictive value in patients treated with beta-blockers and amiodarone. Moreover, it is thought that HRT is mediated by baroreflex and therefore can be used as a non-invasive measure of its sensitivity and autonomic nervous system function. Blunted HRT can be observed in diabetic patients with autonomic dysfunction and in patients with atropine-blocked vagal nerve activity. Moreover, it seems that a diurnal variation of HRT exists because it is better expressed during sleep. However, the use of HRT is limited to patients with dominant sinus rhythm and the presence of single ventricular beat. Nevertheless, the assessment of HRT is an inexpensive and simple method and can be performed with a routine ambulatory 24-hour ECG recording.