Heart Rate Variability in Pulmonary Arterial Hypertension.

IF 2.2 4区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS
Pulmonary Circulation Pub Date : 2025-02-08 eCollection Date: 2025-01-01 DOI:10.1002/pul2.70048
Bishal Gyawali, Dominick Roto, Michael Lachant, R James White, Daniel Lachant
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Abstract

Resting heart rate has been incorporated in REVEAL risk assessment. Rest and sleep heart rate variability (HRV) measured in the home setting could provide early insight into worsening physiology in patients with pulmonary arterial hypertension (PAH). We hypothesized continuous HRV monitoring in the home setting for 7 days would be a treatment responsive measure and be associated with outcomes in PAH. This was a prospective observational study completed at the University of Rochester. We recruited two groups, one with stable background therapy and another with therapy intensification during the study. MC10 Biostamp (continuous electrocardiogram heart rate monitoring) was worn for 7 days at baseline and follow up; stable patients completed monitoring twice within 4 weeks while treatment intensification patients were assessed 3 months later. HRV was calculated using MC10 proprietary algorithm. Baseline, follow up, and changes in heart rate and HRV (rest and sleep) were compared between the groups and correlated to clinical outcomes at 2 years. Periods of activity were excluded from analysis. Non-parametric testing was performed. Twenty-four (10 stable and 14 treatment intensification) PAH patients had paired monitoring sessions during sleep and rest. There were no statistical differences in heart rate or HRV values at baseline or follow-up within either stable PAH patients or those requiring treatment escalation. Additionally, the change in heart rate from baseline to follow-up did not differ significantly between the two groups. There was no difference in HRV between patients who had clinical worsening (parenteral therapy, hospitalization, or death) within 2 years, while elevated rest and sleep heart rate did predict clinical worsening at 2 years. Unlike left ventricular systolic failure, continuous HRV for 7 days in the home setting does not appear to improve assessment in PAH, and functional testing appears to be a better way to assess treatment response and risk for clinical worsening.

肺动脉高压的心率变异性。
静息心率已被纳入REVEAL风险评估。在家庭环境中测量休息和睡眠心率变异性(HRV)可以早期了解肺动脉高压(PAH)患者的生理恶化情况。我们假设在家庭环境中连续监测7天HRV将是一种治疗反应措施,并与PAH的结果相关。这是一项在罗切斯特大学完成的前瞻性观察研究。我们招募了两组,一组采用稳定的背景疗法,另一组在研究期间采用强化疗法。在基线和随访时佩戴MC10 Biostamp(连续心电图心率监测)7天;稳定患者在4周内完成2次监测,治疗强化患者在3个月后进行评估。HRV计算采用MC10专有算法。基线、随访、心率和HRV(休息和睡眠)的变化在两组之间进行比较,并与2年后的临床结果相关。活动期被排除在分析之外。进行非参数检验。24例PAH患者(10例稳定,14例治疗强化)在睡眠和休息期间进行配对监测。在稳定型PAH患者或需要升级治疗的患者中,基线或随访时的心率或HRV值没有统计学差异。此外,从基线到随访的心率变化在两组之间没有显著差异。2年内出现临床恶化(肠外治疗、住院或死亡)的患者HRV没有差异,而休息和睡眠心率升高确实预示着2年内的临床恶化。与左心室收缩衰竭不同,在家庭环境中连续7天HRV似乎并没有改善PAH的评估,功能测试似乎是评估治疗反应和临床恶化风险的更好方法。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Pulmonary Circulation
Pulmonary Circulation Medicine-Pulmonary and Respiratory Medicine
CiteScore
4.20
自引率
11.50%
发文量
153
审稿时长
15 weeks
期刊介绍: Pulmonary Circulation''s main goal is to encourage basic, translational, and clinical research by investigators, physician-scientists, and clinicans, in the hope of increasing survival rates for pulmonary hypertension and other pulmonary vascular diseases worldwide, and developing new therapeutic approaches for the diseases. Freely available online, Pulmonary Circulation allows diverse knowledge of research, techniques, and case studies to reach a wide readership of specialists in order to improve patient care and treatment outcomes.
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