Prognostic value of heart rate variability in patients with renal failure on hemodialysis
Prognostic value of heart rate variability in patients with renal failure on hemodialysis
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DOI：
10.1016/j.ijcard.2007.10.033
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发表时间：
2009-01-24
影响因子：
3.5
通讯作者：
Itoh, Haruki
中科院分区：
文献类型：
--
作者：
Oikawa, Keiko;Ishihara, Reiko;Itoh, Haruki
背景：在肾功能衰竭的血液透析患者中，心血管疾病是主要的死亡原因。有报道称，心率变异性(HRV)降低与心肌梗死后和/或心力衰竭患者预后不良有关。方法和结果：对383例慢性血液透析患者(男性220例，女性163例，平均年龄57+/-13岁，射血分数65+/-12%)进行24小时动态心电图HRV的时间域和频域分析。在2110+/-903天的随访中，146名患者死亡(31名充血性心力衰竭，13名致命性心肌梗死，13名猝死，26名中风，63名非心血管死亡)。Cox单变量分析确定以下因素是全因死亡和心血管死亡的预测因素：年龄、性别、射血分数、糖尿病的存在以及在时间和频率域中计算的HRV参数。在多变量分析中，所有正常RR间期的低标准差与全因死亡和心血管死亡密切相关(危险比[95%可信区间]分别为0.988[0.982-0.994]和0.984[0.974-0.993])。从Kaplan-Meier生存曲线来看，SDNN低的患者全因和心血管死亡的发生率要高得多(
Background: In patients with renal failure on hemodialysis cardiovascular disease is a major cause of death. It has been reported that diminished heart rate variability ( HRV) relates to the unfavorable prognosis in post-infarction and/or heart failure patients. However, the prognostic value of HRV in hemodialysis patients has not been fully established.Methods and results: Time- and frequency-domain analysis of HRV on 24-hour ambulatory electrocardiography recording was assessed prospectively in 383 chronic hemodialysis patients ( 220 men and 163 women, mean age 57 +/- 13 years, ejection fraction 65 +/- 12%). During 2110 +/- 903 days of follow up, 146 patients died ( 31 congestive heart failure, 13 fatal myocardial infarction, 13 sudden deaths, 26 stroke, and 63 non-cardiovascular deaths). A Cox univariate analysis identified the following factors as predictors of both all-cause and cardiovascular death: age, gender, ejection fraction, presence of diabetes, and HRV parameters calculated in the time- and frequency-domain. In multivariate analysis, a low standard deviation of all normal RR intervals ( SDNN) value was the strongly associated with both all-cause and cardiovascular death ( hazard ratios [ 95% confidence intervals] 0.988 [ 0.982-0.994] and 0.984 [ 0.974-0.993], respectively). From Kaplan-Meier survival curves, the incidence of all-cause and cardiovascular death was much greater in patients with a low SDNN (