Kalp yetersizliğinde uzun ve kısa süreli kayıtlarda kalp hızı değişkenliğinin kardiyak otonomik disfonksiyonu belirlemede etkinliği ve prognostik değeri

Abstract

Amac: Kalp yetersizligi olan hastalarda, kalp hizi degiskenligi (KHD) olcumleri noninvazif biryuntem olarak kullanilmakta ve noro-kardiyovaskuler du rum hakkinda bilgi edinilebilmektedir. Bu calisma, kalp yetersizliui olan hastalarda 24 saatlik ve kisa sureli KHD yontemlerinin otonomik disfonksiyonu belirlenmesinde etkinliklerini ve prognostik degerlerini belirlemek amaciyla planlanmistir. Yontemler Calismaya, semptomatik veya asemptomatik sol ventrikul disfonksiyonu (ejeksiyon fraksiyonu <%40) olan 46 hasta dahil edildi. Calisma grubunda,16 hasta NYHA evre I (%35),19 hasta NYHA evre II (%41) ve 11 hasta NYHA evre III (%24) olarak siniflandirildi. Hastalarin ilk gun 24 saatlik Holter kayitlarinda KHD analizi yapildi. Ertesi gun, tilt masasi kullanilarak (1) 10 dk supin pozisyonunda istirahat halinde; (2) 10 dk kontrollu solunum sirasinda (20 solunum/dk); ve (3) 10 dk tilt masasini egimi 80'ye getirerek pasif ortostatizm sirasinda alinan Holter kayitlarinda kisa sureli KHD analizi yapildi. Bulgular: Yirmi dort saatlik ve kisa sureli Holter kayitlarinda, NYHA evre III grubunda; hem uzun-donem LF/HF24 (LF-dusuk frekans, HF-yuksek frekans), hem de kisa sureli LF/HFsupin, LF/HFsolunum ve LF/HFtilt oranlari NYHA evre I-II grubuna oranla anlamli olarak azalmisti (sirasiyla; p=0.0001, p=0.01, p=0.03, p=0.0001). Hastalarm 446 ± 186 gunluk takip suresinde, 20 olguda birlesik kardiyovaskuler son noktalar gelisti. Cox cok degiskenli analizlerde azalmi 24 saatlik LF/HF oraninin (HR=0.4, %95 CI 0.31-0.73, p=0.001) ve dusuk sol ventrikul ejeksiyon fraksiyonunun (HR=0.9, %95CI 0.83-0.99, p=0.03) artmis kardiyovaskuler mortalite ve morbidite ile iliskili oldugu belirlendi. Sonuc: Calismamiz her iki yontemin kardiyak otonomik disfonksiyonun belirlenmesinde etkin oldugunu ve sadece 24 saatlik KHD ulcumlerinin prognostik deger tasidigini gosterdi. (Anadolu Kardiyol Derg 2007; 7: 118-23).Objective: The heart rate variability (HRV) has been used in patients with heart failure as a non-invasive method and provided neuro-cardiovascular evaluation. This study was planned to determine the efficacy and prognostic value of 24-hour and short time HRV in autonomic dysfunction in patients with congestive heart failure. Methods: Forty-six patients with symptomatic or asymptomatic left ventricular dysfunction (ejection fraction <40%) were included to the study. In the study group, 16 patients were in NYHA class I (35%), 19 - were in NYHA class II (41%) and 11- were in NYHA class III (24%). In the first day, HRV was evaluated from the 24-hour Holier recordings. Following day; we assessed the HRV during: (1) 10 min of supine resting, (2) 10 min of regular breathing at a frequency of 20 acts/min, and (3) 10 min of passive orthostatism after tilting 80, with tilt table. Results: Twenty-four hour and short time recordings of HRV showed significant decrease in long-term LF/HF24 (LF- low frequency, HF- high frequency), and short-term LF/HFsupine, LF/HFbreathing and LF/HFtilt ratios in patients with NYHA class III when compared with the patients in NYHA class I-II (p=0.0001, p=0.01, p=0.03, p=0.0001, respectively). During 446 186 days of follow-up, cardiovascular end-points occurred in 20 patients. In Cox multivariate analysis, significant predictors of cardiac mortality and morbidity were, reduced LF/HF ratio (HR=0.4, 95% CI 0.31-0.73, p=0.001) in the 24-hour recordings and low left ventricular ejection fraction (HR=0.9, 95% CI 0.83-0.99, p=0.03). Conclusion: Our study demonstrated that both of the methods were useful for assessment of cardiac autonomic dysfunction and only 24-hour recordings of HRV had a prognostic value.