| Myocardial infarction(MI) is the leading cause of cardiovascular morbidity and mortality, which continues to be the main cause of death and a major cause of morbidity and loss of quality of life in the world. Currently, there are about 2 million patients with MI in our country, and about 500 thousand people annually increased. Furthermore, population aging represents a major challenge for our country in an effort to prevent MI in future. According to the predictions by the WHO, MI will be the most important major killer of both men and women in the world by 2030. Statistical data show that the main sites of MI attack are at home, communities and public places. Because of slow onset, sudden attack and thorny prognosis characters of MI, the irreversible injury to the large areas myocardial cell arrives when the time from onset to treat MI exceed 90 minutes, many people living in community that suffer a sudden MI attack have to distressed endure unfortunate events or death for the delay of the best time of treatment; So grasping the enough time to save myocardium in communities and taken effectively measures of implement early risk stratification and prevent for MI will be of importance and popular. Intense and sustained investigation has produced considerable insight into the pathophysiology of MI, but most of these research concentrate on risk stratification for postinfarction at home and aboard, there are little study about the early risk stratification and prevent for MI in communities or families. Heart rate variability (HRV) can be very good qualitative and quantitative assessment of autonomic nervous system disturbance status. Deceleration capacity (DC) of heart rate, recently brought forth at aboard, is a novel indicator of quantitative assessment of vagal tone. Pulse wave velocity (PWV) is widely used as an index of arterial distensibility or arterial stiffness. For these reasons, it is valuable and important to determine whether combined the HRV, DC and PWV technology identifies people at early risk for MI in community.Based on the development of MI in pathology, we investigate the autonomic nervous system disturbance by HRV and DC methods with analyzing the ECG data, and by detecting the finger and ear photoplethysmography, and calculating the PWV between the finger pulse wave and ear pulse wave, we estimate the hemodynamics functional situation of cardiovascular system by PWV. With the aim at supporting the reference to clinical screening or advanced warning of MI in community, we investigate physiological parameters of the cardiovascular groups and the control group, so as to explore the way on early risk stratification for MI, and to acquare its quantitative indices.In this paper, we have done the following works:(1) Using HRV and DC method we have estimated the autonomic nervous system disturbance status;(2) By detection of finger and ear two pulse wave and calculating of PWV, we have evaluated the hemodynamics functional variation of cardiovascular system(such as arterial compliance and stiffness);(3) We have designed a experiment platform for multivariable parameter measurement and analysis;(4) Based on the above platform, we have had clinical studies at the department of cardiology. Thirty five patients with cardiovascular disease (eleven MI, eight coronary artery disease (CAD), six artery atherosclerosis (AA) and ten hypertension) and thirty-one healthy subjects were randomly selected for our study; fifteen minutes ECG and one minutes pulse wave data were collected. HRV, DC and PWV between the cardiovascular group and the control group were analyzed and compared;From the view of clinical experiment result, we can draw a conclude that both time domain HRV analysis and DC analysis remarkably manifest the progressive deterioration process that a normal person comes to a patient with MI, and PWV(F= 30.027, P<0.001) show significantly difference in control group compared to cardiovascular groups.We have the following results:(1) Among the control, hypertension, AA, CAD, and MI group, the three indices of time domain of HRV (NN50, pNN50 and TINN) present a decline trend that is consistent with the regularity of cardiovascular development process.(2) Among the control, hypertension, AA, CAD, and MI group, the value of DC demonstrate progressively decline trend that reveals the regularity of parasympathetic pathophysiology change.(3) In contrast with the cardiovascular groups, the control group of PWV are slower, which represent that weak arterial compliance and stiffness vessels commonly exist in all cardiovascular group.(4) The clinical studies illustrate that appling HRV analysis, DC analysis and PWV detection in combination with patient clinical symptoms, we’ll be able to implement early risk stratification and prevent for MI.From onset to sudden cardiac death, MI is dynamic and changeable. Long-term monitoring autonomic nervous system disturbances and coronary artery hemodynamic functional status to reveal the development and deterioration of MI, it would be expected and valuable. With the development and wide application of remote medical diagnosis technology for families and individuals, the detection of individual physiological parameters would become daily routine, much physiological data will be countlessly produced, and we can use of HRV and DC technology long-term monitoring the autonomic nervous system disturbances and also monitoring the status of hemodynamic function of cardiovascular system by PWV, and deeply achieve the statistical and quantitative analysis of evolution trend of patient with cardiovascular disease. At that time, the early risk for MI will be predicted successfully by noninvasive detection methods above mentioned. |
PDF Full Text Request