Relationship between heart rate variability and peak pressure difference of left ventricular outflow tract in patients with hypertrophic obstructive cardiomyopathy
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摘要: 目的 探讨肥厚型梗阻性心肌病(HOCM)患者的心脏自主神经作用，评估心率变异性(HRV)指标与超声心动图左室流出道峰值压差的关系。 方法 2020年1月—2024年12月，中国人民解放军北部战区总医院心血管外科收治的103例确诊为HOCM患者被纳入本研究，分为Ⅰ组(NYHA Ⅰ~Ⅱ)50例和Ⅱ组(NYHA Ⅲ~Ⅳ)53例。对照组103例为健康志愿者。获取二维超声心动图和彩色多普勒数据。所有入选者均接受连续7 d动态心电图监测。计算平均HRV的时域和频域因子数值：窦性RR间期标准差(SDNN)、相邻窦性RR间期差值的均方根(RMSSD)、相邻窦性RR间期差值>50 ms个数占总窦性RR间期个数的百分比(PNN50)、低频功率(LF)、高频功率(HF)、低频与高频的功率比(LF/HF)。 结果 Ⅰ组和Ⅱ组的SDNN、RMSSD、PNN50、LF、HF、LF/HF测量值均低于对照组。Ⅰ组和Ⅱ组在左室流出道峰值压差方面差异有统计学意义(P < 0.05)。 结论 HOCM患者HRV数值SDNN、RMSSD、PNN50、LF、HF、LF/HF降低。Abstract: Objective To explore the role of cardiac autonomic nervous system in patients with hypertrophic obstructive cardiomyopathy(HOCM) and evaluate the relationship between heart rate variability(HRV) indicators and peak pressure difference of left ventricular outflow tract in echocardiography. Methods From January 2020 to December 2024, 103 patients diagnosed as HOCM who were admitted to the Department of Cardiac Surgery of the Northern Theater General Hospital of the Chinese People's Liberation Army were included in this study. They were divided into 50 patients in group Ⅰ(NYHA Ⅰ-Ⅱ) and 53 patients in group Ⅱ(NYHA Ⅲ-Ⅳ). The control group consisted of 103 healthy volunteers. Two-dimensional echocardiography and color Doppler were detected. All selected individuals underwent continuous 7-day dynamic electrocardiogram monitoring. We calculated the values of time-domain and frequency-domain factor in HRV: standard deviation of sinus RR intervals(SDNN), root mean square of adjacent sinus RR interval differences(RMSSD), percentage of adjacent sinus RR interval differences>50 ms to the total number of sinus RR intervals(PNN50), low-frequency power(LF), high-frequency power(HF), and ratio of low-frequency power to high-frequency power(LF/HF). Results The measured values of SDNN, RMSSD, PNN50, LF, HF, and LF/HF in Group Ⅰ and Group Ⅱ were lower than those in the control group. There was a significant difference(P < 0.05) in the peak pressure of left ventricular outflow tract between Group Ⅰ and Group Ⅱ. Conclusion The SDNN, RMSSD, PNN50, LF, HF, and LF/HF in HOCM patients are reduced.
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表 1 3组超声资料的比较
Table 1. Comparison of ultrasound data
例(%), M(P25, P75) 项目 对照组(103例) Ⅰ组(50例) Ⅱ组(53例) F/Z P 年龄/岁 59(53，65) 57(48，66) 61(52，67) 2.582 0.078 男性 59(57.3) 27(54.0) 30(56.6) 0.074 0.929 左室流出道峰值压差/mmHg 59(54，73) 94(71，116) -5.340 < 0.01 IVS/mm 20(18，23) 21(18，24) -1.232 0.218 IVS/PW 1.50(1.33，1.72) 1.53(1.35，1.76) -0.809 0.419 LVEF/% 59(57，60) 59(57，60) -0.080 0.936 
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表 2 3组患者HRV相关指标的多重比较
Table 2. Multiple comparisons of HRV related indicators
M(P25, P75) 项目 对照组(103例) Ⅰ组(50例) Ⅱ组(53例) P SDNN/ms 102.1(79.2，115.3) 98.3(74.9，106.1) 78.6(56.7，102.7) A：0.014 B： < 0.01 C：0.030 RMSSD/ms 30.4(23.8，38.1) 27.7(21.1，35.3) 23.9(19.0，28.5) A：0.028 B： < 0.01 C：0.041 PNN50/% 9.1(5.2，15.1) 6.9(2.9，12.0) 5.1(2.7，7.5) A：0.018 B： < 0.01 C：0.017 LF/ms2 427.1(250.4，700.3) 221.9(157.5，424.2) 159.1(81.8，352.9) A：0.003 B： < 0.01 C：0.604 HF/ms2 276(156.8，458) 156.6(98.4，276.3) 154.5(73.4，231.0) A：0.002 B： < 0.01 C：0.615 LF/HF 164.1(94.6，191.6) 111.2(41.5，192.8) 88.9(47.6，157.5) A：0.522 B：0.525 C：0.269
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表 3 左室流出道峰值压差与HRV的相关系数
Table 3. Correlation coefficient between left ventricular outflow tract peak pressure difference and HRV
指标 左室流出道峰值压差(r值) P SDNN -0.091 0.045 RMSSD -0.145 0.021 PNN50% -0.250 0.011 LF -0.035 0.136 HF -0.031 0.143 LF/HF 0.013 0.407
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