| Background and objective Coronary heart disease(CHD) is closely correlated with cardiac autonomic nervous imbalance.On the one hand,the autonomic nervous imbalance can lead to coronary spasm, plaque instability, induce angina and myocardial infarction.On the other hand,the angina or acute myocardial infarction can broke the balance of autonomic nervous system and induce arrhythmias.Cardiac autonomic nervous function is also associated with coronary heart disease prognosis. Nowadays there is growing concern about the CHD and autonomic nervous function,but the research is not deep.Heart rate variability is commonly used to detect the autonomic nervous function.It can indirectly reflect the sympathetic- vagal activity and their balance. In this study, we will explore the relationship between TCM syndromes of coronary heart disease and heart rate variability.As we know,the cardiac autonomic nervous system is not distributed evenly,the left anterior descending artery region is rich in sympathetic nervous,and the right coronary artery region is rich in vagus nervous, especially the sinus node and the atrioventricular junction region.In this study,we will investigate the effect of different parts of acute myocardial infarction on heart rate activity,and explore the relationship between location of acute myocardial infarction and the cardiac automatic nervous function.Methods The first part The relationship between TCM syndromes of CHD and the cardiac autonomic nervous function: 150 patients with angina pectoris were selected during the period from February to July 2014 in Wuhan General Hospital of Guangzhou Command,and 59 patients were selected as the control group, whose results of coronary angiography showed stenosis was <50%.Accoding to the "Standards of TCM on coronary heart disease",150 patients with angina pectoris were divided into three groups: the excess syndrome group(45 cases),the intermingled deficiency and excess syndrome group(62 cases) and the deficiency syndrome group(43 cases).After an average of 3.14 ± 1.28 days,all patients received 24-hours holter examination,then analyze the levels of SDNN, SDANN, SDNNI, r MSSD, PNN50. ⑵ The second part The relationship between the location of acute myocardial infarction and the cardiac autonomic nervous function:137 patients with ST-segment elevation myocardial infarction type were selected during the period from January 2013 to December 2014 in Wuhan General Hospital of Guangzhou Command.According to the results of coronary angiography, patients were divided into three groups:anterior descending artery group(91 cases),circumflex artery group(14cases) and right coronary artery group(32 cases).According to the opening time of infarct-related artery, patients were divided into three groups:less than 4h group(22 cases),4h-8h group(64 cases)and more than 8h group(51 cases).64 patients with stable angina pectoris were selected in the same period of hospitalization,and 68 patients who were excluded of coronary heart disease were selected as control group.After an average of 8.47 ± 3.27 days, the patients received the 24-hours holter examination,and after an average of 7.90 ± 2.95 days,the patients received the echocardiography examination. After an average of 1.14 ± 1.08 days,the control group received the echocardiography examination, According to the echocardiography, patients were divided into two groups:the low LVEF group(23cases)and the normal LVEF group(114cases).Then analyzed the levels of SDNN, SDANN, SDNNI, r MSSD, PNN50 and left ventricular ejection fraction in each group.Results The relationships between TCM Syndromes of angina pectoris and the cardiac autonomic nervous function :⑴The SDNN, SDANN, SDNNI, r MSSD in the excess syndrome group and the intermingled deficiency and excess syndrome group were lower than the control group,and there were significant differences between them(P <0.05),the PNN50 in the deficiency mixed group and the deficiency group were lower than the control group,and there were significant differences between them(P <0.05).However,there were no significant differences between the PNN50 in the empirical group and the control group(P> 0.05).⑵The SDNN, SDANN, SDNNI, PNN50 in the mixed group and the deficiency group were lower than the excess syndrome group,and there were significant differences between them(P <0.05).However,there were no differences between the r MSSD in the mixed group and the deficiency group(P> 0.05).Compared with the control group,the SDNN, SDANN, SDNNI in the mixed group deficiency group was lower,and there were no significant differences between them(P<0.05).The relationship between the location of acute myocardial infarction and the cardiac autonomic nervous function: ⑴ The relationship between acute myocardial infarction and the cardiac autonomic nervous function:the SDNN, SDANN, SDNNI, PNN50 in the AMI group and the SAP group was lower than the control group(P <0.01),and there were significant differences between them(P <0.05);the SDNN, SDANN in the AMI group was lower than the stable angina group,and there were significant differences between them(P <0.05).The SDNN, SDANN, SDNNI, r MSSD, PNN50 in right coronary group, the left anterior descending artery group,circumflex artery group were decreased,but there were no significant differences among them(P> 0.05);There were significant differences between the right coronary and the circumflex artery group(P<0.05). ⑵ The relationship between the opening time of infarcted relative artery and the cardiac autonomic nervous function.There were significant differences(P <0.05) among less than 4h group and 4h-8h group and more than 8h group.The r MSSD in the less than 8h group was lower than the 4h-8h group,and there were significant differences among them(P <0.05).There were significant differences between the 4h-8h group and less than 4h group(P <0.01).⑶ The relationship between the acute myocardial infarction and the cardiac automatic nervous function: compared with the control group,, the LVEF in the acute myocardial infarction group was lower,and there were significant differences between them(P <0.01).The LVEF in the right coronary group and the circumflex artery group was lower than that in the left anterior descending artery group,but there were no significant differences among them(P> 0.05).⑷The relationship between heart function and the cardiac automatic nervous function:the low LVEF group was lower than the normal LVEF group,and there were significant differences between them(P<0.05).Conclusion ⑴There is a relationship between TCM syndromes of the angina pectoris and HRV.Along with the body to shift from empirical to deficiency, the sympathetic activity was increased and the vagal activity was decreased, the imbalance between sympathetic and vagal was aggravated;⑵When patients had acute myocardial infarction or stable angina pectoris,the cardiac automatic nervous function was broken and the sympathetic became activitily;⑶HRV was successively decreased in patients who had anterior descending artery infarction,right coronary artery infarction and circumflex artery infarction,the sympathetic activity was increased and the vagal activity was decreased,the imbalance between sympathetic and vagal was aggravated, however,there were no significant differences among these groups,so further studies are needed;⑷The impacts on cardiac autonomic nervous function was very little in patients who had a earlier time to open the infarct related artery;⑸Heart function got worse in the patients who had acute myocardial infarction.However,there were no significant differences among the anterior descending artery infarction and the right coronary artery infarction and the circumflex artery infarction.⑹There is a relationship between the heart function and the HRV,The sympathetic activity was increased in patients who has a lower LVEF after acute myocardial infarction. |
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