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ABSTRACT BACKGROUND: Coronary artery disease is an important cause of morbidity and mortality. The impact of ventricular arrhythmias with impaired cardiac vagal activity is one of the most recently studied prognostic factors. However, there are no studies evaluating the phenomenon of heart rate turbulence (HRT) during physical exertion. OBJECTIVE: To study the behavior of HRT during exercise testing, among individuals after myocardial infarction. DESIGN AND SETTING: Feasibility study conducted in a university hospital among individuals 4-6 weeks after myocardial infarction. METHODS: All subjects underwent 24-hour Holter monitoring and ergometric stress testing. We considered that abnormal HRT was present if the turbulence onset was ≥ 0% or turbulence slope was ≤ 2.5 mm/relative risk interval. RESULTS: All 32 subjects were asymptomatic. Their median age was 58 years (interquartile range 12.8) and 70% were male. Abnormal HRT was associated with ventricular dysfunction in this population. We found no differences regarding the behavior of HRT, in relation to age, gender, smoking, systemic arterial hypertension, diabetes mellitus or dyslipidemia. Ergometric stress testing detected premature ventricular beats (PVB) in approximately 44% of the examinations, and these occurred both during the active phase of effort and in the recovery period. The low occurrence of several isolated PVB in beta-blocked subjects made it difficult to perform statistical analysis to correlate HRT between ergometric and Holter testing. CONCLUSION: The data obtained in this study do not support performing HRT through ergometric stress testing among patients who remain on beta-blockers post-myocardial infarction, for the purpose of assessing cardiac vagal activity.
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Objective To explore the relationship between heart rate variability (HRV),heart rate turbulence (HRT) and blood pressure (BP) control in hypertensive patients.Methods Hypertensive patients with controlled BP group (n =50) and uncontrolled BP group (n =40) and control group non-hypertensive patients (n =52)were enrolled in this study in our hospital during June 2015 to June 2016.HRV and HRT as well as clinical characteristic of the three groups were analyzed.Results (1) Body mass index was significantly higher in the controlled BP group than in the control group.There was no statistical difference in proportions and categories of antihypertensive medication between the uncontrolled and controlled BP groups (P ＞ 0.05).(2) VLF,LF and TS were significantly lower in the uncontrolled BP group than the control group,and HF was significantly lower in the uncontrolled BP group than in the controlled BP group (P ＜ 0.05).(3) Results of muhiple logistic regression analysis showed that lower rMSSD,pNN50,VLF,LF,HF and TS were risk factors for BP control after adjusting for gender,age,EF value,creatinine,blood lipids,Beta-blockers and history of smoking,coronary heart disease and diabetes mellitus.(4) Spearman correlation analysis of the hypertensive patients showed that LF was negatively correlated with TO,and SDNN,SDANN,rMSSD,pNN50,VLF,LF,HF were positively correlated with TS.Conclusion The present results demonstrate that uncontrolled BP is associated with abnormal HRV and HRT,which suggested autonomous nervous imbalance was existed in uncontrolled hypertensive patients.
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@#Objective To evaluate the effects of trimetazidine on cardiac function and autonomic function in patients with coronary heart disease and chronic heart failure. Methods 73 patients with coronary heart disease and chronic heart failure were randomly divided into control group (conventional therapy, n=35) and trimetazidine group (conventional therapy plus oral trimetazidine, n=38). All the patients underwent echocardiography for left ventricular ejection fraction (LVEF) and left ventricular end-diastolic diameter (LVd), and 24-hour Holter electrocardiogram for heart rate turbulence (HRT) indexes, turbulence onset (TO) and turbulence slope (TS) were calculated before and 3 months after treatment. Results 3 months after treatment, LVEF increased, and LVd shrank in both groups (P<0.01). LVEF improved better in the trimetazidine group than in the control group (P<0.001). TO decreased and TS increased in the trimetazidine group (P<0.05). Only TO decreased in the trimetazidine group (P<0.05). TO and TS improved better in the trimetazidine group than in the control group (P<0.05). Conclusion Trimetazidine could improve cardiac function and autonomic function in patients with coronary heart disease and chronic heart failure.
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Objective To explore the clinical value of Holter heart rate turbulence in diagnosis of patients at high risk for coronary heart disease.Methods 110 patients with suspected coronary artery disease,according to the results of coronary angiography (CAG),were divided into CAG positive group (67 cases) and CAG negative group (43 cases).Heart rate turbulence and heart rate variability were analyzed in two groups.The atrial fibrillation,atrial flutter,and pseudo-differential interference were removed,the qualified ventricular contraction was selected.Two parameters of HRT,the initial shock value (TO) and turbulence slope value (TS) were calculated.Results The average value of TO and TS was (0.36 ± 0.15) ％,(1.98 ± 0.52) ms/RR in positive group,those in the negative group were (-0.87 ± 0.36) ％ and (4.83 ± 0.65) ms/RR,there were statistically significant differences between two groups (t =1.953,1.976,all P ＜ 0.05).After 1 year follow-up,9 cases (13.44％) died in positive group,2 cases (4.65％) died in negative group,the difference was statistically significant (x2 =5.476,P ＜ 0.05).Conclusion The heart rate turbulence with dynamic cardiogram can help to early diagnose the patients at high risk of coronary heart disease.It was important to improve the survival rate of patients.The method is simple,inexpensive,effective,which is worth promoting in the clinic.
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Objective To analyze the influential factors of healthy children′s heart rate turbulence (HRT). Methods One hundred and six healthy children with ventricular premature beat (VPB) were selected in this study and the correlation among HTR parameters as turbulence onset (TO) and turbulence lope (TS) and age, gender, basic heart rate, the number of VPBs were analyzed. Results It was observed that among three age groups, TO decreased with the age, and the difference was statistically significant (P 0.05). TS increased with the age, and intergroup difference was statistically significant (P 0.05). TO and TS decreased with the decline of heart rate (r = 0.494, P < 0.00; r = -0.569,P < 0.00 respectively), and the correlation between TO and HR, TS and HR was found.The number of VPBs had no significant correlation with TO or TS (r = 0.104,P = 0.290; r = 0.122,P =0.212). Conclusions The results demonstrate that influenced by age and basic heart rate, healthy children′s HRT increases with the age and the decline of heart rate. Therefore, the reference index of children′s HRT should differ from that of adults, which requires further evaluation.
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Objective To study the changes and clinical significance of heart rate turbulence(HRT)in patients with diabetic cardiomyopathy.Methods 24h Holter ECG recordings were examined in 33 patients with diabetic cardiomyopathy(DC)and 30 patients in the control group.Turbulence onset(TO)and turbulence slope (TS)were calculated from Holter recordings.The mean value of TO,TS between the two groups were compared,the relativity among TO,TS,SDNN and LEVDD were analyzed as well.Results TO was significantly higher in the DC group compared with the control group[(-0.38 ± 0.12)％ vs(-1.88 ± 0.13)％,t =7.38,P =0.01)].TS in the DC group was significantly lower than that in the control group[(2.02 ± 0.82)ms/R-R vs (9.72 ± 1.18)ms/R-R,t =18.69,P =0.02)].TO was significantly related to SDNN(r =-0.35,P =0.02)and LEVDD(r =0.68,P =0.01),TS was also significantly related to SDNN(r =0.45,P =0.01)and LEVDD (r =-0.39,P =0.03).Conclusion The manifest of heart rate turbulence is significantly impaired in patients with diabetic cardiomyopathy.
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Objective To investigate the clinical effects and significance of different-dose atorvastatin on soluble CD105(sCD105),high sensitive-C reactive protein(hs-CRP)and the parameters of heart rate turbulence in patients with acute coronary syndrome(ACS). Methods One hundred and six ACS patients were divided into three groups by random digits table: control group(30 patients, routine treatment),treatment group Ⅰ(38 patients, routine treatment + atorvastatin 20 mg), and treatment group Ⅱ(38patients, routine treatment + atorvastatin 40 mg). All patients were treated for 4 weeks. The levels of serum sCD105,hs-CRP,and the parameters of heart rate turbulence before and after treatment. Results Before treatment, the levels of turbulence onset(TO), turbulence slope(TS),sCD105 and hs-CRP in three groups had no significant difference(P ＞ 0.05). After treatment, TO,sCD105 and hs-CRP decreased significantly,and TS increased significantly(P＜ 0.05 or ＜ 0.01). The change amplitude of treatment group Ⅱ was the most obvious, and the levels of above mentioned index showed significantly difference compared with that of treatment group Ⅰ[TO:(0.22 ±0.18)% vs.(0.66 ± 0.23)%;TS:(6.22 ±0.83)ms/RR interval(RRI)vs.(3.90 ±0.73)ms/RRI;sCD105:(1.65 ±0.43)mg/L vs.(2.92 ±0.50)mg/L;hs-CRP:(1.68 ±0.55)mg/L vs.(2.08±0.61)mg/L](P ＜0.01). Correlation analysis showed the levels of sCD105 and hs-CRP had significantly positive correlation with TO(P ＜ 0.01)and had negative correlation with TS(P ＜ 0.01).Conclusions The atorvastatin treatment in patients with ACS may stabilize coronary vascular endothelial cells and atherosclerotic plaque, and improve autonomic nerve function. Larger doses of atorvastatin may get more benefit.
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Objective To explore sinus heart rate turbulence (HRT) in patients with different subtypes of essential hypertension (EH), and analyze the relationship between HRT and autonomic nervous system function damage in these patients. Methods The study consisted of 107 patients with EH (EH group) and 46 controls (control group). Based on 24 hours dynamic electrocardiogram, all patients were divided into dipper,non-dipper,and anti-dipper blood pressure group. The indexes about HRT and heart rate variability (HRV) among these groups were calculated and compared,and the relationship between turbulence onset (TO),turbulence slope (TS) and 24 hours mean systolic blood pressure,diastolic blood pressure was analyzed. Results There were significant differences in TO,TS,SDNN between EH group and control group(P ＜ 0.05 ). TO in non-dipper and anti-dipper blood pressure group was significantly higher than that in control group( P ＜ 0.05 ), and TS was lower than that in control group(P ＜ 0.05 ). There was no significant difference in TO,TS between dipper blood pressure group and control group (P ＞ 0.05). TO in non-dipper and anti-dipper blood pressure group was significantly higher than that in dipper blood pressure group, but TS was lower than that in dipper blood pressure group (P ＜0.05). Correlation analysis showed that TO had positive relationship with average heart rate and age (rs = 0.265, P = 0.004;rs = 0.217, P = 0.018 ), but had negative correlation with SDNN and left ventricular ejection fraction (LVEF) (rx = -0.287,P = 0.002;rx =-0. 179, P = 0.049). Whereas, TS had negative correlation with average heart rate and age (r = -0.335, P =0.015 ;r = -0.238,P= 0.009), but had positive relationship with SDNN and LVEF(r = 0.540,P = 0.001 ;r =0.432,P = 0.001 ). Conclusions HRT of EH patients becomes significantly low. It suggests that the autonomic nerve function in EH patients be injured seriously.
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Objective To explore the clinical utility of the sinus rhythm turbulence in the patients with acute myocardial infarction (AMI). Methods All day the dynamic electrocardiogram was monitored in 36 patients with AMI (AMI group) and 60 healthy subjects with ventricular premature beat (VPB) (control group),the TO value and TS value after VPB was compared between two groups. Results The TO value after VPB in AMI group was higher than that in control group (P＜0.01), the TS value after VPB in AMI group was lower than that in control group (P ＜ 0.01). The TO value in the non-survivors with AMI was higher than that in the survivors,while their TS value was lower with a significant difference (P＜ 0.01). The irregular positive rate of the TO value and the TS value in the patients with AMI was 58.1%(50/86) and 67.4%(58/86), while that of the healthysubjects was 16.7%(10/60) and 10.0%(6/60) with a significant difference (P ＜ 0.05). The research from the follow-up visit of the selected patients in 2 years showed that death rate of the patients with both irregular TO and TS was 46.2% (24/52), the death rate with either irregular TO or TS was 25.0%(7/28), the death rate with both regular TO and TS was 16.7%(1/6), and the difference of the three phenomenon was significant (P ＜ 0.01). Conclusion As long as the sinus rhythm turbulence of the patients with AMI disappears or declines,the death rate increases, and to monitor and analyze their TO and TS in time is helpful for us to avoid the sudden death of the patients and to discover the levels of their risks.
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Objective To explore the clinical significance of heart rate turbulence (HRT) in patients with chronic heart failure(CHF).Methods Thirty CHF patients(CHF group) and 28 non-organic heart disease persons (control group) were examined by 24 hours dynamic electrocardiogram (DCG).According to the NYHA grading of the cardiac function,CHF group were divided into low-degree heart failure (LdHF) sub-group (NYHA Ⅰ -Ⅱ,16 cases) and high-degree heart failure (HdHF) sub-group (NYHA Ⅲ-Ⅳ,14 cases).In CHF group,ischemic heart disease (IHD) patients were 18 cases and non-ischemic heart disease (NIHD) patients were 12 cases.Two indexes of HRT including turbulence onset (TO) and turbulence slope (TS) were measured and analyzed.Results The TO value in CHF group [(0.43 ±0.83)%] was significantly higher than that in control group [( - 1.49 ± 1.00)%] (P ＜0.05),and the TS value in CHF group[( 2.67 ± 0.66) ms/RRI] was significantly lower than that in control group [( 8.52 ± 2.09)ms/RRI] (P ＜0.05).The TO value in the HdHF sub-group [(0.79 ± 0.67)%] was significantly higher than that in LdHF sub-group[(0.12 ± 0.86)%] (P = 0.026),and the TS value in the HdHF sub-group [(2.88 ±0.79) ms/RRI] was significantly higher than that in LdHF sub-group [(2.40 ± 0.35) ms/RRI] (P= 0.045).The TO and TS values had no significant difference between the IHD and the NIHD patients (P＞0.05).In CHF group,53.3%(16/30) patients' TO and TS values were both abnormal (TO ≥ 0,TS ≤ 2.5 ms/RRI),and 40.0% (12/30) patients had only TO or TS value abnormal,93.3% (28/30) patients had abnormal HRT.Conclusion The phenomenon of HRT in the patients with CHF obviously decrease,and the HRT can be used to evaluate the severity of heart failure and predict the prognosis of the heart failure.
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Objective To evaluate the association between parameters of heart rate turbulence (HRT) and the severity of the coronary arteries disease. Methods 60 patients with unstable angina pectoris (UAP) who under-went angiographic examination and 40 healthy controls were chosen. HRT including turbulence onset (TO), turbu-lence slope (TS) and turbulence dynamicity (TD) were determined by 24 h ambulatory electrocardiogram(Hoher) in all the patients. The value of above indices were compared between UAP group and control group,and between subgroups of UAP. The correlation of HRT with the severity of coronary arteries diseases was analyzed. Results The levels of TO and TD in patients with UAP were significantly higher than those in controls [(1.18±0.88) % vs lower TS (P<0.05) and higher TD (P<0.05 ) than those in patients with coronary single vessel lesion. The same -0.296, P<0.05 ) and coronary artery stenosis score (r=-0.372, P<0.05 ) ; TD was positively correlated with number of abnormal coronary artery (r=0.353, P<0.01 ) and coronary artery stenosis score (r=0.510, P < 0.05). Conclusion . HRT is impaired in patients with UAP,especially the changes of TS and TD is signflcant,and is correlated with the severity of coronary arteries disease. TD is not influenced by premature ventricualr contractionheart rate so the combinatoin of TD and TS might be used as objective index in predicting the severity of the coronary arteries disease.
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Objective To investigate the relationship of blood pressure circadian rhythm with myocardial hypertrophy and the changes of autonomic nerve function in patients with essential hypertension (EH). Methods Eighty-two female patients with essential hypertension (EH) underwent 24-hours ambulatory blood pressure monitorings (ABPM), dynamic electrocardiogram (Holter) and echocardiography examination. Patients were classified into non-dipping group (n=40) and dipping group (n=42) according to the result of ABPM. Left ventricular mass index (LVMI), heart rate variability (HRV) in time domain (including SDNN, SDANN, rMSSD, PNN50) and heart rate turbulence (HRT) parameters (including turbulence onset [TO] and turbulence slope [TS]) were measured. Results Compared with those in dipping group, patients in non-dipping group have higher incidence of LVH (19.0% vs 52.5%, P<0.01), greater mean LVMI (112.39±12.79 g/m2 vs 121.98±13.35 g/m2, P<0.01), decreased PNN50 and rMSSD. TS value was decreased while TO was increased in non-dipping group compared with those in dipping group (both P <0.01); patients with LVH showed decreased TS and increased TO, compared with those without LVH. Conclusion In female patients with EH, non-dipping blood pressure circadian is associated with higher incidence of LVH. The HRV and HRT were more remarkably blunted in non-dipping patients, as well as those with LVH.
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Objective To discuss the significance and alteration of heart rate turbulence (HRT) of diabetics with ventricular premature beats of coronary heart disease (CHD). Methods 107 patients were chosen and divided into DM group(n=30), CHD group (n=32)and normal group(n=45).The turbulence onset(TO)and turbulence slope(TS) were calculated and analyzed. Results For the diabetics with ventricular premature beats, TO value was higher and TS value was lower than the normal group(all P<0.05).The value of TO and TS of the diabetics with ventricular premature beats were similar to those of CHD(P>0.05). Conclusions HRT can be used to estimate the integrality and stability of cardiac autonomic nerve function for the diabetics and it is an important factor for diagnosis.
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Objective To observe the changes of the heart rate turbulence(HRT)in patients with isolated systolic hypertension(ISH).Methods 85 patients with ISH,80 patients with common hypertension and 58 control subjects were investigated.Turbulence onset(TO)and turbulence slope(TS)were recorded of 24 hours dynamic electrocardiogram.Results The difference of HRT in the three groups was significant(P＜0.01).The values of TO and TS was significantly higher in common hypertension group and ISH group than in control group(P＜0.05);TS was significantly lower in ISH group than in common hypertension group(P＜0.05),but the difference of TO between ISH group with common hypertension group was not obvious.Conclusion The HRT in patients with primary hypertension is significantly lower,which is more significant in patients with ISH than in patients with common hypertension.It suggests that the cardiac autonomic nerves dysfunction perhaps has an important influence on development of hypertension and its prognosis.
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Objective To observe the correlation between heart rate turbulence (HRT) and heart rate variability in patients with essential hypertension.Methods 50 cases of essential hypertension were selected and 30 healthy subjects were taken as controls.Turbulence onset (TO) and turbulence slope (TS) were calculafed according to 24 h Holter results of the two groups.The correlation between TO,TS and SDNN of 24 h RR,every-5-min of 24 h RR and rMSDD of RR as well as the correlation between TO and TS Was studied.Results TO in essential hypertension group Was remarkably higher than in control group but TS Was lower.TO and TS were correlated with SDNN, SDANN and rMSDD (r=-0.587,r=0.679,r=0.423,r=0.513,r=0.336,r=0.417)(P<0.05 respectively). Conclusion Systolic HRT before ventricular period is weakened in patients with essential hypertension.TS can be an index in evaluating autonomic nerve function of primary hypertension.
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Heart rate turbulence (HRT) as novel predictor of sudden cardiac death were superior to all other presently available indicators. HRT significantly was improves after successful reperfusion reflecting rapid restoration of baroreceptor response. We investigated turbulence onset (TO) and turbulence slope (TS) values among patients with acute ST-elevation myocardial infarction (STEMI) underwent revascularization by means of primary PCI or fibrinolytic. We hypothesized that the values of TO and TS were different in two kinds of revascularization treatment. The subjects underwent 24 hours ECG recording after revascularization therapy. TO was quantified by the relative change of the first two sinus RR intervals following a ventricular premature beat (VPB) and the last two sinus RR intervals before the VPB. TS was quantified by the maximum positive slope of a regression line assessed over any sequence of five subsequent sinus rhythm RR intervals within the first two sinus rhythm intervals after a VPB. Thirteen patients (mean of age 56 ± 9 years old) who underwent revascularization treatment of acute STEMI were eligible as subject of this study.Ten patients underwent fibrinolytic therapy and three patients underwent primary PCI. TO value was significantly different between PCI group and fibrinolytic group (-3.3 ± 1.7 % vs -0.2 ± 0.9 % ; P=0.03). The Primary PCI group has better outcome on turbulence slope value (TS) than fibrinolytic group but not significance (7.7 ± 4.4 msec/RR interval vs 3.4 ± 2.6 msec/RR interval; P = 0.056). In conclusion, TO was better in acute STEMI patient undergone PCI compare to that undergone fibrinolytic therapy.
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Myocardial Infarction , Myocardial RevascularizationABSTRACT
Objective:To investigate the correlation between heart rate turbulence(HRT)and heart rate variability(HRV)indices,and the impact of mean R-R interval,?-blocker and other factors on HRV and HRT.Methods:76 postinfarction patients were recruited.24-hour,three-lead ambulatory electrocardiography was performed in all subjects for the analysis of HRV(including SDNN,PNN50,RMSSD,HF,LF)and HRT(including TO and TS).And the general clinical data of each case were collected.Results:TS was positively correlated with SDNN(r=0.559,P
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Objective To evaluate the clinical significance of sinus heart rate turbulence(HRT)and the heart rate variability(HRV)in the patients with essential hypertension(EH).Methods HRV and HRT examination were carried out in sixty patients with EH.A subgroup of patients receive metoprolol+nifedipine(n=26)or nife- dipine alone(n=34)were investigated seperately to evaluate the effect of ?-blocker on the HRV and HRT.Fifty healthy persons were served as control.In the HRT determination,turbulence onset(TO)was defined as sinus heart rate acceleration,after ventrieular mature beat while turbulence slope(TS)as sinus heart rate deceleration slope after ventricular premsture beat.Normal value of TO was2.5 ms/RR period. SDNN,RMSSD,LF/HF in HRV were analysed from 24 hours ambulatory electrocardiography(before and after 1 month medication).Results ① In hypertensive group,52 patients showed positive TO(86.6%),48 patients pos- itive TS(80.0%)and 46 patients TO+TS(76.7%),compared with hypertension group only 2(4%)positive TO and 3(6%)positive TS in the healthy control.Forty-two cases SDNN(70.0%),41 cases RMSSD(68.3%)and 38 cases LF/HF(63.3 %)were positive in hypertensive group,while only 1(2 %)SDNN,1(2 %)RMSSD and 3(6 %) LF/HF in control. ② Metoprolol didn't change the positive percentage of parameters in HRT but parameters showing Heart rate variablity in HRV was decreased significantly found between TO,TS and TO+TS.Conclusion HRT and HRV is two indices for determination the dysfunction of autonomic nervous system in hypertension.?-re ceptor blocker inhibit sympathic activity,miligate the decreasing of HRV,but the bipbase accelerative and decelera- tive phenomena of HRT didn't change,HRT seems to be a more sensitive index for monitoring of autonomic sysfunc tion in hypertension.
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Objective To investigate the change of heart rate turbulence in patients with chronic heart failure and relationship to age、LVEF、LVED、heart rate before ventricular premature complex (VPC)、coupling interval、compensatory interval、the number and origin of VPC.Methods HRT was measured in 30 CHF patients and 30 healthy controls.HRT onset and slope were measured by the original definitions using Holter records and compared with the clinical factors.Results The HRT TS was significantly lower in patients wtih heart failure than in control (3.17?2.03vs9.64?6.47,P
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Objective:To exam sinus heart rate turbulence in patients with essential hypertension(EH)and left ventricular hypertrophy (LVH),and to analyzeautonomic nervous system of the patients.Methods:The study group consisted of 89 patients with EH.Based on echocardiogram,the hypertensives were divided into those with left ventricular hypertrophy(LVH)(n=45)and those without LVH (n=44).The control group is normotensive participants(n=47).In each subject,24 hours dynamic electrocardiogramwas recorded,Turbulence Onset(TO)and Turbulence Slope(TS)were calculated and the difference was compared.Results:The difference in TO in three group was statistically significant(P