The Clinical Research Of Cardiac Structure As Well As Function In Patients With Idiopathic Ventricular Premature Beat

Objective To investigate the correlation among idiopathic ventricular ventricular premature beat and autonomic nervous system,as well as cardiac structure and function in different PVCs burden and different ventricular outflow tract by analyzing the parameter of cardiac structure and function by Ultrasonic cardiogram and doppler ultrasound,as well as the deceleration capacity of heart rate(DC),the acceleration capacity of heart rate(AC),the heart rate deceleration runs(DRs)and the indexes of hean rate variability(HRV)in PVCs patients and normal people by 24-hour Holter monitoring.To explore the causality among the idiopathic ventricular ventricular premature beat and autonomic nervous system,as well as cardiac structure and function through contrasting the conditions after the Radio frequency catheter ablation(RFCA).Methods 108 cases of PVCs which had been treated by RFCA was selected continuously from the Department of Cardiology of the First Affiliated Hospital of Fujian Medical University from Jan.2012 to Sep.2016 by retrospective cohort study method,in which 39 males and 69 females,mean age 49.22±14.76 years(aged 14-80 years).Selected another 89 cases of normal person as control matched for sex,age and comorbidities,in which 39 males and 50 females,mean age 48.19±11.66 years(aged 16-75 years).Recorded all subjects of clinical data detailedly,including,sex,age,height,weight,operation time,the PVC site,pro-brain natriuretic peptide pro-BNP,echocardiography,and 24h-Holter.And do some reasearch as followings:(1)59 cases of PVCs whose Holter information was complete and located in RVOT or LVOT was selected.Then we divided PVCs patients into two groups: 13 case in LVOT and 46 case in RVOT.And 39 cases of health person who had completed Holter information was choosed.Compared the Holter indicators among these three groups.(2)88 cases of PVCs whose echocardiography information was complete and located in RVOT or LVOT was selected.Then we divided PVCs patients into two groups as well: 18 case in LVOT and 70 case in RVOT.And 50 cases of health person who had completed echocardiography information was selected.Compared the echocardiography indicators among these three groups.(3)Divided 59 PVCs from group(1)into two groups according the PVCs burden: the higher one and the lower one,then compared the Holter indicators between two groups.(4)Divided 40 PVCs with the complete Holter indicators as well from group(2)into two groups according the PVCs burden: the higher one and the lower one,then compared the echocardiography indicators between two groups.(5)31 cases of PVCs whose Holter information was complete and had been treated by RFCA was selected,and 20 cases of PVCs whose echocardiography indicators was complete was selected as well.Try to compared the indicators after the surgery,and between the normal person as also.(6)48 cases of PVCs whose Holter information and echocardiography indicators was all complete was selected,and try to analyse the relation between the change of the vegetative nerve and the cardiac structure,the cardiac fuction as well.Results(1)-a There were no significant differences in sex,age,BMI,BSA among the RVOT group,LVOT group and the control group(P> 0.05).The differences in the level of DC,AC and LF/HF between the RVOT group and the control group was significant in statistics(P<0.05).There were significant differences in DR1-DR10 between the RVOT group and the control group,as well as the LVOT group and the control group(P<0.05),but not between the RVOT and LVOT group(P> 0.05).(1)-b There were significant differences in LAD、LVDd、LVDs、LVVd、LVVs、SV、EF between the RVOT group and the control group,as well as the LVOT group and the control group(P<0.05),but not between the RVOT and LVOT group(P> 0.05).IVST、LVPWT were significant differences in RVOT group and LVOT group,as well as LVOT group and control group.LVM had statistical significance among these three groups(P<0.05).(2)-a There were no significant differences in sex,age,BSA among the different burden group and the control group(P>0.05).The differences in the level of BMI、HF between the higher group and the control group was significant in statistics(P<0.05).There were significant differences in DC、AC、DR9、DR10 between the higher group and the control group,as well as the lower group and the control group(P<0.05),but not between the different burden groups(P> 0.05).DR1-DR8 had statistical significance among these three groups(P<0.05).(2)-b There were significant differences in LAD、LVDd、LVDs、LVVd、LVVs、SV、CO、LVM between the higher group and the control group,as well as the lower group and the control group(P<0.05),but not the same in different burden groups(P> 0.05).(3)-a There were significant differences in DC、DR1-DR8、DR10、LF、HF、LF/HF between the pre-operation and post-operation groups(P<0.05),As to the statistical significance between the post-operation and the control group,the DR1-DR8、DR10、RMSSD、LF、HF、LF/HF made the sense(P<0.05).(3)-b There were significant differences in LVDd、LVDs、EF、PVE between the pre-operation and post-operation groups(P<0.05),As to the statistical significance between the post-operation and the control group,the LAD、LVDd、LVDs、LVVd、LVVs、SV、CO、LVM、e made the sense.(4)On single factor correlation analysis,the level of DC correlated positively with EF and FS(P <0.05),DR1 and IVST、LVPWT the same correlation,DR6、DR9 and E/e、SDNN、SDANN、RMSSD and LAD、LF/HF and IVST、NT-pro BNP and DR2、SDNN、RMSSD、p NN50% had the opposite correlation(P <0.05).(5)There were non-significant correlation between PVCs burden and the change of cardiac structure as well as function(P> 0.05).The PVCs burden correlated positively with LF/HF、NT-pro BNP,and had negative correlation with AC、DR1-DR9、SDNN、LF、HF.(6)Multivariate Logistic regression analysis showed that: DR6 and DR7 were both independent predictor for early cardiac dysfunction in PVCs and the protective factor(OR values were all 0,P <0.05).Conclusion(1)The adjustment unevenness of the autonomic nervous system was related to the PVCs occurring in LVOT and RVOT,which had not significant differences between two outflow tract PVCs,mainly because of the weakeness of vagal tone.And the higher PVCs burden was,the weaker the vagus activity were.(2)The cardiac remodeling and the impairment of cardiac function can happen in both RVOT and LVOT PVCs: the ventricular enlarged,the function of cardiac damaged,in which the changes of the IVST、LVPWT and LVM had significant differences between LVOT and RVOT.And the more burden was,the higher NT-pro BNP were.(3)The RFCA can improve the adjustment unevenness of the autonomic nervous system and the cardiac remodeling,as well the impairment of cardiac function.The idiopathic ventricular premature beat was the reason of the adjustment unevenness of the vegetative nervous system,as well as the cause of the cardiac remodeling and the impairment of cardiac function.The vegetative nervous system dysfunction induced the PVCs which can exacerbate in turn.(4)The vegetative nervous system dysfunction was closely related with the cardiac remodeling and cardiac function damagement.The vagus activity was the independent protective factor,DR6 and DR7 were both independent predictor for early cardiac dysfunction in PVCs.