Correlation between heart rate variability and the severity of coronary artery disease evaluated by Syntax score in patients with primary hypertension
LI Ke1,2 LIU Jianxiong2 LIANG Wei2 LIN Lanlan2 YANG Shijian2 WANG Xin2
1.Graduate School, Zunyi Medical University, Guizhou Province, Zunyi 563003, China;
2.Department of Cardiology, Chengdu Second People′s Hospital Affiliated to Zunyi Medical University, Sichuan Province, Chengdu 610017, China
Abstract：Objective To investigate the relationship between severity of coronary artery disease and heart rate variability (HRV) in patients with primary hypertension. Methods From January 2016 to December 2017, 307 patients who were diagnosed as primary hypertension in Chengdu Second People′s Hospital Affiliated to Zunyi Medical University and underwent coronary angiography (CAG) were enrolled in this study. According to the principle of CAG diagnosis of coronary heart disease (CHD), the samples were divided into non-CHD group (121 cases) and CHD group (186 cases), the general clinical data, the biochemical indexes of serology and the 24 h dynamic electrocardiogram of the two groups were compared. Syntax score system was used to evaluate the severity of coronary artery disease, and the CHD group was divided into severe group (53 cases), moderate group (64 cases) and mild group (69 cases) according to the Syntax score. The differences on HRV of the three groups and the relationship between the severity of coronary artery disease and HRV was analyzed. Results The ratio of male, smoking, high cholesterol history, age and high density lipoprotein cholesterol levels of the non-CHD group were lower than those of the CHD group, the differences were statistically significant (P < 0.05). There were no statisticaly significant differences on body mass index, drinking alcohol, history of hyperuricemia, uric acid, total cholesterol, triglyceride and low density lipoprotein cholesterol between non-LDH group and LDH group (P > 0.05). Multivariate two element Logistic regression analysis showed that smoking, age and hyperlipidemia were related to CHD in patients with primary hypertension, the differences were statistically significant (P < 0.05). When comparing the HRV indexes [standard diviation of NN intervals (SDNN), standard deviation of the mean of all 5 minutes segments of normal RR intervals (SDANN), root mean square successive difference between adjacent normal RR intervals (rMSSD), percent of difference between adjacent normal RR intervals that was longer than or equal to 50 ms (PNN50) and low frequency (LF), high frequency (HF), LF/HF] in each group, the indexes of non-CHD group were significantly higher than those of the other groups (P < 0.05), the indexes of the mild group were significantly higher than those of the moderate group and severe group, and the indexes of the moderate group were significantly higher than those of the severe group, the differences were statistically significant (P < 0.05). The time domain and frequency domain indicators in HRV were negatively correlated with the severity of coronary artery disease in patients with CHD (SDNN: r = -0.52, P = 0.000; SDANN: r = -0.50, P = 0.007; rMSSD: r = -0.41, P = 0.018; PNN50: r = -0.45, P = 0.017; LF: r = -0.67, P = 0.009; HF: r = -0.58, P = 0.021). Conclusion Age, smoking and history of hyperlipidemia are the risk factors of CHD in hypertensive patients. The HRV is negatively correlated with severity of coronary artery disease. HRV index can be used to evaluate the severity of coronary artery disease in patients with hypertension.
李科1,2 刘剑雄2 梁伟2 林兰兰2 杨世建2 王馨2. 原发性高血压患者心率变异性与Syntax评分评价冠脉病变程度的关系[J]. 中国医药导报, 2018, 15(32): 58-62.
LI Ke1,2 LIU Jianxiong2 LIANG Wei2 LIN Lanlan2 YANG Shijian2 WANG Xin2. Correlation between heart rate variability and the severity of coronary artery disease evaluated by Syntax score in patients with primary hypertension. 中国医药导报, 2018, 15(32): 58-62.
[1] Yildiz BS，?魻zkan E，Esin F，et al. Evaluation of heart rate variability in patients with coronary artery ectasia and coronary artery disease [J]. Turk Kardiyol Dern Ars，2016， 44（4）：306-314.
[2] 王丽媛，韩雅君.SYNTA及SYNTAX Ⅱ评分的研究进展[J].内蒙古医学杂志，2015，47（3）：312-314.
[3] 刘力生.中国高血压防治指南2010[J].中国医学前沿杂志：电子版，2011，3（5）：42-93.
[4] 周玉杰，贾德安.批阅三载增删十次——《冠状动脉粥样硬化性心脏病诊断标准》诞生记[J].中国卫生标准管理，2010，1（4）：20-21.
[5] 陈尔冬，周菁.心率变异性的研究及应用进展[J].心血管病学进展，2014，35（4）：435-439.
[6] Ibanez B，Halvorsen S，Roffi M. Integrating the results of the CULPRIT-SHOCK trial in the 2017 ESC ST-elevation myocardial infarction guidelines: viewpoint of the task force [J]. Eur Heart J，2018. [Epub ahead of print]
[7] 段飞，胡镜清.基于主成分分析法对冠心病痰湿证理化指标的权重研究[J].世界中医药，2017，12（9）：1989-1992.
[8] Sianos G，Morel MA，Kappetein AP，et al. The SYNTAX Score：an angeographic tool grading the complexity of coronary artery disease [J]. Eurolntervention，2005，1（2）：219-227.
[9] Serruys PW，Morice MC，Kappetein AP，et al. Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease [J]. N Engl J Med，2009，360（10）：961-972.
[10] 张勇.NT-proBNP与冠心病患者冠状动脉病变程度的关系[J].中国当代医药，2016，23（10）：33-35.
[11] 刘向阳，唐良秋，李爱华.冠心病患者心率变异与氨基末端脑钠肽前体的相关性研究[J].现代医院，2017，17（2）：227-229.
[12] Grad C. Heart rate variability and heart rate recovery as prognostic factors [J]. Clujul Med，2015，88（3）：304-309.
[13] 曲桂一，张姝兰，李敬涛，等.血管迷走性晕厥者无症状期间自主神经功能状态研究[J].中国现代医生，2016， 54（26）：16-18，23.
[14] Muhadi，Nasution SA，Putranto R，et al. The Ability of Detecting Heart Rate Variability with the Photoplethysmography to Predict Major Adverse Cardiac Event in Acute Coronary Syndrome [J]. Acta Med Indones，2016，48（1）：48-53.
[15] Shved M，Tsuglevych L，Kyrychok I，et al. Cardioreabilitation peculiarities and correction of violations of sistolic，diasolic function and heart rate variability in patients with acute coronary syndrome and coronary artery revascularization [J]. Georgian Med News，2017（265）：46-53.
[16] 黄祖坚.心率变异性与慢性稳定性心绞痛分级的关系及β-受体阻滞剂的干预作用[J].中国当代医药，2018， 25（4）：50-53.
[17] Thayer JF，Yamamoto SS，Brosschot JF. The relationship of autonomic imbalance，heart rate variability and cardiovascular disease risk factors [J]. Int J Cardiol，2010， 141（2）：122-131.
[18] 雷莹，潘利飞，许红，等.BNP、HRV及LEVF水平变化在心衰并室性心律失常患者中的应用[J].中国现代医生，2016，54（11）：1-3，8.
[19] 洪必莹，何森，陈晓平.心率变异性研究进展[J].华西医学，2013，28（4）：614-618.
[20] 张丹.不同剂量阿托伐他汀治疗冠状动脉粥样硬化性心脏病效果对比[J].中国现代药物应用，2015，5（15）：177-178.
[21] 刘灿，海宝，张稳，等.骨内单次注射小剂量辛伐他汀对大鼠心梗后血管新生的影响[J].中国实验动物学报，2017， 25（5）：506-512.
[22] 叶健英，黄玉萍，杨瑞红，等.瑞舒伐他汀联合依那普利治疗原发性高血压合并冠心病的疗效观察[J].现代医院，2018，18（3）：408-410.
[23] 杨宁，王恒亮，司定然，等.自主神经功能与冠心病患者血管损害的相关性及影响因素分析[J].安徽医学，2017， 38（6）：754-756.
[24] 侯艳杰，李娜.心率变异性在冠心病患者和冠心病合并高血压患者中应用价值的比较[J].临床和实验医学杂志，2016，15（4）：325-327.
[25] 陈洪波，刘仁光.心率变异性分析临床应用研究近况[J].新医学，2010，41（6）：407-411.
[26] 高治宇.心率变异性与心血管疾病的研究进展[J].世界最新医学信息文摘，2016，16（50）：213.
[27] 陆艳，曹燕.心率变异性与急性冠脉综合征患者冠状动脉病变程度的相关性研究[J].实用心脑肺血管病杂志，2016，24（6）：16-18.
[28] Li R，Guo X，Zhai J. Analysis of the clinical factors that influence the heart rate variability [J]. J Clin Electrocardiol，2010，19（4）：272-273.
[29] Escaned J，Banning A，Farooq V，et al. Rationale and design of the SYNTAX Ⅱ trial evaluating the short to long-term outcomes of state-of-the-art percutaneous coronary revascularisation in patients with de novo threevessel disease [J]. Euro Intervention，2016，12（2）：e224-e234.
2018, Vol. 15 
京公网安备 11010502046598号