经导管主动脉瓣置换术对主动脉瓣狭窄患者心率变异性的影响  

Impact on heart rate variability of patients with aortic valve stenosis after transcatheter aortic valve re-placement

作　　者：陈巳楣 郭晋村 林镇国 周法光 叶明才 CHEN Simei;GUO Jincun;LIN Zhenguo;ZHOU Faguang;YE Mingcai(Department of Cardiac Function,Xiamen Cardiovascular Hospital,Xiamen University,Xiamen Key Laboratory of Precision Medicine for Cardiovascular Diseases,Xiamen Fujian 361009,China)

机构地区：[1]厦门大学附属心血管病医院心功能科,厦门市心血管疾病精准医学重点实验室,福建厦门361009

出　　处：《实用心电学杂志》2022年第5期341-345,共5页Journal of Practical Electrocardiology

基　　金：福建省科技计划项目(2017D0020);厦门市科技计划医疗卫生重点项目(3502Z20191103)。

摘　　要：目的分析接受经导管主动脉瓣置换术(transcatheter aortic valve replacement,TAVR)的主动脉瓣狭窄患者心率变异性(heart rate variability,HRV)、Lorenz散点图相关指标与心功能的相关性。方法以接受TAVR的主动脉瓣狭窄患者为研究对象,对比术前、术后3个月的HRV时域指标SDNN、SDANN、rMSSD、pNN50、HRV三角指数,以及HRV频域指标HF、LF、LF/HF。对比患者术前、术后Lorenz散点图形态及其在x轴的投影长度L、在y轴的离散度D;比较术前、术后的心功能指标,包括左心室射血分数(LVEF)、左心室舒张末期内径(left ventricular end-diastolic diameter,LVEDD)、左心室收缩末期内径(left ventricular end-systolic diameter,LVESD)及NT-proBNP水平。结果SDNN、SDANN、HRV三角指数、L这4项指标在术后高于术前,D值在术后低于术前,且差异均有统计学意义(P<0.01);术后LF、HF有改善的趋势,但与术前相比差异无统计学意义;HRV时域指标在TAVR术后显著改善;部分HRV指标与LVEF呈正相关,与NT-proBNP水平及LVEDD、LVESD呈负相关。结论TAVR术后主动脉瓣狭窄患者的自主神经系统功能状态有所改善,HRV改变与心功能存在相关性。Objective To explore the relativity between heart rate variability(HRV),related indexes of Lorenz scatter plot,and cardiac function in patients with aortic valve stenosis after transcatheter aortic valve replacement(TAVR).Methods Patients with aortic valve stenosis after TAVR were enrolled in our study.The time domain indexes of HRV(SDNN,SDANN,rMSSD,pNN50 and HRV triangular index),and frequency domain indexes of HRV(HF,LF and LF/HF)were compared before and 3 months after surgery.We compared the morphology of Lorenz scatter plot,and its projection length of L in the x-axis and dispersion of D in the y-axis before and after surgery.The indexes of cardiac function including LVEF,left ventricular end-diastolic diameter(LVEDD)and left ventricular end-systolic diameter(LVESD),and NT-proBNP level were compared before and after surgery.Results The values of SDNN,SDANN,HRV triangular index and L are higher after TAVR while D value is lower after surgery,with statistically significant differences(P<0.01).LF and HF show a tendency to improve after surgery,but there is no statistically significant difference as compared to those before surgery.The time domain indexes of HRV are significantly improved after TAVR;parts of HRV indexes are positively correlated with LVEF,and negatively correlated with NT-proBNP level,LVEDD and LVESD.Conclusion The functional status of the autonomic nervous system is improved in patients with aortic valve stenosis after TAVR.HRV changes are associated with cardiac function.

关 键 词：心率变异性 LORENZ散点图 经导管主动脉瓣置换术 主动脉瓣狭窄 瓣膜性心脏病 

分 类 号：R542.52[医药卫生—心血管疾病]