Male Patients With Dilated Cardiomyopathy Exhibiting a Higher Heart Rate Acceleration Capacity or a Lower Deceleration Capacity Are at Higher Risk of Cardiac Death.

The effects of dilated cardiomyopathy (DCM) on cardiac autonomic regulation and electrophysiology, and the consequences of such changes, remain unclear. We evaluated the associations between heart rate acceleration capacity (AC) and deceleration capacity (DC), heart structural and functional changes, and cardiac death in 202 healthy controls and 100 DCM patients. The DC was lower and the AC was higher in DCM patients (both males and females). Multivariable, linear, logistic regression analyses revealed that in males, age was positively associated with AC in healthy controls (N = 85); the left atrial diameter (LAD) was positively and the left ventricular ejection fraction (LVEF) was negatively associated with AC in DCM patients (N = 65); age was negatively associated with DC in healthy controls (N = 85); and the LAD was negatively and the LVEF was positively associated with DC in DCM patients (N = 65). In females, only age was associated with either AC or DC in healthy controls (N = 117). Kaplan-Meier analysis revealed that male DCM patients with greater LADs (≥46.5 mm) (long-rank chi-squared value = 11.1, P = 0.001), an elevated AC (≥-4.75 ms) (log-rank chi-squared value = 6.8, P = 0.009), and a lower DC (≤4.72 ms) (log-rank chi-squared value = 9.1, P = 0.003) were at higher risk of cardiac death within 60 months of follow-up. In conclusion, in males, DCM significantly affected both the AC and DC; a higher AC or a lower DC increased the risk of cardiac death.

Correlation between the heart rate deceleration capacity and the scope of coronary artery lesions in patients with unstable angina pectoris / 中国综合临床

Objective To investigate the changes of heart rate deceleration capacity(DC)in patients with unstable angina pectoris(UAP)and its correlation with the scope and severity of coronary artery disease. Methods From September 2016 to January 2017,one hundred and nine patients with UAP and 52 with non-coronary artery disease were diagnosed in the department of cardiology in the Third Affiliated Hospital of Anhui Medical University. They were all measured with 24h dynamic electrocardiogram and the corresponding analysis software was used to analyze the results,and the difference in deceleration capacity between the two groups was compared. The severity and the number of coronary artery lesions were compared with different deceleration capacity in UAP patients. The relationship between deceleration capacity and the number of coronary artery stenosis, the scope and severity of coronary artery lesions were then analyzed. Results The deceleration capacity value of UAP group was significantly lower than that of the control group((5.10 ± 1.34)vs.(6.03 ±1.40),t=-3.775,P<0.01). The number of coronary artery lesions and Gensini score in group deceleration capacity>4.5 ms were smaller than those in group deceleration capacity ≤4.5 ms((1.67± 0.77)branches vs. (26.76±25.31)branches;(21.27±5.541)points vs.(42.69±8.61)points)(t= -3.910,-2.277,P<0.05). The deceleration capacity value was negatively correlated with the number of coronary artery stenosis(r=-0.206,P<0.01)and the Gensini score(r=-0.358, P<0.01)in patients with UAP. Conclusion Deceleration capacity decreased in patients with UAP and it was closely associated with the severity and the scope of coronary artery lesions.

[Analysis of influencing factors of heart rate deceleration capacity in patients with dilated cardiomyopathy].

Objective: To investigate the determinants affecting the heart rate deceleration capacity (DC) in patients with dilated cardiomyopathy (DCM). Methods: One hundred patients with DCM (DCM group) and 202 healthy subjects (control group) were respectively enrolled. Echocardiography and 24 hours electrocardiogram were performed in all subjects. DC value was compared between the two groups. Multiple regression analysis was made to evaluate the related determinants of DC ((age, sex, echocardiographic parameters including the left atrial diameter (LAD) and left ventricular ejection fraction (LVEF)). Results: (1) DC value was significantly lower in DCM group than in control group( (4.40±2.03) ms vs. (7.30±1.81) ms, P<0.01), prevalence of DC value≤4.5 ms was significantly higher in DCM group than in control group (62% vs. 6%, P<0.01). (2) DC value in the DCM group decreased in proportion to increasing LAD dimension, DC value was (5.60±2.04) ms, (4.50±2.07) ms and (3.60±1.62) ms (P<0.05) in DCM patients with LAD≤40 mm, 40 mm50 mm, respectively. (3) DC value in the DCM group was negatively related to the LAD (r=-0.366, P<0.01), positively related to the LVEF (r= 0.241, P<0.01), but not related with age and sex. Multiple factors regression analysis showed that increased LAD was related to the reduced DC values independtly. Conclusion: DC value of the patients in the DCM group is decreased, which indicate the decrease of the vagus nerve tension, and increased LAD is related to the reduced DC value independtly in DCM patients.

Analysis of influencing factors of heart rate deceleration capacity in patients with dilated cardiomyopathy / 中华心血管病杂志

Objective@#To investigate the determinants affecting the heart rate deceleration capacity (DC) in patients with dilated cardiomyopathy (DCM).@*Methods@#One hundred patients with DCM (DCM group) and 202 healthy subjects (control group) were respectively enrolled. Echocardiography and 24 hours electrocardiogram were performed in all subjects. DC value was compared between the two groups. Multiple regression analysis was made to evaluate the related determinants of DC ((age, sex, echocardiographic parameters including the left atrial diameter (LAD) and left ventricular ejection fraction (LVEF)).@*Results@#(1) DC value was significantly lower in DCM group than in control group( (4.40±2.03) ms vs. (7.30±1.81) ms, P<0.01), prevalence of DC value≤4.5 ms was significantly higher in DCM group than in control group (62% vs. 6%, P<0.01). (2) DC value in the DCM group decreased in proportion to increasing LAD dimension, DC value was (5.60±2.04) ms, (4.50±2.07) ms and (3.60±1.62) ms (P<0.05) in DCM patients with LAD≤40 mm, 40 mm<LAD≤50 mm and LAD>50 mm, respectively. (3) DC value in the DCM group was negatively related to the LAD (r=-0.366, P<0.01), positively related to the LVEF (r= 0.241, P<0.01), but not related with age and sex. Multiple factors regression analysis showed that increased LAD was related to the reduced DC values independtly.@*Conclusion@#DC value of the patients in the DCM group is decreased, which indicate the decrease of the vagus nerve tension, and increased LAD is related to the reduced DC value independtly in DCM patients.

Heart acceleration and deceleration capacities associated with dilated cardiomyopathy.

BACKGROUND: Heart rate deceleration capacity and acceleration capacity are novel autonomic nervous system indicators of cardiac neural regulation. Dilated cardiomyopathy (DCM) changes cardiac electrophysiology; however, how deceleration capacity and acceleration capacity associated with DCM remain unclear. MATERIALS AND METHODS: To evaluate the association between heart rate acceleration capacity, deceleration capacity and DCM, 66 DCM patients with DCM and 209 controls were enrolled in the study. Demographic data, echocardiographic data, heart rate variability, deceleration capacity and acceleration capacity were collected. The association pattern between DCM and these indexes were studied by multiple logistic regression analysis. RESULTS: Deceleration capacity and acceleration capacity were independent risk factors for DCM with an odds ratio (OR) and 95% confidence interval (CI), determined by multiple logistic regression analysis, of 7·97 (3·87-16·42) and 0·09 (0·05-0·19), respectively. Univariate ordinal logistic regression analysis showed that acceleration capacity, fastest heart rate, standard deviation of normal-to-normal RR intervals (SDNN) and left ventricular ejection fraction (LEVF) associated with heart failure grade. The OR for each covariate was further adjusted for the effects of other significant covariates in multivariate ordinal logistic regression analysis. Acceleration capacity, fastest heart rate and LVEF were still independent risk factors in the final equation with ORs of 1·32 (1·03-1·79), 1·04 (0·01-1·07) and 0·46 (0·23-0·93), respectively. CONCLUSION: Heart rate acceleration capacity and deceleration capacity are independent risk factors for DCM, and acceleration capacity is a predictive factor for heart failure exacerbation in patients with DCM.

Clinical value of heart rate deceleration capacity test in predicting epirubicin-induced cardiotoxicity / 中国肿瘤临床

Objective:To investigate the effectiveness of heart rate deceleration capacity (DC) measurement in predicting the car-diotoxicity of malignant tumor patients treated with epirubicin-based chemotherapy. Methods:The clinical medical records, including CK-MB and cTnI levels and dynamic electrocardiogram (ECG) parameters before and after each chemotherapy cycle, of 140 patients treated with epirubicin-based chemotherapy were analyzed. Patients were divided into the DC>4.5 ms group and the DC≤4.5 ms group based on the calculated DC values. The CK-MB and cTnI levels and the dynamic ECG parameters of the two groups were compared af-ter two and four cycles of chemotherapy. Results:Patients in the two groups exhibited no statistically significant difference in their rele-vant clinical and pathological data before receiving chemotherapy (P>0.05). However, after four cycles of chemotherapy, the DC≤4.5 ms group showed a significantly greater increase in serum CK-MB and cTnI concentrations over the pre-chemotherapy levels compared with the DC>4.5 ms group. After two and four cycles of chemotherapy, the DC≤4.5 ms group also exhibited a significantly greater in-crease in mean heart rate (beats/min) and supraventricular and ventricular arrhythmia counts (times/24 h) over the pre-chemotherapy values compared with the DC>4.5 ms group (P0.05). However, the DC values of patients with elevated cTnI were significantly lower than those with normal cTnI level (P<0.05). Conclusion:The risk of epirubicin-induced cardiotoxicity increased with decrease in DC value. The DC test was shown to be an effective predictor of the risk of epirubicin-induced cardiotoxicity.

Effect of six-minute walking training on autonomic nerve function in patients having chronic heart failure / 中国医师进修杂志

Objective To investigate the influence of six-minute walking training on autonomic nerve function in patients having chronic heart failure.Methods Eighty chronic heart failure patients with heart function Ⅱ-Ⅲ grade were divided into training group (40 cases) and control group (40 cases) by random digits table method.Patients in two groups were treated with conventional anti heart failure drug.Patients in training group insisted six-minute walking training twice a day on the basis of the conventional treatment.Changes of the index of heart function,heart rate variability (HRV) and heart rate deceleration force (DC) before and after treatment were tested in two groups.Results After treatment,the cardiac function in training group and control group was significantly improved (P ＜ 0.05).The indexes of HRV and DC in two groups were significantly higher than those before treatment (P ＜ 0.05).After treatment,the indexes of HRV and DC in training group were significantly higher than those in control group (P ＜ 0.05).Conclusion Six-minute walking training in patients having chronic heart failure can significantly improve the autonomic nerve function,which is an effective and safe rehabilitation exercise for patients having chronic heart failure.