冠状动脉病变程度和自主神经功能失平衡之间的关系尚未完全明确.docx

冠状动脉病变程度和自主神经功能失平衡之间的关系尚未完全明确.docx

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冠状动脉病变程度和自主神经功能失平衡之间的关系尚未完全明确

冠状动脉病变程度和自主神经功能失平衡之间的关系尚未完全明确

AlteredheartratevariabilitydependonthecharacteristicsofcoronarylesionsinstableanginapectorisIntroductionHRV,whichmeansalterationofintervalsamongcontinuoussinoatrialnodebeatsincludingR-Rinterval,isanoninvasive,practicalandreproducibletestfordetectingautonomicnervoussystemfunction1,2,3,4.ItisbelievedthatreductionofHRVreflectsinabilityorattenuationofautonomicnervesystemandalterationofsinoatrialnodesresponse.Moreover,reducedHRVmayberelatedtoworsecardiovasculardisease5.Recently,researchershavefrequentlyusedtime-domainparameterstoassesstheprognosiseffectofHRVamongpatientssufferingdifferentkindsofcardiovasculardiseaseincludingmyocardialinfarction,chronicheartfailure,unstableanginaanddiabetes6,7,8,9.Otherstudieshaveshownthatdysfunctionofautonomicnervesystemmaybeeffectiveindevelopmentofatherosclerosis10,butthistheoryremainscontroversial,especiallyforamongpatientswithstableangina11.Furthermore,itisuncertainthatwhetherflexibletoexplorecorrelationbetweenthemwithHRVornot12,13,14.Currently,moststudiesassessingHRVamongsubjectswithcoronaryatheroscleroticheartdiseasehavelesssignificancebecauseofspecificselectionrequirements.ThesignificanceofHRVamongsubjectsexcludedwithstableanginaanditspredictionvalueincoronaryobstructionhasbeenunknownyet13.Inthisarticle,wehypothesizecorrelationbetweendamageofcoronaryarteryanddysfunctionofautonomicnervoussystembyHRVamongsubjectswithstableangina.MethodsandresultsSubjectsOutof322subjectsreceivingselectiveCAG,236patients,hospitalizedduetostableanginapectorisbecauseofahistory（198malepatientsand38femalepatientswiththemeanageof59.89.5years）inCardiologyDepartmentoftheaffiliatedHefeihospitalofAnhuiMedicalUniversityfromDecember2019toMarch2019wereenrolledinthisstudy.SubjectswerediagnosedandconfirmedbyCAG,includingleftanteriordescendingartery（LAD）,leftcircumflex（LCX）andrightcoronaryartery（RCA）affiliatedwithmaincoronaryartery.AccordingtoGensiniscore15,allsubjects（singlevesseldiseased,98;Bi-vesseldiseased,74;Tri-vesseldiseased,64）weredividedintotwogroups:

GS32（GS1）andGS232（GS2）.Basedonlesion（definedas70%luminaldiameterstenosis）,meanwhile,subjectsweredividedintothreesubgroups:

RCAp-m,LADp-mandLCXp-m（p-mi.eproximal-middle）.Thecontrolgroup（n=86,male57andfemale29,themeanage62.110.2years）involvedsubjectswithnormalcoronaryarterybyCAG.Allsubjectswithothercomplicationswereexcludedincludingvalvularheartdisease,severeliverandkidneydysfunction,diabetes,rheumaticdiseases,hyperthyroidism,connectivetissuedisease,heartfailure,atrialflutteractionsandfibrillationandinfection.Meanwhile，thecasesofchronicobstructivelesions,leftmainlesions,oldmyocardialinfarction,coronaryarterybypassgraftingorpercutaneouscoronaryintervention,wereexcludedalso.Therewasnostatisticalsignificance（P0.05）amongitemsincludinggender,age,LVEF,historyofhypertensionbetweentwogroups（Table1）.Table1KeycharacteristicsofsubjectsMethodDataofdynamicelectrocardiogramcollectionAllsubjectswerefamiliarizedwiththeresearchprotocoland48hoursbeforethisstudy,unlessnecessary,hadsuspendedanyagentsinfluencingheartrate.Finally,theywereaskedtostayinaquietroomandhavearestfor15minutes.Electrodeswereconnectedandtheresultswereanalyzedbythesamedoctor.Dataof24-hourambulatoryECGforallsubjectswerecollectedfrom9:

00amtothesamemomentinthenextday.Assessmentofarrhythmiawasconductedbyatechnicianwhowasblindtogroupdistribution.HRVparametersvaluewasanalyzedbyusingtheECG-92Cmultichannelelectrocardiograph（ShanghaiPhotoelectricElectronicMedicalInstrumentsCo.Ltd）.Time-domainanalysisindicatorsareincludingSDNN,SDANN,SDNNindex,RMSSDandPNN50bythebeat-to-beatorN-Nintervals.Eachparameterwasshowninthefollowingform（table2）SelectedHRVMeasures（TimeDomainMeasures）ParameterUnitDescriptionSDNNmsSDofallnormalRwave（N-N）intervalsSDANNmsSDofall5minaverageN-NintervalsSDNNindexmsMeanoftheSDsfor5minsegmentsRMSSDmsSquarerootofmeanofthesumofsquaresofsuccessiveN-Nintervaldifference.ReflectsvagalmodulationpNN50%NumberofsuccessiveN-Nintervalsdifferingby50msdividedbythetotalnumberofsuccessiveN-Nintervals.ReflectsvagalfunctionControlgroupsn=86Diseasegroupsn=236tPAge（years）Male（%）Smoker（%）RestSBP（mmHg）RestDBP（mmHg）BMI（kg/m2）LVEF（%）TotalCholesterol（mg/dl）HDL（mg/dl）LDL（mg/dl）Triglycerides（mg/dl）ACEinhibitors（%）ARBs（%）Statins（%）62.110.267（77.9）34（39.5）1282076824.64.158.18.1166.321.154.515.095.628.876.834.251（59.3）9（10.4）61（70.9）59.89.5198（83.9）82（34.7）1322274923.73.556.47.6171.623.552.916.392.528.270.735.5122（53）24（10）190（80）1.8841.5530.6271.4781.8161.9481.1361.8390.7960.8681.3771.4670.0063.3640.0600.2130.4280.1400.0700.0520.4550.0670.4270.3860.1690.2260.9380.067AngiographicassessmentAllsubjectswerecatheterizedpercutaneouslyviafemoralarterywithstandardJudkinstechnique,orrightbrachialarterywiththeSonestechnique.Theangiographiccharacteristicsincludinglesions,stenosispercentage,andtheindexcoronaryangiogramofallcoronarylesionswasobtainedbytotallyreviewingangiogram.CADwasdefinedas50%luminaldiameterstenosiswasfoundinatleastonemajorepicardialcoronaryartery.TheGensiniscoresystemwasusedtoestimatecoronarydiseasedseverity.Thestenosisdegreeofthelumenincoronaryarterieswasclassifiedas1for1-25%stenosis,2for26-50%,4for51-75%,8for76-90%,16for91-99%,and32fortotalocclusion.Thescoreswerethenmultipliedbyafactorrepresentingtheimportanceofthelesionsincoronaryarterysystem.Amonglocationscores,5-pointwasmadeforleftmainlesion;2.5forproximalleftanteriordescending（LAD）orleftcircumflex（LCX）artery;1.5formidsegmentLADandLCX;1fordistalsegmentofLADandLCX,firstdiagonalbranch,firstobtusemarginalbranch,rightcoronaryartery,posteriordescendingartery,andintermediateartery;and0.5forseconddiagonalandsecondobtusemarginalbranches.Theclassificationoflumenstenosiswasdeterminedbasedonconsensusopinionoftwoexperiencedinterventionalcardiologists.ResultsCorrelationbetweencoronaryarterydiseasedseverityandtheHRVindicatorsandthecomparisonaboutthetime-domainindicatorsofHRVinthreegroupswereshowninTable3.IncoronaryarterydiseasedgroupsofGS1,thevaluesofSDNN,SDNNindandRMSSDweresignificantlylowerthanthatofcontrolgroup（P0.05）.InGS2,thevaluesofSDNN,SDANN,SDNNind,RMSSDandPNN50weresignificantlylowerthanthatofcontrolgroup（P0.05）.Furthermore,compareswithGS1,thevaluesofSDNNinGS2wasalsosignificantlylower（P0.05）.ThecorrelationbetweenthenumbersofcoronaryarterydiseasedandHRVindicatorswasshowninTable4.Comparedwithcontrolgroup,SDNNinsingle-vessel,SDNN,SDANNinbi-vesseldiseasedandintri-vesseldiseasedwerelowersignificantly（P0.01）,andcomparedwithbi-vesseldiseased,SDNN,SDANNwerelowersignificantlyintri-vesseldiseased（P0.01）.SDNNinbi-vesseldiseasedwaslowersignificantly（P0.05）,butSDANNnodifference.ThecorrelationbetweencoronaryarterylesionsandHRVindicatorswasshowinTable5.Comparedwithright-coronaryarterydiseased,SDNNandSDANNinleft-coronaryarterydiseasedgroupwerelowersignificantly（P0.05）,whilecomparedwithlesionsinleftcircumflex,SDNNinleftanteriordescendingarterywaslowersignificantly（P0.01）.Table3CorrelationbetweencoronaryarterydiseasedseverityandtheHRVindicatorsinthreegroups（unit=ms）Note：

awassignificantcomparedwithcontrolgroup,bwassignificantcomparedwithGS132Table4CorrelationbetweenthenumbersofcoronaryarterydiseasedandtheHRVindicators（unit=ms）Note：

awassignificantcomparedwithcontrolgroup,bwassignificantcomparedwithsi-vesseldiseased,cwassignificantcomparedwithbi-vesseldiseasedTable5ThecorrelationbetweencoronaryarterylesionsandHRVindicators（unit=ms）Note：

awassignificantcomparedwithcontrolgroup,bwassignificantcomparedwithVariableControls（n=86）GS132（n=136）GS232（n=100）PSDNN121.917.6112.325.1a101.521.4ab0.002SDANN104.824.3102.421.297.120.3a0.045SDNNind50.524.443.018.3a40.119.2a0.002RMSSD35.917.330.620.8a27.716.2a0.010PNN50（%）8.13.57.63.36.65.2a0.034VariableControls（n=86）Si-vesseldiseased（n=98）Bi-vesseldiseased（n=74）Tri-vesseldiseased（n=64）PSDNN121.917.6112.622.2a101.125.0ab89.120.7abc0.001SDANN104.824.397.831.495.626.282.128.0abc0.001SDNNind50.524.445.322.643.824.240.422.00.063RMSSD35.917.331.421.032.526.129.719.30.306PNN50（%）8.13.58.24.17.34.26.84.00.091VariableControls（n=86）RCAp-m（n=46）LCXp-m（n=72）LADp-m（n=44）PGS29.413.230.618.235.615.80.155SDNN121.917.6116.527.0114.929.4103.826.8abc0.007SDANN104.824.3101.319.797.320.190.123.0ab0.004SDNNind50.524.440.724.244.222.040.525.20.055RMSSD35.917.330.218.529.516.730.017.70.080PNN50（%）8.13.57.75.37.24.26.43.40.139RCAp-m,cwassignificantcomparedwithLCXp-mStatisticalanalysisKeycharacteristicsandclinicalparameterswereshown（asmeanSEM）,andindependentsamplest-testusedtodeterminedifferencebetweenthecoronaryarterydiseasedgroupsandcontrolgroups.CorrelationsbetweencoronaryarterydiseasedseverityandtheHRVindexeswereassessed