Changes Of Heart Rate Turbulence And Heart Rate Variability In Patients With Coronary Heart Disease

Objective: To analyze the changes of heart rate turbulence (HRT) and heart rate variability (HRV) in the coronary heart disease (CHD), to evaluate the relationship between CHD, coronary artery disease (CAD), and the 2 parameters of HRT and HRV, and to investigate the correlation of the 2 parameters and the changes of HRT in patients undergoing direct percutaneous coronary intervention after acute myocardial infarction (AMI).Methods: We performed coronary angiography in all 103 patients with CHD (group A), who were classified into 3 subgroups: 35 patients of stable angina pectoris (group A₁), 28 patients of unstable angina pectoris (group A) and 40 patients of AMI (group A3), and 30 structurally normal patients with ventricular premature contraction were included in healthy control group (group B). The 24-hour ambulatory electrocardiogram was performed in all the patients and the parameters of HRT and HRV were obtained, including the parameters for HRT (TO and TS) and those for HRV (SDNN, PNN50, and HF). The investigation included: (1)analyzing the changes of HRT and HRV in group A and group B; (2)analyzing the correlation between Gensini score and HRT,as well as HRV in patients of group A₁; (3)analyzing the correlation between HRT and HRV; and (4) monitoring the dynamic electrocardiogram before percutaneous coronary intervention (PCI) and within 2h, 12～24h, and 1 week after PCI in patients with AMI, and analyzing the changes of HRT.Results: (1)The value of the TO onset of group A was significantly higher than that of group B, the value of TS of group A was lower than that of group B (P<0.05 or P<0.01). The value of TO/TS onset of group A3 had significant difference with group A₁ and group A₂, while the value of TO/TS onset had no significant difference between group A₁ and group A₂. (2)The values of SDNN, PNN50, and HF of group A were significantly lower than those of group B (P<0.05). The values of SDNN and HF were also statistically different among the 3 subgroups of A₁, A₂, A₃ (P<0.01), while the value of PNN50 onset was not statistically different between group A₁ and group A₂(P>0.05); (3)TO was positively correlated with Gensinies score while TS, SDNN, PNN50. and HF were negatively correlated with Gensinies score, and TS showed the strongest negative correlation with Gensini score (r=-0.45); (4)TO was negatively correlated with SDNN, PNN50, and HF; while TS was positively correlated with SDNN, PNN50 and HF, and TS showed much stronger correlation with HF (r=0.47); and (5)The value of TS onset was significantly higher within 2h after successful PCI (TIMI-III) in patients with AMI (P<0.01). Compared with 2h after PCI and before PCI ,the value of TO and TS onset were all improved significantly in 12-24h and 1 week after PCI (TIMI-III) (P<0.01). There was no significant difference in TO and TS between 12²4h and 1 week after PCI(TIMI-III) (P>0.05); HRT (TO and TS) values after PCI (TIMI-II) were not improved significantly (P>0.05).Conclusions: (1) HRT is dramatically blunted and HRV is significantly lower in patients with CHD; (2)HRT and HRV of group A₁ were significantly correlated with Gensini score, and TS had the strongest correlation with Gensini score; (3)TO and TS were correlated with SDNN, PNN50, and HF, and TS had much stronger correlation with HF; and (4)Successful direct PCI (TIMI-III) could improve HRT significantly after AMI (P<0.01). PCI could improve and revive heart autonomic nerve system, especially vagal antiarrhythmia protection integrity.