LF、HF与LF/HF在心率变异性分析中的应用与争议

心率变异性(heart rate variability, HRV)指连续正常心动周期的微小差异，是评估自主神经调节功能的重要指标。尽管HRV的LF(low frequency)、HF(high frequency)、LF/HF等频域指标被广泛用于评估交感神经系统与副交感神经系统的活性及其两者的相互调节作用，然而它们作为衡量自主神经系统功能指标的有效性一直受到质疑。本研究剖析了有关LF、HF与LF/HF等频域指标意义的不同观点，探讨了其作为评估自主神经系统功能的合理性与有效性。本研究认为，LF虽然受到交感神经活动的控制，但由于同时受迷走神经活动等其他因素的影响，且此影响程度较大，不建议单独使用LF以反映交感神经系统的活动；HF主要受心脏迷走神经的控制，能够较准确的反映迷走神经系统活动；LF/HF在一定程度上能够反映自主神经系统的调节作用，但由于存在非线性关系和其他因素的影响，LF/HF这一指标并不精准。     

原发性高血压患者心率变异性及血压变异性与血管损害的相关性研究

目的:探讨原发性高血压患者心率变异性(HRV)及血压变异性(BPV)与血管损害的相关性。方法:选取2014年12月到2017年12月期间在我院接受治疗的原发性高血压患者94例,根据脉搏波传导速度(PWV)的不同分为对照组(60例)和血管受损组(34例)。比较两组患者的HRV、BPV指标,并分析PWV与HRV、BPV指标的相关性。结果:血管受损组的5 min心搏R-R间期平均值的标准差(SDANN)低于对照组,低频(LF)、高频(HF)、低高频之比(LF/HF)高于对照组,差异均有统计学意义(P0.05);血管受损组的24h平均收缩压(24h SBP)、24h平均脉压(24h PP)、白天平均收缩压(dSBP)、白天平均脉压(dPP)、夜间平均收缩压(nSBP)、夜间平均脉压(nPP)高于对照组,差异均有统计学意义(P0.05);PWV与LF、HF、LF/HF、24h SBP、24h PP、dSBP、dPP、nSBP、nPP均呈正相关(P0.05)。结论:原发性高血压患者部分HRV、BPV指标与PWV呈明显的相关性,说明HRV和BPV与患者的血管损害密切相关。     

创伤患者伤后自主神经功能的研究

目的:探讨创伤惠者伤后自主神经的功能改变。方法:应用HRV频域分析观察创伤患者伤后自主神经功能的变化情况。30例创伤患者依照ISS评分分为轻伤、重伤和严重伤三组,分别收集伤后第1天、第7天和第14天上午8点至10点间的心电图资料,选取其中5分钟的无干扰、无早搏的心电图数据,应用频域分析法进行短时程HRV分析。结果:创伤患者伤后早期HRV的低频功率(low-frequency,LF)、高频功率(high-frequency,HF)均明显降低;但LF/HF却明显升高。结论:伤后早期自主神经功能有明显改变,即交感神经兴奋性增高,迷走神经兴奋性降低。损伤越严重,这种改变越明显。随着病情的缓解,LF、HF逐渐升高,LF/HF逐渐降低,交感神经和副交感神经之间的平衡逐渐恢复。     

特发性室性早搏与心率变异性的相关性分析

目的:探讨特发性室性早搏(IPVCs)与心率变异性(HRV)的相关性。方法:回顾性分析2016年2月～2018年2月我院心内科收治的150例IPVCs患者的临床资料,根据负荷量、心功能,将IPVCs患者分别分为低负荷组(1%～10%,n=51)、中负荷组(10%～20%,n=65)、高负荷组(20%,n=34)及LVEF50%组(n=106)、LVEF≤50%组(n=44)。另选取同期健康者50例作为对照组。检测和比较各组HRV相关指标变化,并分析IPVCs与HRV的相关性。结果:高负荷组RMMSD、PNN50明显低于对照组、低负荷组和中负荷组,中负荷组和高负荷组LF、HF明显低于对照组、低负荷组(P0.05),高负荷组LF、HF均明显低于中负荷组(P0.05)。LVEF≤50%组RMMSD、PNN50、LF、HF较对照组、LVEF50%组明显降低(P0.05)。IPVCs负荷与LVEDD、LVESD呈显著正相关,与LVEF呈显著负相关(P0.05)。IPVCs负荷与RMMSD、PNN50、LF、HF呈显著负相关(P0.05)。结论:IPVCs的发生与自主神经功能调节失衡有关,迷走神经张力减弱具有重要作用,从而诱发HRV异常。     

肌电生物反馈对脑梗死急性期心率变异性的影响

为观察肌电生物反馈对脑梗死急性期心率变异性的影响。本研究选取脑梗死患者60例,随机分为对照组28例和实验组32例,两组均进行常规卒中康复治疗,实验组加做肌电生物反馈治疗。分别于入院一周内和治疗2周检测动态心电图。选取同年龄段、排除脑梗死等影响自主神经活性疾病的动态心电图检查的患者60例,做为正常组,收集其动态心电图数据。正常组与脑梗组比较,脑梗组SDNN、LF、HF值均明显低于正常组(p0.01),LF/HF比值明显高于正常组(p0.05);脑梗死患者中实验组与对照组比较,治疗前两组SDNN、LF、HF、LF/HF均无显著性差异(p0.05);治疗后对照组中SDNN、LF、HF高于治疗前,但无显著性差异(p0.05),LF/HF低于治疗前,但无显著性差异(p0.05);实验组中SDNN、LF、HF明显高于治疗前(p0.01),LF/HF明显低于治疗前(p0.05)。通过相关分析表明脑梗死患者心率变异指标存在异常。研究结果表明肌电生物反馈可以促进脑梗死急性期患者心率变异指标恢复。     

去自主神经效应对环肺静脉消融房颤疗效的影响

目的：探讨去自主神经效应对环肺静脉消融(CPVA)治疗心房颤动(房颤)的远期成功率的影响。方法：选择104 例药物治疗无 效的、有临床症状的阵发性房颤患者作为研究对象,所有患者均接受CPVA 术。分别于术前、术后进行动态心电图检查,术后每3 个月复查一次动态心电。随访房颤消融成功率(术后3个月无房颤被定义为无复发);并记录动态心电心率变异性(HRV)以反映自 主神经功能。结果：本组研究共104 例患者完成了CPVA术,平均手术次数为(1.35术次数为。变次,成功率为77.9%,共随访(24.27 次数为。变异性个月。根据术后是否发生房颤,将患者分为成功组(81例)和复发组(23 例),所有患者CPVA术后的时域和频域各项 参数均显著降低(P<0.01),两组术后心率变异性(HRV) 各项参数均较术前明显降低,成功组患者的SNDD、SDANN、rMSSD、 PNN50、HF、TF、LF、VLF 较对照组患者呈现不同程度的降低。结论：CPVA术可使心房出现去自主神经效应,进而增加去神经化 效应,有利于提高其治疗房颤的远期成功率。     

五指山小型猪高脂血症模型的心脏自主神经功能变化

目的观察五指山小型猪高脂血症模型的心脏自主神经功能的动态变化,探讨血脂异常对自主神经功能的影响和与昼夜的关系。方法利用高脂饮食诱发五指山小型猪高脂血症,造模后,每2周一次测定小型猪TG、TC、HDL-C和LDL-C和监测动态心电图,并进行24 h和昼夜心率变异性（HRV）分析,以评估小型猪的心脏自主神经功能。结果高脂饮食2周后五指山小型猪血清TC、HDL-C、LDL-C水平均显著升高（P〈0.01）,TG水平亦在高脂饮食后6周显著升高（P〈0.05）,其中,TC、LDL-C在高脂饮食0～4周时呈快速上升,在4～6周达到高峰,8～10周基本稳定并维持在一定水平;HDL-C在高脂饮食0～2周迅速上升并达到高峰,2～10周基本稳定。HRV参数分析结果,时域指标（RRI、SDNN、RMSDD、SDANN、PNN50、SDANN index、STV、LTV）和频域指标（VLF、LF、HF和TP）均渐进性显著降低（P〈0.05,P〈0.01）,LF/HF升高（P〈0.05）,夜间HRV参数变化程度均高于白天;相关分析显示HRV各参数与TC、LDL-C、TC/HDL-C、LDL-C/HDL-C具有显著的相关性（P〈0.05,P〈0.01）,经多元线性逐步回归分析发现,SDNN与TC、LDL-C、TC/HDL-C、LDL-C/HDL-C比值的相关性依次为0.673、0.672、0.665、0.681。结论高脂饮食诱发五指山小型猪高脂血症的血脂异常可引起自主神经功能的下降和紊乱,自主神经功能的紊乱程度与高血脂状态的持续时间有关;血脂异常所致心血管疾病的危险程度夜间高于白天;HRV降低与TC、LDL-C、TC/HDL-C和LDL-C/HDL-C比值升高呈一定的依赖性,SDNN降低可作为预测高脂血症引发心血管病风险的独立相关指标。     

先天性心脏病患儿介入封堵术治疗前后CRP、NT-proBNP、心率变异性的变化及与术后心功能的关系研究

摘要 目的：探讨先天性心脏病（CHD）患儿介入封堵术治疗前后C-反应蛋白（CRP）、N末端B型利钠肽原（NT-proBNP）、心率变异性（HRV）的变化及与术后心功能的关系。方法：选择2020年10月至2021年6月在本院行介入封堵术治疗的95例CHD患儿为研究对象,采用化学发光法检测血清CRP水平,采用电化学发光免疫技术检测血清NT-proBNP水平,采用24 h动态心电图及12导联同步心电图分析HRV指标,观察手术前后患儿的血清CRP、NT-proBNP水平及HRV指标变化,比较术后不同NYHA心功能分级患儿的血清CRP、NT-proBNP水平和HRV指标,分析患儿术前血清CRP水平、血清NT-proBNP水平、HRV指标与术后NYHA心功能分级的相关性。结果：介入封堵术后患儿血清CRP、NT-proBNP、LF/HF水平逐渐降低,术后3 d、术后1个月时均低于术前,术后1个月时均低于术后3 d时（P<0.025）;而TP、HF、LF、R-R、PNN50%、ASDNN、SDANN、SDNN、rMSSD水平逐渐升高,术后3 d、术后1个月时均高于术前,术后1个月时均高于术后3 d 时（P<0.025）。患儿术后3 d的血清CRP、NT-proBNP水平及LF/HF水平随着NYHA心功能分级的升高而升高,TP、HF、LF、R-R、PNN50%、ASDNN、SDANN、SDNN、rMSSD水平随着NYHA心功能分级的升高而降低（多有P＜0.05）。患儿术后3 d的NYHA心功能分级与治疗前血清CRP、NT-proBNP及LF/HF水平呈负相关,与TP、HF、LF、R-R、PNN50%、ASDNN、SDANN、SDNN、rMSSD水平呈正相关（P＜0.05）。结论：CHD患儿经介入封堵术治疗后,血清CRP、NT-proBNP及HRV指标变化明显,与术后NYHA心功能分级显著相关,血清CRP、NT-proBNP及HRV指标有望成为评估CHD患儿介入封堵术后预后的较敏感性指标。     

学龄前儿童不同距离往返跑后HR和HRV改变的比较*

目的: 筛选一种适用于评估学前儿童速度和心功能的测试方法。方法: 选取某幼儿园30名健康儿童作为实验对象,分别建立“10 m、20 m和30 m往返跑”的运动模型,通过佩戴人体能耗检测仪的方式,监测其运动前后心率和心率变异性(HRV)指标的变化特征,进而通过计算其运动负荷和生理负荷指数,通过HRV时域、频域和庞莱恩散点图参数的变化,判断学前儿童在不同距离往返跑后心脏交感神经和迷走神经的活性与支配功能状态。结果: 儿童10 m、20 m和30 m往返跑依次为中、大和超大强度的范围;HRV指标测试结果显示:与运动前基线值相比较,三种往返跑后的R-R间期标准差(SDNN)均呈现显著性的降低;儿童30 m往返跑后,除了低频与高频的比值(LF/HF)显著升高(P<0.01),其余频域指标以及庞莱恩散点图参数较基线值均有不同程度的降低(P<0.05,0.01);此外,与10 m往返跑后相比较,儿童20 m往返跑后LF呈现显著性的增加(P<0.01),其余HRV指标均无显著性变化,但30 m往返跑后的HRV频域指标和庞莱恩散点图参数均不同程度呈现显著降低(P<0.05,0.01),且LF/HF值超出正常参考值范围。结论: 20 m往返跑后儿童的心交感神经活性和迷走神经活性变化不显著、综合调节能力未下降,心功能安全性较好。     

冠心病患者心率变异性与冠状动脉病变狭窄范围及严重程度的关系研究

目的:探讨冠心病患者心率变异性(HRV)与冠状动脉病变狭窄范围及严重程度的关系。方法:选取上海市第十人民医院2015年1月至2018年7月期间收治的冠心病患者220例,所有患者均行冠脉造影及24 h动态心电图检查。按狭窄范围分为单支狭窄组(n=68)、双支狭窄组(n=82)、三支狭窄组(n=70),按狭窄严重程度分为轻度组(狭窄≤50%,n=62),中度组(50%狭窄70%,n=66),重度组(狭窄≥70%,n=92),另选取51例同期于我院体检的健康志愿者作为对照组。记录冠心病患者与对照组HRV各项指标,比较不同冠脉病变狭窄范围患者、不同狭窄严重程度患者正常平均N-N间期(SDNN)、正常相邻每5minR-R间期均数标准差(SDANN)、正常相邻正常N-N间期的均方根(RMSSD)、正常相邻间期差值高于50 ms心搏数占总心搏数的百分比(pNN50)、低频(LF)、高频(HF)及低频/高频比值(LF/HF)。结果:冠心病患者与对照组RMSSD、pNN50、LF、HF比较差异无统计学意义(P0.05),冠心病患者SDNN、SDANN低于对照组,LF/HF值高于对照组(P0.05)。不同冠脉狭窄范围、不同冠脉病变狭窄严重程度患者pNN50、LF、HF整体比较无统计学差异(P0.05),随着冠脉狭窄范围的增加或狭窄病变严重程度的加重SDDN、SDANN、RMSSD逐渐降低,LF/HF值逐渐升高(P0.05)。结论:HRV是评估心脏自主功能的良好指标,该指标中SDDN、SDANN、RMSSD、LF/HF值可作为评估冠心病患者冠状动脉的狭窄程度和狭窄范围的良好指标,具有重要的临床指导意义。     

Dynamic time-varying analysis of heart rate and blood pressure variability in cats exposed to short-term chronic intermittent hypoxia

Chronic intermittent hypoxia (CIH) contributes to the development of hypertension in patients with obstructive sleep apnea and animal models. However, the early cardiovascular changes that precede CIH-induced hypertension are not completely understood. Nevertheless, it has been proposed that one of the possible contributing mechanisms to CIH-induced hypertension is a potentiation of carotid body (CB) hypoxic chemoreflexes. Therefore, we studied the dynamic responses of heart rate, blood pressure, and their variabilities during acute exposure to different levels of hypoxia after CIH short-term preconditioning (4 days) in cats. In addition, we measured baroreflex sensitivity (BRS) on the control of heart rate by noninvasive techniques. To assess the relationships among these indexes and CB chemoreflexes, we also recorded CB chemosensory discharges. Our data show that short-term CIH reduced BRS, potentiated the increase in heart rate induced by acute hypoxia, and was associated with a dynamic shift of heart rate variability (HRV) spectral indexes toward the low-frequency band. In addition, we found a striking linear correlation (r = 0.97) between the low-to-high frequency ratio of HRV and baseline. CB chemosensory discharges in the CIH-treated cats. Thus, our results suggest that cyclic hypoxic stimulation of the CB by short-term CIH induces subtle but clear selective alterations of HRV and BRS in normotensive cats.     

Hilbert-Huang transform for analysis of heart rate variability in cardiac health

This paper introduces a modified technique based on Hilbert-Huang transform (HHT) to improve the spectrum estimates of heart rate variability (HRV). In order to make the beat-to-beat (RR) interval be a function of time and produce an evenly sampled time series, we first adopt a preprocessing method to interpolate and resample the original RR interval. Then, the HHT, which is based on the empirical mode decomposition (EMD) approach to decompose the HRV signal into several monocomponent signals that become analytic signals by means of Hilbert transform, is proposed to extract the features of preprocessed time series and to characterize the dynamic behaviors of parasympathetic and sympathetic nervous system of heart. At last, the frequency behaviors of the Hilbert spectrum and Hilbert marginal spectrum (HMS) are studied to estimate the spectral traits of HRV signals. In this paper, two kinds of experiment data are used to compare our method with the conventional power spectral density (PSD) estimation. The analysis results of the simulated HRV series show that interpolation and resampling are basic requirements for HRV data processing, and HMS is superior to PSD estimation. On the other hand, in order to further prove the superiority of our approach, real HRV signals are collected from seven young health subjects under the condition that autonomic nervous system (ANS) is blocked by certain acute selective blocking drugs: atropine and metoprolol. The high-frequency power/total power ratio and low-frequency power/high-frequency power ratio indicate that compared with the Fourier spectrum based on principal dynamic mode, our method is more sensitive and effective to identify the low-frequency and high-frequency bands of HRV.     

Automatic filtering of outliers in RR intervals before analysis of heart rate variability in Holter recordings: a comparison with carefully edited data

Background  

Undetected arrhythmic beats seriously affect the power spectrum of the heart rate variability (HRV). Therefore, the series of RR intervals are normally carefully edited before HRV is analysed, but this is a time consuming procedure when 24-hours recordings are analysed. Alternatively, different methods can be used for automatic removal of arrhythmic beats and artefacts. This study compared common frequency domain indices of HRV when determined from manually edited and automatically filtered RR intervals.     

Synthesis of HRV signals characterized by predetermined time-frequency structure by means of time-varying ARMA models

In this paper we present two methodologies to generate heart rate variability (HRV) signals characterized by controlled and real-like time-frequency (TF) structure to be used to assess different methods of non-stationary HRV analysis. The synthesized signals are stochastic processes whose TF structure is predetermined by choosing either the time-course of the instantaneous frequencies and powers or the shape of the TF model function. They consist of three steps: (a) choice of the desired TF structure of the signals by choosing a set of design parameters; (b) automatic identification of the parameters of the corresponding models via simple closed-form expressions; (c) synthesis of the desired stochastic signals. Two measures to evaluate the goodness of the simulated signals are also given. Using this framework we were able to model the wide range of non-stationarities observed in heart rate modulation during exercise stress testing and experiments of music-induced emotions. We used the proposed methodology to assess the capability of the smoothed pseudo Wigner–Ville distribution (SPWVD) to quantify HRV patterns. We observed that the SPWVD followed the temporal evolution of the spectral components even when sudden and sharp transitions occur.     

Analysis of Heart Rate Variability in Masked Hypertension

To investigate heart rate variability (HRV) in patients with masked hypertension (MH), participants were classified based on clinic and 24-h ambulatory blood-pressure monitoring: essential hypertension (EH, n = 40; MH, n = 36) and normotension (NT, n = 48). The HRV parameters were observed using a 24-h Holter monitor. Compared with NT controls, the parameters of HRV (SDNN, SDANN, SDNN Index, RMSSD, HF) and parameters in EH and MH patients had significantly decreased. No statistically significant difference in the HRV parameters was found between the EH and MH groups. The changes in HRV parameters show cardiac autonomic nerve dysfunction in patients with MH.     

Semiautomatic procedure for the investigation of synchronized activity of EEG and heart rate--examination of preterm births]

Recordings of the electroencephalogram (EEG) and of the heart rate variability (HRV) of preterm neonates can give important information on the actual state of the nervous system. Both signals, EEG and HRV, are affected by parameters such as gestational age, stage of maturation and behavioral state. This work describes a method for automatic detection of slow wave EEG-bursts and a tool to average changes in the EEG and the corresponding heart rate. The detection is based on the hjorth activity (HA), calculated from the EEG. HA spikes (HAS) are identified by the determination of the beginning and end of existing spikes. HAS maxima and the time between two consecutive HAS are the basis for the triggering of the bursts. EEG power and time synchronized HR changes are averaged with a time window length of 20 s. Resultant, HR increase and duration are determined. These parameters, obtained by the automatic detection, proved to be comparable to the results of an expert.     

Heart rate variability signal processing: A quantitative approach as an aid to diagnosis in cardiovascular pathologies

The heart rate variability (HRV) signal carries important information about the systems controlling heat rate and blood pressure, mainly elicited by autonomic nervous system (sympathetic and parasympathetic) controls. The present paper illustrates methods of HRV signal processing by using autoregressive (AR) modeling and power spectral density estimate. The information enhanced in this way seems to be particularly sensitive in discriminating various cardiovascular pathologies (hypertension, myocardial infarction, diabetic neuropathy, etc.). This method provides a simple non-invasive analysis, based on the processing of spontaneous oscillations in heart rate. Particular emphasis is directed to the algorithms used and to their direct application by using proper computerized techniques: only a few paradigmatical examples will be illustrated as preliminary results.     

Functional characteristics of the cardiovascular system in adolescents with high normal blood pressure

Sanogenetic monitoring of schoolchildren’s health has demonstrated that, among high school students, the proportion of adolescents with elevated blood pressure (hypertension + hypernormotension) has risen from 15–20% in 8th-year students to 30–50% in 9th- to 11th-year students, while the proportion of adolescents with hypertension was 3.7% in all age groups. The level of blood pressure (BP) was compared with parameters of the autonomic control of the cardiovascular system. A high normal BP in adolescents 13–14 and 17–18 years of age was correlated with the higher proportion of low frequencies in the spectrum of heart rate variability (HRV) and with the lower sensitivity of the arterial baroreflex. At the age of 15–16 years, a high normal BP was accompanied by a reduced heart rate and a higher sensitivity of the arterial baroreflex; BP correlated also with a decrease in power of the high-frequency region of the HRV spectrum. Unlike normotensive age-matched subjects, hypernormotensive adolescents 15–16 years of age have a lower finger blood pressure and reduced relative power of the low-frequency range in the HRV spectrum during the functional test (an increase in the dead space). This may be a result of a functional inadaptability of sympathetic autonomic regulation.     

基于高阶复杂性测度的心率变异信号分析

心率变异性反映了交感神经和迷走神经对心血管系统的综合调节作用,是评价心血管系统功能的重要指标。复杂度是描述时间信号序列信息量的一个重要参数,传统算法中的过分粗略化会丢失大量的有用信息,而高阶复杂度的引入可较大程度地避免这一问题。在利用Lorenz模型数据仿真的基础上,分别对25例正常人样本和25例充血性心力衰竭病人样本的心率变异信号的1～15阶Kolmogorov复杂度进行了计算,通过对比分析后确定,5阶Kolmogorov复杂度在临床医学上可以为分析心率变异信号获得更为理想的效果。     

Sex differences in baroreflex sensitivity, heart rate variability, and end organ damage in the TGR(mRen2)27 rat

The aim of this investigation was to evaluate sex differences in baroreflex and heart rate variability (HRV) dysfunction and indexes of end-organ damage in the TG(mRen2)27 (Ren2) rat, a model of renin overexpression and tissue renin-angiotensin-aldosterone system overactivation. Blood pressure (via telemetric monitoring), blood pressure variability [BPV; SD of systolic blood pressure (SBP)], spontaneous baroreflex sensitivity, HRV [HRV Triangular Index (HRV-TI), standard deviation of the average NN interval (SDNN), low and high frequency power (LF and HF, respectively), and Poincaré plot analysis (SD1, SD2)], and cardiovascular function (pressure-volume loop analysis and proteinuria) were evaluated in male and female 10-wk-old Ren2 and Sprague Dawley rats. The severity of hypertension was greater in Ren2 males (R2-M) than in Ren2 females (R2-F). Increased BPV, suppression of baroreflex gain, decreased HRV, and associated end-organ damage manifested as cardiac dysfunction, myocardial remodeling, elevated proteinuria, and tissue oxidative stress were more pronounced in R2-M compared with R2-F. During the dark cycle, HRV-TI and SDNN were negatively correlated with SBP within R2-M and positively correlated within R2-F; within R2-M, these indexes were also negatively correlated with end-organ damage [left ventricular hypertrophy (LVH)]. Furthermore, within R2-M only, LVH was strongly correlated with indexes of HRV representing predominantly vagal (HF, SD1), but not sympathetic (LF, SD2), variability. These data demonstrated relative protection in females from autonomic dysfunction and end-organ damage associated with elevated blood pressure in the Ren2 model of hypertension.