Download Heart rate variability in the course of ST

PRACE ORYGINALNE
Jerzy Wiliński1
Tomasz Sondej1
Aleksander Kusiak1
Bogdan Wiliński2
Tomasz Kameczura1
Bogumiła Bacior1,
Danuta Czarnecka1
Heart rate variability in the course of ST
- segment elevation myocardial infarction
treated with primary percutaneous
transluminal coronary angioplasty in elderly
and younger patients
Zmienność rytmu serca u chorych z zawałem serca
z uniesieniem odcinka ST leczonych pierwotną
przezskórną angioplastyką tętnic wieńcowych w wieku
podeszłym oraz w młodszej grupie wiekowej
I Klinika Kardiologii i Elektrokardiologii
Interwencyjnej oraz Nadciśnienia Tętniczego
Uniwersytet Jagielloński Collegium Medicum
Kierownik:
Prof. dr hab. med. Danuta Czarnecka
1
Zakład Biologii Rozwoju Człowieka,
Instytut Pielęgniarstwa i Położnictwa,
Wydział Nauk o Zdrowiu,
Uniwersytet Jagielloński Collegium Medicum
Kierownik:
Dr hab. Leopold Śliwa
2
Additional key words:
acute coronary syndrome,
myocardial infarction,
percutaneous transluminal angioplasty,
heart rate variability,
heart rate
Dodatkowe słowa kluczowe:
ostry zespół wieńcowy,
zawał serca,
przezskórna angioplastyka wieńcowa,
zmienność rytmu serca,
częstotliwość rytmu serca
Corresponding address:
Jerzy Wiliński MD, PhD
1st Departament of Interventional Cardiology
and Electrocardiology and Hypertension,
Jagiellonian University Medical College,
Kopernika 17, 31-501 Kraków, Poland
Tel. +48 012 424 73 00;
Fax: +48 012 424 73 20
e-mail: [email protected]
Przegląd Lekarski 2014 / 71 / 2
Background: The aim of the study
was to appraise time domain heart rate
variability (HRV) parameters in patients
with ST-segment elevation myocardial
infarction (STEMI) in different age
groups.
Material and methods: Retrospective analysis included 357 consecutive
patients in sinus rhythm without diabetes, aged 27 – 87 years (mean age
– 63.0 ± 11.8 years, 243 men) treated
with primary percutaneous transluminal coronary angioplasty (PTCA) due
to first in their life STEMI. Each patient
had an echocardiographic examination
and 24-hour ECG monitoring results
interpreted. Participants were divided
in the analysis applying the WHO old
age criterion into two groups: group A
< 65 years old (n = 188) and B aged ≥
65 years (n = 169).
Results: In the whole study group
age negatively correlated with SDNN,
SDANNI, SDNNI and EF, whereas
positive correlation between EF and
SDANN, and EF and SDNNI was observed. Elderly patients as compared
to the younger individuals had significantly diminished SDNN, SDANN,
SDNNI and more often SDNN <70 ms
(33.7% vs 20.7%, p<0.0001). When the
circumflex artery lesion was the cause
of myocardial infarction SDNN and
SDANN were significantly lower in the
group B, whereas in case of PTCA of
RCA, apart from decreased SDNN and
SDANN, EF was also compromised in
this group.
Conclusions: Elderly patients with
myocardial infarction with ST-segment
elevation treated with primary PTCA,
compared to the younger age group,
are characterized by increased sympathetic activation assessed by heart
rate variability and heart rate in 24-hour
ECG monitoring.
Tło: Celem pracy była ocena parametrów analizy czasowej zmienności
rytmu serca (HRV) u chorych z zawałem
serca z uniesieniem odcinka ST (STEMI) w różnych grupach wiekowych.
Materiał i metody: Retrospektywną
analizą objęto 357 kolejnych chorych
bez cukrzycy, w wieku 27 – 87 lat
(średnio 63,0 ± 11,8 lat; 243 mężczyzn)
leczonych pierwotną przezskórną
angioplastyką wieńcową (PTCA) z
powodu pierwszego w życiu STEMI. U
każdego chorego analizowano wyniki
przezklatkowego badanie echokardiograficznego oraz 24-godzinnego
monitorowania EKG metodą Holtera.
Chorych podzielono przyjmując kryterium wieku 65 lat na dwie grupy - grupa
A: < 65 lat – 188 chorych oraz grupa B:
≥ 65 lat – 169 osób
Wyniki: W całej badanej grupie
obserwowano negatywną korelację
pomiędzy wiekiem oraz parametrami
HRV: SDNN, SDANNI, SDNNI i frakcją
wyrzutową lewej komory serca (EF),
podczas gdy odnotowano pozytywne
korelacje pomiędzy EF i SDANN oraz
EF i SDNNI. Osoby starsze w porównaniu do grupy młodszej cechowały
się istotnie niższymi wartościami
SDNN, SDANN, SDNNI oraz częstszym
występowaniem SDNN <70 ms (33,7%
vs 20,7%, p<0,0001). Gdy tętnicą
zawałową była gałąź okalająca lewej
tętnicy wieńcowej SDNN i SDANN
były istotnie niższe w grupie B. Przy
lokalizacji zmiany w RCA u tych chorych, oprócz istotnie niższych wartości
SDNN, SDANN, obserwowano niższą
EF.
Wnioski: U chorych w wieku
podeszłym w porównaniu do pacjentów
młodszych zawał serca z uniesieniem
odcinka ST leczony pierwotną PTCA
wiąże się ze zwiększoną aktywacją
sympatyczną ocenianą za pomocą
HRV i częstotliwością rytmu serca w
24-godzinnym monitorowaniu EKG.
61
Introduction
Myocardial ischemia in the course of
acute coronary syndrome (ACS) is associated with a broad array of autonomic nervous
system functional changes. The enhanced
sympathetic activation increases the oxygen
demand, myocardial electrical instability,
platelets aggregation ability, it affects the
endothelial and coronary arteries’ smooth
muscle function and promotes arrhythmias
[1]. Heart rate variability (HRV), which can
be assessed i.a. within 24-hour ECG Holter
monitoring, reflects the autonomic nervous
system activity [2].
One of the most important aspects of
post-ACS follow-up is the identification of the
individuals at high risk of sudden cardiac death (SCD). These patients demand special
cardiologic care, specific pharmacotherapy
and many times the difficult decision of the
cardioverter-defibrillator implantation [3].
This is a serious concern of people aged
≥65 years, specifically categorized as the
elderly patients, who are affected by anatomical and functional changes in the cardiovascular system stemming from the ageing
process, numerous concomitant diseases
and differences in the myocardial infarction
course [4]. HR and HRV evaluation within
the 24-hour ECG Holter monitoring pose a
potentially useful tool in the estimation of
SCD risk in patients after ACS [5-7].
The aim of the study was to assess the
time domain HRV parameters in patients
with first in their life myocardial infarction
with persistent ST-segment elevation
(STEMI) treated with the percutaneous
transluminal coronary angioplasty (PTCA) in
different age groups: in elderly individuals as
compared to the younger persons.
Material and methods
The retrospective analysis included 357
consecutive patients aged 27 – 87 years
(average age: 63.0 ± 11.8 years; 243 men,
114 women) without diabetes, admitted
to the 1st Department of Cardiology and
Hypertension between 2007 and 2010 AD
due to first in their life STEMI treated with
primary PTCA. Individuals with left main artery stenosis, three-vessel coronary disease
and cardiogenic shock during the hospitalization, atrial fibrillation and other atrial
tachyarhythmias were excluded from the
study. In the whole analyzed group 73.0%
had hypertension, 79.1% had dyslipidaemia,
43.0% the history of smoking. The clinical
characteristics is presented in the Table I.
The participants had the 24-hour ECG monitoring performed in the fourth or fifth day
of the hospitalization (DMS300-3A Digital
Recorders, software Cardioscan 11, Oxford
Pol; tracings verified and data cleared of
artifacts by experienced technicians) and a
standard transthoracic echocardiographic
examination done (Vivid 7 ultrasound machine, GE Healthcare) [8]. In the 24-hour
ECG monitoring the following parameters
were appraised: the maximum, minimum
and average heart rate (max HR, min HR,
average HR, respectively), the numbers of
ventricular and supraventricular extrasystoles (VE and SVE, respectively), time domain
HRV parameters: the standard deviation of
NN intervals (SDNN), the standard deviation
of the average NN (SDANN), the average of
the standard deviation of NN (SDNNI), the
square root of the mean squared difference
of successive NNs (rMSSD), the proportion
of the number of pairs of successive NNs
that differ by more than 50 ms divided by
total number of NNs (pNN50).
In the echocardiographic examination
the end-diastolic left ventricular diameter, left
ventricular ejection fraction (EF), left atrial
diameter and right ventricular diameter were
included in the analysis.
HRV parameters were compared between male and female groups and among
various artery-related ACS. The correlations
between age, EF and HRV variables, and
the prevalence of SDNN < 70 ms were
assessed. Subsequently, the patients were
divided into two groups regarding the age
Table I
Clinical characteristics and medication administered of the patients groups: A (<65 years old) and B (≥65
years old).
Charakterystyka kliniczna chorych w grupach A (wiek <65 lat) i B (wiek ≥65 lat).
Parameter
Group A (n=188)
Group B (n=169)
p
Age (years)
53.5 ± 7.0
73.5 ± 5.3
<0.0001
Male gender (%)
80.8
53.8
<0.0001
Female gender (%)
19.2
46.2
<0.0001
BMI (kg/m2)
27.5 ± 4.4
27.8 ± 4.3
ns
Hypertension (%)
64.4
82.9
<0.0001
Hyperlipidaemia (%)
80.9
75.7
ns
Smoking (%)
64.4
16.7
<0.0001
Aspirin (%)
99
97
ns
Clopidogrel (%)
98
96
ns
ACEI or ARB (%)
84
76
<0.01
Statin (%)
95
94
ns
β-blocker (%)
94
92
ns
BMI – body mass index, ns – statistically not significant, ACEI – angiotensin-converting enzyme inhibitor,
ARB – angiotensin receptor blocker, ns – statistically not significant
62
criterion: the group A < 65 years old participants (n=188) and the group B ≥ 65 years
old individuals (n=169). HRV parameters
were analyzed with respect to the myocardial infarction-related artery (circumflex
artery – CX, left anterior descending artery–
LAD, right coronary artery – RCA).
The statistical analysis was performed
with the SAS System software 9.1 version
(SAS Institute Inc., Cary North Karolina,
USA). The Kolmogorov-Smirnov test was
applied to examine a normal distribution.
The mean values of certain parameters
were compared with the use of the Student-t
test or the Mann Whitney U test for the quantitative variables and chi-square test for
qualitative variables. Spearman’s rank correlation coefficient was applied to assess the
correlation indexes. For the analysis of variance (ANOVA) the Kruskal–Wallis one-way
analysis of variance by ranks was utilized.
The statistical significance was considered
when p<0.05. The data are presented as
mean values ± standard deviation (SD) or
as a percentage share of the patients in the
analyzed groups.
The study design was compliant with
the Helsinki Declaration of 1975 as revised
in 1996.
Results
Gender role
SDNN, SDANN and SDNNI were higher
in men than in women, although in the age
subgroups (<65 years and ≥65 years) analysis the significant difference concerned only
SDNNI in patients aged at least 65 years
(41.5 ± 14.7 ms in male patients vs 35.3 ±
13.5 ms in female patients, p=0.023). No
gender difference regarding EF in the whole
study group and different age subgroups
was noted.
Correlations analysis
In the whole study group significant correlation between EF and SDANN (r=0.143,
p=0.040) and SDNNI (r=0.137, p=0.049)
was observed. Age was associated with
SDNN (r = - 0.274, p<0.001), SDANNI (r
= - 0.247, p<0.001), SDNNI (r = - 0.300;
p<0.001) and EF (r = - 0.254, p<0.001).
SDNN < 70 ms prevalence, HRV parameters and the ACS related artery
No differences regarding the prevalence
to SDNN < 70 ms between male and female
patients and in the analysis of various infarct-related artery groups were recorded.
HRV parameters did not differ among LAD,
RCA and CX-related ACS in the whole
study group.
Aged <65 years vs ≥65 years comparison
In the group of elderly patients the percentage share of women was dominant and
the arterial hypertension prevalence was higher. Considering medication, the difference
regarded only angiotensin-converting enzyme inhibitors (ACEI) or angiotensin receptor
blockers (ARB) that were administered more
often in the younger group (Table I). In the
echocardiographic parameters comparison
the older group had significantly decreased
EF and larger left atrial diameter (Table II).
J. Wiliński i wsp.
They had also higher average and minimum
heart rate and more supraventricular extra
systoles. Considering the time domain HRV
parameters, the aged patients had remarkably lower SDNN, SDANN, SDNNI and more
often SDNN < 70 ms (Table III). When the
relation of HRV and the infarction artery was
analyzed the differences between the two
various age groups were noted regarding
CX and RCA. If CX was the infarction-related
artery SDNN and SDANN were markedly
decreased in the old age group. When
RCA occlusion or stenosis was the cause of
ACS, apart from compromised SDNN and
SDANN, significantly lower EF accompanied
by increased minimum HR and average HR
were observed in the ≥65-year-old individuals (Table IV).
If HRV parameters were analyzed with
respect to the ACS artery within each group,
in the younger patients rMSSD and pNN50
were lower in LAD-related STEMI as compared to RCA undergone PTCA (p<0.05). In
the group B only pNN50 differentiated LAD
and RCA subgroups (p<0.01).
Discussion
Demographic changes and the ageing
of Western societies result in remarkable
numbers of old people affected by ACS.
Elderly patients had a different profile of
concomitant diseases from the younger
persons [4]. This was also observed in the
presented analysis. In the aged group the
share of women and patients with the history of hypertension was markedly higher,
while the smokers’ share reduced, what is
in concordance with epidemiological studies
[9]. A slight reduction in HRV parameters
along with rising age, independent of comorbidities such as ischemic heart disease
or diabetes, was noted in different publications [10]. Also our survey displayed agedependent changes of SDNN, SDANNI and
SDNNI. Analogically, a decline in EF with
age was also recorded although patients
with the history of myocardial infarction
were not enrolled in the study. The gender
analysis, affected by unequal female and
male shares, showed no significant sex
impact on time domain HRV parameters in
STEMI, despite the fact that the influence
of gender on HRV was previously reported
[11,12]. The dichotomized comparison using
the age of 65 years border revealed lower
EF, larger atrial diameter and increased
Table II
Selected echocardiographic parameters of the patients groups: A (<65 years old) and B (≥65 years old).
Wybrane parametry echokardiograficzne chorych w grupach A (wiek <65 lat) i B (wiek ≥65 lat).
Parameter
Group A (n=188)
Group B (n=169)
p
EF (%)
51.9 ± 8.4
46.7 ± 9.6
<0.0001
LVEDd (mm)
52.5 ± 6.1
52.3 ± 7.0
ns
LVESd (mm)
36.6 ± 6.6
36.1 ± 8.2
ns
LAd (mm)
40.8 ± 5.4
43.4 ± 5.7
<0.0001
RVd (mm)
23.3 ± 3.1
24.1 ± 3.8
ns
EF – left ventricular ejection fraction, LVEDd – left ventricular end-diastiolic diameter, LVESd – left ventricular end-systolic diameter, LAd – left atrial diameter, RVd – right ventricular diameter, ns – statistically not
significant
Table III
Heart rate and time domain heart rate variability parameters assessed within 24-hour ECG Holter monitoring
of the patients groups: A (<65 years old) and B (≥65 years old).
Parametry analizy czasowej zmienności rytmu serca w 24-godzinnym monitorowaniu EKG metodą Holtera w grupach
A (wiek <65 lat) i B (wiek ≥65 lat).
Parameter
Group A
(n=188)
Group B
(n=169)
HR max (bpm)
102.3 ± 16.5
105.3 ± 22.4
ns
HR min (bpm)
51.2 ± 8.3
53.8 ± 8.7
0.016
HR average (bpm)
70.8 ± 10.1
73.7 ± 11.6
0.033
VE (No. per 24 h)
139.5 ± 753.1
216.4 ± 948.4
ns
SVE (No. per 24 h)
276.0 ± 1826.3
799.3 ± 2785.3
< 0.0001
SDNN (ms)
94.6 ± 35.2
81.3 ± 23.0
0.0004
SDANN (ms)
81.6 ± 29.8
69.5 ± 23.3
0.0003
SDNNI (ms)
46.0 ± 20.7
38.5 ± 13.8
0.0007
rMSSD (ms)
26.9 ± 17.9
33.1 ± 21.1
ns
pNN50 (%)
6.2 ± 7.4
10.3 ± 13.9
ns
SDNN < 70 ms
39 (20.7%)
59 (33.7%)
< 0.0001
p
HR max – maximum heart rate, HR min - minimum heart rate, HR average - average heart rate, VE - numbers
of ventricular extrasystoles, SVE – number of supraventricular extrasystoles, SDNN – the standard deviation
of NN intervals, SDANN – the standard deviation of the average NN, SDNNI – the average of the standard
deviation of NN, rMSSD - the square root of the mean squared difference of successive NNs, pNN50 - the
proportion of the number of pairs of successive NNs that differ by more than 50 ms divided by total number
of NNs, ns – statistically not significant
Table IV
Left ventricular ejection fraction and time domain heart rate variability parameters in the patients groups: A (<65 years old) and B (≥65 years old) with respect to the
coronary artery undergone percutaneous transluminal angioplasty.
Frakcja wyrzutowa lewej komory serca oraz parametry analizy czasowej zmienności rytmu serca w grupach A (wiek <65 lat) i B (wiek ≥65 lat) w zależności od tętnicy poddawanej
angioplastyce.
Group A (n=188)
Group B (n=169)
CX (n=41)
LAD (n=66)
RCA (n=81)
CX (n=36)
LAD (n=69)
RCA (n=64)
EF (%)
51.0 ± 7.4
47.4 ± 9.3
54.8 ± 6.3***
50.4 ± 10.4
44.4 ± 9.4
48.2 ± 6.5
HR max (bpm)
102.3 ± 12.3
104.6 ± 18.0
99.9 ± 17.1
96.6 ± 29.4
108.1 ± 18.1
105.5 ± 20.2
HR min (bpm)
52.5 ± 8.2
54.2 ± 8.7
49.8 ± 7.6**
53.1 ± 9.5
56.6 ± 7.6
53.4 ± 9.0
HR average (bpm)
71.5 ± 9.1
74.1 ± 11.3
69.3 ± 9.5*
72.5 ± 10.8
76.2 ± 11.1
73.1 ± 11.8
VE (No. per 24 h)
388.3 ±1585.4
115.6 ± 322.5
68.2 ± 246.5
123.0 ± 428.6
211.7 ± 1154.3
87.9 ± 300.0
SDNN (ms)
87.6 ± 23.3**
82.3 ± 25.1
100.8 ± 41.9***
67.5 ± 12.4
82.0 ± 22.9
81.5 ± 26.0
SDANN (ms)
76.4 ± 21.9**
70.7 ± 22.0
86.5 ± 33.6**
57.6 ± 12.7
73.8 ± 23.6
69.5 ± 27.0
rMSSD (ms)
25.8 ± 9.0
22.3 ± 13.7
29.7 ± 23.2
25.8 ± 15.8
27.7 ± 14.2
32.0 ± 20.0
pNN50 (%)
5.8 ± 5.5
4.4 ± 7.5
7.2 ± 8.4
6.8 ± 13.8
6.4 ± 8.8
13.9 ± 14.4
*p<0.05, **p<0.01, *** p< 0.001 – for the comparisons between the groups <65 years old and ≥65 years old; EF – left ventricular ejection fraction, CX – circumflex artery,
LAD – left anterior descending artery, RCA – right coronary artery; other abbreviations explained in the Table 3 footnotes.
Przegląd Lekarski 2014 / 71 / 2
63
number of supraventricular extra systoles
it the elderly group what should rather be
accrued to concomitant diseases than to
the effects of ageing of the cardiovascular
system itself [13]. Noteworthy, apart from
ACEI/ARB administration, medication showed no difference regarding β-blocker use,
which could affect the autonomic nervous
system functional status. The influence of
physical activity on HR and HRV was limited
due to in-hospital settings and restricted to
a rehabilitation programme what eliminates
the remarkable impact of exercise on the
autonomic nervous system [14].
In the guidelines of the European Society of Cardiology on the management of acute
myocardial infarction in patients presenting
with persistent ST-segment elevation the
stratification of the risk of life-threatening
ventricular arrhythmias and SCD is based
largely on the EF measurement [6,7]. Nevertheless, data from literature indicate that
HRV and HR have a prognostic value independent of EF and heart failure symptoms
[15-18]. This is of great importance among
post-infarction patients with better preserved
left ventricular function in whom sudden
deaths prevail [19]. HR assessed in 1054
hospitalized patients presenting with myocardial infarction independently related to
overall mortality during the follow-up period
of one year [5]. Resting HR at discharged
remained a strong predictor of mortality
and HR ≥ 70 b.p.m. indicated two times
increased risk of cardiovascular mortality at
four-year follow-up in 1453 STEMI patients
treated in primary PTCA [20]. Interestingly,
in our study both analyzed age subgroups
were characterized by average HR exceeding 70 b.p.m. and elderly participants had
the HR significantly higher.
Decreased time domain HRV parameters (fall in SDNN and the markers of the
vagal nerve activity: pNN50, r-MSSD) and
frequency domain HRV measures (highfrequency activity: HF and low-frequency to
high-frequency components ratio - LF/HF
ratio) are considered to be features of autonomic nervous system function impairment
[4]. In our analysis the older group presented
with lower SDNN, SDANN, SDNNI as compared to the younger individuals. Analogical
observations come from the study of Karp et.
al. in which the decreased HRV in patients
with ACS was associated not only with older
age, but also with higher concentrations of
creatine kinase MB, later arrival time to the
hospital, a greater degree of left ventricular
dysfunction, ischemia area location within
the anterior wall of the left ventricle, a high
degree of Killip class and intrahospital complications [1]. According to the metaanalysis
of Buccelletti et al., which included 3489
patients with myocardial infarction who had
HRV assessed, SDNN < 70 ms was associated with nearly four times higher overall
mortality rate in the three-year follow-up
compared to patients in whom this parameter
equaled at least 70 ms (21.7% vs 8.1%) [21].
Olasińska-Wiśniewska et al. have shown that
patients with ACS and SDNN < 70 ms were
characterized by older age (63.3 years vs
56.0 years), had more often the history of
hypertension, lower EF, what is analogical
to our observations, and had higher levels
64
of serum creatine kinase [22].
It has been demonstrated that the restoration of the patency of the vessel responsible for a myocardial infarction significantly
improves the impaired HRV profile [23-25].
However, Airaksinen et al. revealed that it is
hard to predict the effects of either occlusion
or the restoration of the artery patency on
the autonomic nervous system, since the
outcome seems to be dependent on many
other factors and is often variable among
individuals [26]. Nevertheless, JanowskaKulińska et al. have managed to present
certain patterns of functional autonomic
responses with regards to the vessel undergoing PTCA [27].
The HRV profile of the elderly patients
differed in our analysis from the one of the
younger age group. In <65-year-old individuals, like in the GUSTO ECG trial, HRV
parameters were lower when LAD was
responsible for the myocardial infarction as
compared to other arteries [28]. The elderly
patients group, opposed to the younger counterparts, had lower HRV parameters when
CX or RCA underwent PTCA. One reason
for these differences may be the presence
of a more developed collateral circulation in
the elderly. Ozdemr et al. displayed that the
collateral circulation has a crucial impact on
HRV in the course of ACS [29]. In addition,
elderly patients in whom an infarction vessel
was RCA were characterized by lower EF at
higher values ​​of minimum and average HR.
The importance of preliminary data requires
confirmation in long-term observations,
since, despite the vascular lesion location
responsible for ACS, many other factors
potentially influence the autonomic nervous
system function [30-33].
Conclusions
Time domain heart rate variability parameters are associated with age and left
ventricular ejection fraction in patients with
ST elevation acute coronary syndrome treated with primary percutaneous transluminal
coronary angioplasty.
Elderly patients with acute myocardial
infarction with ST-segment elevation treated
with primary percutaneous transluminal coronary angioplasty, compared to the younger
age group, are characterized by increased
sympathetic activation assessed by heart
rate variability and heart rate within 24-hour
ECG monitoring.
Right coronary artery-related myocardial
infarction with ST-segment elevation treated
with primary percutaneous transluminal
coronary angioplasty in patients aged ≥65
years as compared to younger individuals is
associated with not only increased sympathetic activation appraised by time domain
heart rate variability parameters, but also
compromised left ventricular systolic function estimated by echocardiography.
References
1. Karp E, Shiyovich A, Zahger D, Gilutz H, Grosbard
A, Katz A: Ultra-short-term heart rate variability for
early risk stratification following acute ST-elevation
myocardial infarction. Cardiology 2009; 114: 275283.
2. Chattipakorn N, Incharoen T, Kanlop N, Chattipakorn S: Heart rate variability in myocardial infarction
and heart failure. Int J Cardiol. 2007; 120: 289-296.
3. Zipes DP, Camm AJ, Borggrefe M, Buxton AE,
Chaitman B et al: ACC/AHA/ESC 2006 guidelines
for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death-executive summary: A report of the American College
of Cardiology/American Heart Association Task Force
and the European Society of Cardiology Committee
for Practice Guidelines (Writing Committee to Develop Guidelines for Management of Patients with
Ventricular Arrhythmias and the Prevention of Sudden
Cardiac Death) Developed in collaboration with the
European Heart Rhythm Association and the Heart
Rhythm Society. Eur Heart J. 2006; 27: 2099-2140.
4. Polewczyk A, Janion M, Gąsior M, Gierlotka M:
Myocardial infarction in the elderly. Clinical and therapeutic differences. Kardiol Pol. 2008; 66: 166-172.
5. Facila L, Morillas P, Quiles J, Soria F, Cordero A. et
al: Prognostic significance of heart rate in hospitalized
patients presenting with myocardial infarction. World
J Cardiol. 2012; 4: 15-19.
6. Steg G, James SK, Atar D, Badano LP, BlömstromLundqvist C. et al: European Society of Cardiology
Guidelines for the management of acute myocardial
infarction in patients presenting with ST-segment
elevation. Eur Heart J. 2012; 33: 2569-2619.
7. Van de Werf F, Bax J, Betriu A, BlomstromLundqvist C, Crea F. et al: Management of acute
myocardial infarction in patients presenting with
persistent ST-segment elevation: the Task Force on
the Management of ST-Segment Elevation Acute
Myocardial Infarction of the European Society of
Cardiology. Eur Heart J. 2008; 29: 2909-2045.
8. Kasprzak D, Hoffman P, Płońska E, Szyszka A,
Braksator W. i wsp: Echokardiografia w praktyce
klinicznej – Standardy Sekcji Echokardiografii Polskiego Towarzystwa Kardiologicznego 2007. Kardiol
Pol. 2007; 65: 1142-1162.
9. Panico S, Mattiello A: Epidemiology of cardiovascular diseases in women in Europe. Nutr Metab
Cardiovasc Dis. 2011; 20: 379-385.
10. Stein PK, Barzilay JI, Chaves PH, Domitrovich
PP, Gottdiener JS: Heart rate variability and its
changes over 5 years in older adults. Age Aging
2009; 38: 212-218.
11. Moodithaya S, Avadhany ST: Gender differences in
age-related changes in cardiac autonomic nervous
function. J Aging Res. 2012; 2012: 679345.
12. Sookan T, McKune AJ: Heart rate variability in
physically active individuals: reliability and gender
characteristics. Cardiovasc J Afr. 2012; 23: 67-72.
13. Wieczorowska-Tobis K: Zmiany narządowe w
procesie starzenia. Pol Arch Med Wewn. 2008;
118: 63-69.
14. Santos-Hiss MD, Melo RC, Neves VR, Hiss FC,
Verzola RM. et al: Effects of progressive exercise
during phase I cardiac rehabilitation on the heart rate
variability of patients with acute myocardial infarction.
Disabil Rehabil. 2011; 33: 835-842.
15. Bigger JT Jr, Fleiss JL, Steinman RC, Rolnitzky
LM, Kleiger RE, Rottman JN: Frequency domain
measures of heart period variability and mortality
after myocardial infarction. Circulation 1992; 85:
164-171.
16. Cripps TR, Malik M, Farrell TG, Camm AJ: Prognostic value of reduced heart rate variability after
myocardial infarction: clinical evaluation of a new
analysis method. Br Heart J. 1991; 65: 14-19.
17. Stein KM: Noninvasive risk stratification for sudden death: signal-averaged electrocardiography,
nonsustained ventricular tachycardia, heart rate
variability, baroreflex sensitivity, and QRS duration.
Prog Cardiovasc Dis. 2008; 51: 106-117.
18. Trusz-Gluza M, Filipecki A, Wita K: Nagła śmierć
sercowa - jak przewidywać? Pol Przegl Kardiol.
2007; 9: 125-129.
19. Perkiomaki JS: Heart rate variability and non-linear
dynamics in risk stratification. Front Physiol. 2011;
2: 81.
20. Antoni ML, Boden H, Delgado V. et al: Relationship
between discharge heart rate and mortality in patients
after acute myocardial infarction treated with primary
percutaneous coronary intervention. Eur Heart J.
2012; 33: 96-102.
21. Buccelletti E, Gilardi E, Scaini E, Boersma E, Fox
K. et al: Heart rate variability and myocardial infarction: systematic literature review and metanalysis. Eur
Rev Med Pharmacol Sci. 2009; 13: 299-307.
22. Olasińska-Wiśniewska A, Mularek-Kubzdela T,
J. Wiliński i wsp.
Seniuk W, Bręborowicz P, Wachowiak-Baszyńska
H. et al: Prognostic value of decreased heart rate
variability in long-term follow-up in patients with acute
myocardial infarction treated with fibrynolysis. Arch
Med Sci. 2009; 5: 97-102.
23. Hermosillo AG, Dorado M, Casanova JM, Ponce de
Leon S, Cossio J. et al: Influence of infarct-related
artery patency on the indexes of parasympathetic
activity and prevalence of late potentials in survivors
of acute myocardial infarction. J Am Coll Cardiol.
1993; 22: 695-706.
24. Klecha A, Bryniarski L, Dragan J, Królikowski T,
Jankowski P. i wsp: Wpływ udrożnienia przewlekle
zamkniętych tętnic wieńcowych na zmienność rytmu
serca. Przegl Lek. 2002; 59: 687-690.
25. Szydło K, Trusz-Gluza M, Drzewiecki J, WoźniakSkowerska I, Szczogieł J: Correlation of heart rate
variability parameters and QT interval in patients
after PTCA of infarct related coronary artery as an
indicator of improved autonomic regulation. Pacing
Clin Electrophysiol. 1998; 21: 2407-2410.
Przegląd Lekarski 2014 / 71 / 2
26. Airaksinen KE, Ikaheimo MJ, Huikuri HV, Linnaluoto MK, Takkunen JT: Responses of heart rate
variability to coronary occlusion during coronary
angioplasty. Am J Cardiol. 1993; 72: 1026-1030.
27. Janowska-Kulińska A, Torzyńska K, MarkiewiczGrochowalska A, Sowińska A, Majewski M. et al:
Changes in heart rate variability caused by coronary
angioplasty depend on the localisation of coronary
lesions. Kardiol Pol. 2009; 67: 130-138.
28. Singh N, Mironov D, Armstrong PW, Ross AM,
Langer A: Heart rate variability assessment early
after acute myocardial infarction. Pathophysiological
and prognostic correlates. GUSTO ECG Substudy
Investigators. Global Utilization of Streptokinase
and TPA for Occluded Arteries. Circulation 1996;
93: 1388-1395.
29. Ozdemr O, Soylu M, Demr AD, Geyk B, Alyan O. et
al: Do collaterals affect heart rate variability in patients
with acute myocardial infarction? Coron Artery Dis.
2004; 15: 405-411.
30. Monmeneu JV, Chorro FJ, Bodi V, Sanchiz J,
Llacer A. et al: Relationships between heart rate
variability, functional capacity, and left ventricular
function following myocardial infarction: an evaluation
after one week and six months. Clin Cardiol. 2001;
24: 313-320.
31. Szot WM, Bacior B, Hubalewska-Hola A, Grodecki
J, Szybiński Z. et al: Early and late changes in myocardial function and heart rate variability in patients
after myocardial revascularisation. Nucl Med Rev
Cent East Eur. 2002; 5: 113-119.
32. Szwoch M, Ambroch-Dorniak K, Sominka D,
Dorniak W, Daniłowicz-Szymanowicz Ł. et al:
Comparison the effects of recanalisation of chronic
total occlusion of the right and left coronary arteries
on the autonomic nervous system function. Kardiol
Pol. 2009; 67: 467-474.
33. Piotrowicz R, Król J: Dynamiczna elektrokardiografia. In: Nagła śmierć sercowa, Dłużniewski M, editor.
Lublin (Polska): CZELEJ 2009: 81-93.
65