Relationship Between Heart Rate Variability And Coronary Artery Gensini Score In Patients With Non-dialysis Chronic Kidney Disease And Coronary Heart Disease

Objective(s):1.To investigate the relationship between heart rate variability(HRV)and coronary disease(CAD)in patients with non-dialysis chronic kidney disease(CKD).And find out whether HRV time-domain indicators can be used to evaluate CAD in non-dialysis CKD patients.2.To investigate the relationship between HRV time-domain indicators and the severity of coronary artery disease and number of lesions in non-dialysis CKD patients with CAD.To investigate whether HRV time-domain indicators can be used to evaluate the progress of patients with non-dialysis CKD combined with CAD.Methods:1.163 non-dialysis CKD patients were selected.According to the results of coronary angiography,they were divided into simple CKD group(n=30)and CKD combined with CAD group(n=133).The detailed history data,biochemical examination data,and coronary angiography results were collected for the included patients.At the same time,the HRV time-domain indicators of 24-hour dynamic electrocardiogram were collected,including SDNN,SDANN,rMSSD,and pNN50.The difference between the two groups was analyzed using spss17.0.Then HRV time-domain indicators with statistically significant differences in univariate analysis and traditional risk factors for CAD in CKD patients such as gender,age,hypertension,and diabetes were included in the model for binary classification logistic regression analysis.The ROC curve is used to analyze the judgment ability of HRV.time domain indicator on CAD.2.133 non-dialysis CKD patients with CAD selected.Spearman linear correlation analysis was used to evaluate the correlation between Gensini score and gender,age,BMI,GFR,HCY,Cys-C,SDNN,SDANN,rMSSD,and pNN50.The impact of HRV time-domain indicators on Gensini scores was analyzed by multiple linear regression analysis.According to the quartile of Gensini score,the included patients were divided into group A1(score≤ 15.5,n=33),group A2(15.5<score≤34,n=37),group A3(34<score≤60.25,n=30),and group A4(score>60.25,n=33).Then differences in general data of different Gensini score groups and HRV time-domain indicators between the four groups were compared.Multivariate Logistic Regression analysisze explore the relationship between Gensini Score Grouping and HRV Time Domain Indicators.According to the number of coronary artery lesions,the patients were divided into three groups:group B1(single-branch lesion group,n=39),group B2(double-branch lesion group,n=39),and group B3(multi-branch lesion group,n=55).The differences of general data and HRV time-domain indicators in different groups were compared.The relationship between the number of coronary lesions and the time-domain indicators of HRV was analyzed by Logistic regression.Results:1.Among 163 non-dialyzed CKD patients,30 were in the simple CKD group,and 133 were in the CKD combined with CAD group.Statistical analysis showed that there was no significant difference between the two groups in terms of age,gender,BMI,smoking history,drinking history,hypertension history,diabetes history,GFR,TC,TG,HDL-C,LDL-C(P>0.05).And compared with the simple CKD group,the heart valve calcification rate,HCY,and Cys-C in the CKD combined CAD group were significantly increased(P<0.05).SDNN,SDANN,rMSSD and pNN50 were all significantly decreased(P<0.05).Logistic regression showed that SDNN may be a risk factor for CAD in non-dialysis CKD patients(OR=0.978,95%CI:0.967-0.989,P<0.001).The ROC curve shows that the optimal critical point for SDNN to predict coronary artery disease was 136.5ms,sensitivity 85%,specificity 60%,and area under the curve 0.718(95%CI:0.598-0.838,P<0.001).2.Spearman correlation analysis of 133 non-dialysis CKD atients with CAD showed that there was no correlation between age,BMI,GFR,rMSSD and Gensini score.SDNN(r=-0.604,P<6.001),SDANN(r=-0.423,P<0.001),pNN50(r=-0.228,P<0.01)were negatively correlated with Gensini scores,respectively.Furthermore,multiple linear regression analysis showed that SDANN and pNN50 were adjusted(adjusted R2:0.210).SDNN(P<0.001)was significantly negatively correlated with the Gensini score.In the group of Gensini score,the distributions of SDNN,SDANN,and pNN50 in each group were not all the same(P<0.01).Multiple logistic regression analysis showed that after adjusting for confounding factors SDANN and pNN50,SDNN was a risk factor for the severity of coronary artery disease(OR:0.952,95%CI:0.934-0.971,P<0.001).At the same time,in the coronary artery lesion count group,the distributions of SDNN,SDANN,rMSSD,and pNN50 in each group were not all the same(P<0.05).Multiple Logistic regression analysis showed that SDNN was a risk factor for the number of coronary artery lesions after adjusting for confounding factors such as SDANN,rMSSD and pNN50(OR:0.972,95%CI:0.955-0.990,P<0.01).Conclusion(s):1.The sympathetic-parasympathetic coordination ability decreased in non-dialysis CKD patients with CAD,and the HRV time domain indicators of non-dialysis CKD patients with CAD are significantly reduced.Decreased SDNN may be a risk factor for CAD in non-dialysis CKD patients.SDNN has high clinical diagnostic value for non-dialysis CKD patients with coronary artery disease.2.SDNN is significantly negatively correlated with the Gensini score and the number of coronary artery disease in non-dialysis CKD patients with CAD.Therefore,SDNN may play an important role in determining the severity of coronary artery disease and the extent of myocardial ischemia.HRV time-domain indicator SDNN can be used as one of the reference methods for non-invasive diagnosis of coronary artery disease and its severity in non-dialysis CKD.