Analysis Of Heart Rate Variability In Patients With Coronary Artery Non-obstructive Luminal Narrowing And Export The Risk Factors

BackgroundCoronary atherosclerotic heart disease(coronary heart disease, CHD)is one of the popular cardiovascular diseases in clinic, and it also is the frequently disease harming mankind healthiness. With the progress and development of the human society, the prevalence rate of coronary heart disease is also increasing, and more and more patients are to be younger. In recent years, with the percutaneous coronary angiography is used more and more widely in clinic, coronary angiography(CAG) is regarded the“ gold standard” for the diagnosis of coronary artery disease. According the classification suggested by American Heart Association, the severity of coronary artery stenosis was graded as normal(0%)、non-obstructive(<50%)and obstructive(≥50%) luminal narrowing. Since the 24 hours dynamic electrocardiogram(DCG) is used more widely as a noninvasive 、simple and convenient tool, the heart rate variability become the hotspot of research in recent years. At the same time, a lot of scholars thought that the autonomic neuropathy(ANP) is correlated with many diseases development, especially cardiovascular disease. And the heart rate variability is considered to be the most commonly used quantitative indicator which reflect the function of autonomic neuropathy. Currently, the heart rate variability have affirmative value of some disease in the clinic application and medical research, such as diabetes mellitus(DM) 、acute myocardium infarction(AMI) 、hypertension、congestive heart failure(CHF)。The study confirmed the heart rate variability decrease remained a independent risk factors on predictor of the death for heart disease. The some research of home and abroad proved that the patients with coronary heart disease have the heart rate variability decrease, and the degree of coronary artery lesions more serious, the heart rate variability decrease much more. So the heart rate variability can predict the prognosis and sudden death rate of coronary heart disease to some extent. Many factors take part in the slowly pathophysiological procedure of coronary artery atherosclerosis, it is considered that the dysfunction of cardiac autonomic neuropathy plays a major role in the development of CHD. In clinic, some doctors can found a phenomenon: the result of coronary angiography is only non-obstructive luminal narrowing for some people with suspected cardiac chest pain. The date showed that 50%-60% patients of acute myocardium infarction can be attributed to the patients with non-obstructive luminal narrowing and atypical symptoms. But there is no study for the relationships of the patients with coronary artery luminal non-obstructive narrowing and the heart rate variability, so the paper establishes that whether the patients with coronary artery luminal non-obstructive narrowing exists the changes of the heart rate variability, and which are the risk factors among the risk factors of coronary heart disease. ObjectiveTo analysis that whether the patients with coronary artery luminal non-obstructive narrowing exists changes of the time domain indexes of the heart rate variability, and to explore the relationships of the patients with coronary artery luminal non-obstructive narrowing and the heart rate variability. To know more about the high risk factors of coronary heart disease have influence on the heart rate variability; So they can show that there exists the dysfunction of cardiac autonomic neuropathy at the initial stage of the coronary artery atherosclerosis, and the high risk factors of coronary heart disease are the reasons for this. Finally it can guide the clinical workers for the prevention and treatment of coronary artery atherosclerosis from the primary prevention.MethodsSelecting 70 cases of hospitalized patients as the non-obstructive narrowing group who received CAG, and the result of CAG is coronary artery luminal non-obstructive narrowing(<50%). The other 60 cases of hospitalized patients as control group who did the same, but the coronary artery luminal is normal(luminal narrowing 0%). We census their age, sex, the cases of hypertension, diabetes, newly diagnosed diabetes, dyslipoidoses, smoking, and the time domain indexes of the heart rate variability are SDNN、SDANN、RMSSD、PNN50.We sorts through the resulting data and uses statistical methods to analyze. Results1. The coronary artery luminal non-obstructive narrowing group compared to the control group, the cases of hypertension, diabetes, newly diagnosed diabetes, dyslipoidoses, smoking are significantly higher(P<0.05).2. The SDNN、SDANN、RMSSD、PNN50 of the time domain indexes are decreased in the coronary artery luminal non-obstructive narrowing group compared to the control group, SDANN、RMSSD、PNN50 were no significant differenc between the two group(P>0.05), but SDNN are significantly decreased(P<0.05).3. In the coronary artery luminal non-obstructive narrowing group, the results of SDNN and hypertension, diabetes, dyslipoidoses, smoking were analysis by the multivariate Logistic regression analysis, and found there are correlation among SDNN with hypertension(95%CI-1.053,4.935), diabetes(95%CI-1.511,8.380), dyslipoidoses(95%CI-1.054,5.682), smoking(95%CI-1.544,8.102).4. Hypertension, diabetes, dyslipoidoses, smoking were influencing factors of the heart rate variability decrease for the coronary artery luminal non-obstructive narrowing patients(P<0.05). Conclusion1. Hypertension, diabetes, dyslipoidoses, smoking are the risk factors for the coronary artery atherosclerosis.2. The patients with the coronary artery luminal non-obstructive narrowing have the heart rate variability decrease, witch reflects the dysfunction of cardiac autonomic neuropathy; And Hypertension, diabetes, dyslipoidoses, smoking are contributed to this result.3. It can show that there exists the dysfunction of cardiac autonomic neuropathy at the initial stage of the coronary artery atherosclerosis, and dysfunction of cardiac autonomic neuropathy promotes the development of coronary diseases; Associated with analysis of the risk factors, witch fully shows primary prevention is more important in the development of coronary diseases.