ASSESSMENT OF CARDIOVASCULAR AUTONOMIC FUNCTION - AGE-RELATED NORMAL RANGES AND REPRODUCIBILITY OF SPECTRAL-ANALYSIS, VECTOR ANALYSIS, AND STANDARD-TESTS OF HEART-RATE VARIATION AND BLOOD-PRESSURE RESPONSES
ASSESSMENT OF CARDIOVASCULAR AUTONOMIC FUNCTION - AGE-RELATED NORMAL RANGES AND REPRODUCIBILITY OF SPECTRAL-ANALYSIS, VECTOR ANALYSIS, AND STANDARD-TESTS OF HEART-RATE VARIATION AND BLOOD-PRESSURE RESPONSES
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DOI：
10.1111/j.1464-5491.1992.tb01754.x
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发表时间：
1992-03-01
影响因子：
3.5
通讯作者：
GRIES, FA
中科院分区：
文献类型：
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作者：
ZIEGLER, D;LAUX, G;GRIES, FA
为了建立评价自主神经功能障碍的正常范围，利用计算机技术对120名15-67岁的健康受试者进行了一系列心血管反射试验。心率变异(HRV)测试包括8项指标：安静时的变异系数(CV)、均方根连续差(RMSSD)、仰卧位和立位HRV的低频、中频和高频频谱分析，深呼吸时的5项指标：CV(B)、RMSSD(B)、呼气-吸气(E-I)差、E/I比、向量分析的平均圆形结果、Valsalva比和max/min 30：15。此外，还测定了站立反应时的收缩压和舒张压的变化，以及持续握手时的舒张压反应。除血压测试外，所有测量结果均随年龄增长而显著下降(r=-0.16至-0.59；p<；0.05)。此外，RMSSD、RMSSD(B)和E-I差值随着心率的增加而显著减小(r=-0.37to-0.52p<；0.001)。站立反应的最长R-R间期和最短R-R间期分别分布在21-39次和6-24次内。所有测试都与性别无关。除E/I、Valsalva和最大/最小30：15比值外，所有HRV试验的正常下限与年龄相关，均为2.3百分位数。这些测试的结果必须使用log(y-1)变换进行分析。对20名健康受试者和21名糖尿病患者连续两天的个体内可重复性测定表明，两组之间的测试结果的日变化没有显著差异，Valsalva比率最高。我们的结论是：(1)HRV的所有频谱和向量分析指标都是年龄相关的，并且具有独立于心率的优势；(2)RMSSD、E-I差值和以前使用的30：15比率不适合用于糖尿病自主神经功能障碍的评估；(3)需要LOG(y-1)变换来确定这三个比率随年龄变化的正常范围和重复性。
To establish normal ranges for assessment of autonomic dysfunction, a battery of cardiovascular reflex tests was performed in 120 healthy subjects aged 15-67 years using a computer-based technique. Tests of heart rate variation (HRV) included 8 measures at rest: coefficient of variation (CV), root mean squared successive difference (RMSSD), spectral analysis of HRV in the low frequency, mid frequency, and high frequency bands in the supine and standing postures; 5 measures during deep breathing: CV(b), RMSSD(b), Expiration-Inspiration (E-I) difference, E/I ratio, and mean circular resultant of vector analysis; Valsalva ratio, and max/min 30:15 ratio. In addition, the change in systolic and diastolic blood pressure in response to standing and the diastolic blood pressure response to sustained handgrip were determined. The results of all measures, the blood pressure tests excepted, declined significantly with increasing age (r = -0.16 to -0.59; p < 0.05). Moreover, RMSSD, RMSSD(b), and E-I difference decreased considerably with increasing heart rate (r = -0.37 to -0.52; p < 0.001). The longest and shortest R-R intervals in response to standing were distributed within beats 21-39 and 6-24, respectively. All tests were independent of sex. Log transformation was used to define the age-related lower limits of normal at the 2.3 centile for all tests of HRV, except for the E/I, Valsalva, and max/min 30:15 ratios. The results of these tests had to be analysed using a log(y - 1) transformation. The intra-individual reproducibility determined on two consecutive days in 20 healthy subjects and 21 diabetic patients indicated that there were no major differences between the two groups regarding the day-to-day variation of test results, which was highest for the Valsalva ratio. We conclude that: (1) all indices of spectral and vector analyses of HRV are age-dependent and have the advantage of being independent of heart rate; (2) RMSSD, E-I difference, and the 30:15 ratio as it was used previously are not suitable for evaluation of autonomic dysfunction in diabetes; (3) log(y - 1) transformation is required to determine age-dependent normal ranges and reproducibility for the three ratios.