| Objective: The cardiovascular autonomic balance is closely correlated with incidence, progression and prognosis of coronary heart disease. Heart rate variability (HRV) can reflect cardiovascular autonomic balance. In present study, time and frequency domain measures of HRV were analyzed in 208 patients without myocardial infarction who were undergone coronary atherosclerosis and follow-up in 427 patients with acute myocardial infarction (AMI). The purpose of the study was: (1) to examine the relation between HRV and coronary artery stenosis in patients with coronary atherosclerosis, (2) to determine the relationship between HRV and the patients'cardiovascular events, heart failure after acute myocardial infarction, (3) to determine the relationship between HRV decreased and progression and prognosis of coronary atherosclerosis.Methods: We performed coronary arteriography in all 208 patients with coronary atherosclerosis, who were classified 3 groups: 48 patients of mild stenosis(grade≤50%),74 patients of moderate stenosis(grade50%-75%) and 86 patients of severe stenosis(grade>75%). Patients diagnosed as severe stenosis were assigned to 3 subgroups: left anterior descending group (n=42), left circumflex artery group (n=16) and right coronary artery (n=28). All patients were performed 24-hour dynamic electrocardiograms and ultrasonic cardiograms, which time-domain measures of HRV in 24-hour dynamic electrocardiograms include SDNN, SDANN and RMSSD, ultrasonic cardiograms include left ventricular ejection fraction(LVEF). Analysis the relationship between HRV and the degree, site of coronary stenosis.24-hour dynamic electrocardiograms and ultrasonic cardiograms were performed later 2 weeks after acute myocardial infarction. Patients diagnosed as acute myocardial infarction were assigned to HRV midrange and severe decrease (SDNN<50ms, n=187) or HRV slightly decrease and normal (SDNN≥50ms, n=240). The primary outcome was a composite of death, myocardial infarction at 180 days. The secondary outcome was death, myocardial infarction, heart failure, coronary revascularization at 180 days.Results: (1) In 208 patients with coronary atherosclerosis, time-domain measures of HRV (SDNN, SDANN) decreased significantly in severe coronary artery stenosis group than in slightly coronary artery stenosis group, but time-domain measures of HRV is not correlated with site of coronary stenosis.(2) In 427 patients with acute myocardial infarction, baseline clinical characteristics were comparable between two groups. Incidence of both primary (5.9% vs. 0.4% P=0.00) and secondary (30.4% vs. 10.8% P=0.00) endpoints were significantly lower in HRV slightly decrease and normal group than in HRV midrange and severe decrease group. Incidence of heart failure was significantly lower in HRV slightly decrease and normal group than in HRV midrange and severe decrease group (14.9% vs. 5.8% P=0.00) at 180 days.Conclusion: (1) HRV decreased is closely correlated with degree of coronary stenosis.(2) HRV decreased is correlated lowly with site of coronary stenosis.(3) HRV decreased associated with the cardiovascular events after acute myocardial infarction.(4) HRV decreased is a useful tool to predict heart failure and poor prognosis after acute myocardial infarction.(5) HRV decreased is closely correlated with progression and prognosis of coronary atherosclerosis. |
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