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

1、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 Altered heart rate variability depend on the characteristics of coronary lesions in stable angina pectoris Introduction HRV, which means alteration of intervals among continuous sinoatrial node beats including R-R interval, is a noninvasive

2、, practical and reproducible test for detecting autonomic nervous system function 1,2,3,4 . It is believed that reduction of HRV reflects inability or attenuation of autonomic nerve system and alteration of sinoatrial nodes response. Moreover, reduced HRV may be related to worse cardiovascular disea

3、se 5 . Recently, researchers have frequently used time-domain parameters to assess the prognosis effect of HRV among patients suffering different kinds of cardiovascular disease including myocardial infarction, chronic heart failure, unstable angina and diabetes 6,7,8,9 . Other studies have shown th

4、at dysfunction of autonomic nerve system may be effective in development of atherosclerosis 10 , but this theory remains controversial, especially for among patients with stable angina 11 . Furthermore, it is uncertain that whether flexible to explore correlation between them with HRV or not 12, 13,

5、 14 . Currently, most studies assessing HRV among subjects with coronary atherosclerotic heart disease have less significance because of specific selection requirements. The significance of HRV among subjects excluded with stable angina and its prediction value in coronary obstruction has been unkno

6、wn yet 13 . In this article, we hypothesize correlation between damage of coronary artery and dysfunction of autonomic nervous system by HRV among subjects with stable angina. Methods and results Subjects Out of 322 subjects receiving selective CAG, 236 patients, hospitalized due to stable angina pe

7、ctoris because of a history (198 male patients and 38 female patients with the mean age of 59.89.5 years) in Cardiology Department of the affiliated He fei hospital of Anhui Medical University from December 2019 to March 2019 were enrolled in this study. Subjects were diagnosed and confirmed by CAG,

8、 including left anterior descending artery (LAD), left circumflex (LCX) and right coronary artery (RCA) affiliated with main coronary artery. According to Gensini score15, all subjects (single vessel diseased, 98; Bi-vessel diseased, 74; Tri-vessel diseased, 64) were divided into two groups: GS32（GS

9、1）and GS232 (GS2). Based on lesion （defined as 70% luminal diameter stenosis）, meanwhile, subjects were divided into three subgroups: RCAp-m, LADp-m and LCXp-m (p-m i.e proximal-middle). The control group (n=86, male 57 and female 29, the mean age 62.110.2 years) involved subjects with normal corona

10、ry artery by CAG. All subjects with other complications were excluded including valvular heart disease, severe liver and kidney dysfunction, diabetes, rheumatic diseases, hyperthyroidism, connective tissue disease, heart failure, atrial flutter actions and fibrillation and infection. Meanwhile，the c

11、ases of chronic obstructive lesions, left main lesions, old myocardial infarction, coronary artery bypass grafting or percutaneous coronary intervention, were excluded also. There was no statistical significance (P0.05) among items including gender, age, LVEF,history of hypertension between two grou

12、ps（Table 1）. Table 1 Key characteristics of subjects Method Data of dynamic electrocardiogram collection All subjects were familiarized with the research protocol and 48 hours before this study, unless necessary, had suspended any agents influencing heart rate. Finally, they were asked to stay in a

13、quiet room and have a rest for 15 minutes. Electrodes were connected and the results were analyzed by the same doctor. Data of 24-hour ambulatory ECG for all subjects were collected from 9:00 am to the same moment in the next day. Assessment of arrhythmia was conducted by a technician who was blind

14、to group distribution. HRV parameters value was analyzed by using the ECG-92C multichannel electrocardiograph (Shanghai Photoelectric Electronic Medical Instruments Co.Ltd). Time-domain analysis indicators are including SDNN, SDANN, SDNNindex, RMSSD and PNN50 by the beat-to-beat or N-N intervals. Ea

15、ch parameter was shown in the following form（table 2） Selected HRV Measures ( Time Domain Measures ) Parameter Unit Description SDNN ms SD of all normal R wave （N-N）intervals SDANN ms SD of all 5min average N-N intervals SDNN index ms Mean of the SDs for 5min segments RMSSD ms Square root of mean of

16、 the sum of squares of successive N-N interval difference. Reflects vagal modulation pNN50% Number of successive N-N intervals differing by 50ms divided by the total number of successive N-N intervals. Reflects vagal function Control groups n=86 Disease groupsn=236 t P Age(years) Male(%) Smoker(%) R

17、est SBP(mmHg) Rest DBP(mmHg) BMI(kg/m 2 ) LVEF(%) Total Cholesterol(mg/dl) HDL(mg/dl) LDL(mg/dl) Triglycerides(mg/dl) ACE inhibitors(%) ARBs(%) Statins(%) 62.110.2 67(77.9) 34(39.5) 12820 768 24.64.1 58.18.1 166.321.1 54.515.0 95.628.8 76.834.2 51(59.3) 9(10.4) 61(70.9) 59.89.5 198(83.9) 82(34.7) 13

18、222 749 23.73.5 56.47.6 171.623.5 52.916.3 92.528.2 70.735.5 122(53) 24(10) 190(80) 1.884 1.553 0.627 1.478 1.816 1.948 1.136 1.839 0.796 0.868 1.377 1.467 0.006 3.364 0.060 0.213 0.428 0.140 0.070 0.052 0.455 0.067 0.427 0.386 0.169 0.226 0.938 0.067 Angiographic assessment All subjects were cathet

19、erized percutaneously via femoral artery with standard Judkins technique, or right brachial artery with the Sones technique. The angiographic characteristics including lesions, stenosis percentage, and the index coronary angiogram of all coronary lesions was obtained by totally reviewing angiogram.

20、CAD was defined as 50% luminal diameter stenosis was found in at least one major epicardial coronary artery. The Gensini score system was used to estimate coronary diseased severity. The stenosis degree of the lumen in coronary arteries was classified as 1 for 1-25% stenosis, 2 for 26-50%, 4 for 51-

21、75%, 8 for 76-90%, 16 for 91-99%, and 32 for total occlusion. The scores were then multiplied by a factor representing the importance of the lesions in coronary artery system. Among location scores, 5-point was made for left main lesion; 2.5 for proximal left anterior descending (LAD) or left circum

22、flex (LCX) artery; 1.5 for mid segment LAD and LCX; 1 for distal segment of LAD and LCX, first diagonal branch, first obtuse marginal branch, right coronary artery, posterior descending artery, and intermediate artery; and 0.5 for second diagonal and second obtuse marginal branches. The classificati

23、on of lumen stenosis was determined based on consensus opinion of two experienced interventional cardiologists. Results Correlation between coronary artery diseased severity and the HRV indicators and the comparison about the time-domain indicators of HRV in three groups were shown in Table 3.In cor

24、onary artery diseased groups of GS1, the values of SDNN, SDNNind and RMSSD were significantly lower than that of control group (P0.05).In GS2, the values of SDNN, SDANN, SDNNind, RMSSD and PNN50 were significantly lower than that of control group (P0.05). Furthermore, compares with GS1, the values o

25、f SDNN in GS2 was also significantly lower (P0.05). The correlation between the numbers of coronary artery diseased and HRV indicators was shown in Table 4. Compared with control group, SDNN in single-vessel, SDNN, SDANN in bi-vessel diseased and in tri-vessel diseased were lower significantly (P0.0

26、1), and compared with bi-vessel diseased, SDNN, SDANN were lower significantly in tri-vessel diseased (P0.01).SDNN in bi-vessel diseased was lower significantly (P0.05), but SDANN no difference. The correlation between coronary artery lesions and HRV indicators was show in Table 5 .Compared with rig

27、ht-coronary artery diseased, SDNN and SDANN in left-coronary artery diseased group were lower significantly (P0.05), while compared with lesions in left circumflex, SDNN in left anterior descending artery was lower significantly (P0.01). Table 3 Correlation between coronary artery diseased severity

28、and the HRV indicators in three groups (unit = ms) Note： a was significant compared with control group, b was significant compared with GS132 Table 4 Correlation between the numbers of coronary artery diseased and the HRV indicators(unit = ms) Note： a was significant compared with control group, b w

29、as significant compared with si-vessel diseased, c was significant compared with bi-vessel diseased Table5 The correlation between coronary artery lesions and HRV indicators (unit = ms) Note： a was significant compared with control group, b was significant compared with Variable Controls（n=86） GS132

30、（n=136） GS232（n=100） P SDNN 121.917.6 112.325.1a 101.521.4 ab 0.002 SDANN 104.824.3 102.421.2 97.120.3 a 0.045 SDNNind 50.524.4 43.018.3a 40.119.2 a 0.002 RMSSD 35.917.3 30.620.8a 27.716.2 a 0.010 PNN50(%) 8.13.5 7.63.3 6.65.2 a 0.034 Variable Controls （n=86） Si-vessel diseased（n=98） Bi-vessel disea

31、sed（n=74） Tri-vessel diseased（n=64） P SDNN 121.917.6 112.622.2 a 101.125.0 ab 89.120.7 abc 0.001 SDANN 104.824.3 97.831.4 95.626.2 82.128.0 abc 0.001 SDNNind 50.524.4 45.322.6 43.824.2 40.422.0 0.063 RMSSD 35.917.3 31.421.0 32.526.1 29.719.3 0.306 PNN50(%) 8.13.5 8.24.1 7.34.2 6.84.0 0.091 Variable

32、Controls （n=86） RCAp-m （n=46） LCXp-m （n=72） LADp-m （n=44） P GS 29.413.2 30.618.2 35.615.8 0.155 SDNN 121.917.6 116.527.0 114.929.4 103.826.8 abc 0.007 SDANN 104.824.3 101.319.7 97.320.1 90.123.0 ab 0.004 SDNNind 50.524.4 40.724.2 44.222.0 40.525.2 0.055 RMSSD 35.917.3 30.218.5 29.516.7 30.017.7 0.08

33、0 PNN50(%) 8.13.5 7.75.3 7.24.2 6.43.4 0.139 RCAp-m, c was significant compared with LCXp-m Statistical analysis Key characteristics and clinical parameters were shown (as mean SEM), and independent samples t-test used to determine difference between the coronary artery diseased groups and control groups. Correlations between coronary artery diseased severity and the HRV indexes were assessed